MALNUTRITION INCHILDRENOBJECTIVES To understand meaning of Malnutrition To understand the etiology of Malnutrition. To list the Causes KWO and Marsmus inchildren. Diagnose Malnutrition To identify the treatment and prevention forKWO and marasmus.2
HUMAN NUTRITIONNutrients are substances that arecrucial for human life, growth &well-being.•Macronutrients (carbohydrates,lipids, proteins & water)•Micronutrients are trace elements& vitamins, which are essential formetabolic processes.
MALNUTRITIONMALNUTRITIONimproper and / or inadequatefood intakeinadequate absorptionof foodDeficient supply of foodpoor dietary habitsfood faddismemotional factors metabolic abnormalitiesdiseases
WHO IS AFFECTED BYMALNUTRITION? Infants, children, the elderly, prisoners) Mentally disabled or ill because they are notaware of what to eat. People who are suffering from tuberculosis, eating disorders, HIV/AIDS, cancer, or who have undergone surgical procedures aresusceptible to interferences with appetite orfood uptake which can lead to malnutrition.
MALNUTRITION Malnutrition: Is defined as pathological stateresulting from relative or absolute deficiency ofone or more essentialnutrients( Malnutrition…..Kwashiorkor)Kwashiorkor :is a form of malnutrition caused byinadequate Protein intake in the presence of fairto good energy (total calories) intake. Malnutrition is common in children between ageof above one year 2 years Under nutrition It is the outcome of insufficientfood. It is caused primarily by an inadequateintake of dietary or food energy. Under nutrition…….Marasmus
DEFINITIONS OF MALNUTRITION Kwashiorkor: protein deficiency Marasmus: energy deficiency Marasmic/ Kwashiorkor: combination of chronicenergy deficiency and chronic or acute proteindeficiency
PROTEIN MALNUTRITIONPROTEIN MALNUTRITION))PCM or PEM, Protein-Calorie (Energy) MalnutritionPCM or PEM, Protein-Calorie (Energy) Malnutrition,,KwashiorkorKwashiorkor((
Clinical syndrome resultedfrom a severe deficiency ofprotein & inadequate caloricintakeKWASHIORKORKWASHIORKOR
FACTORS THAT EFFECTPROTEIN NEED1) Age -- child needs more protein2) Size -- bigger person needs moreprotein.3) Sex -- male needs more than female.4) Danger -- increases need due tostress hormones5) Exercise -- increases need foralanine6) Fever -- increases need7) Growth -- increases need
Deficient intake of protein Impaired absorption of protein, as inchronic diarrheal states Abnormal losses of protein in proteinuria Infection(TB) Hemorrhage or burns Failure of protein synthesis, as in chronicliver diseasesETIOLOGYETIOLOGY
DIAGNOSIS OF KWO The physical examination may show anenlarged liver (hepatomegaly) and generalswelling. Tests may include: Arterial Blood Gas. Complete Blood Count CBC Creatinine Clearance. Serum Creatinine. Serum Potassium. Total Protein Level. Urinanalysis
CLINICALMANIFESTATIONConstant or cardinalmanifestationUsual manifestation
CONSTANT OR CARDINALMANIFESTATION 1-Growth Retardation Weight is diminished Retarded liner growth length HC may be affected Bone age may be retarded 2-Oedema Hypoprotenemia Start in lower part and become generalized Usually soft and pitting edema The cheek become pale and waxy
CONSTANT OR CARDINALMANIFESTATION3-Muscle WastingDisturbed muscles fat ratioGeneralized muscle waste determined bymid arm circumference which isdiminishedThe children is weak hypotonicUnable to stand or walk4- PSYCHOMOTOR CHANGESApathyLack interest in surroundingLook sad and never smileHis cry is weak(Moon Face)
USUALLY PRESENTSIGNS1-HAIR CHANGES sparse, hair lose its color become reddish orgrayish2-Gastrointestinal manifestationAnorexia-Vomiting- Diarrhea3-SKIN DEPIGMENTATION (dermatosis-rash appear in the back of thighand axillary Hyopigmentation lead to skin damage4-MOON FACE5-Hepatomegalycaused6-Poor resistance and liability to infection
COMPLICATIONS1) DehydrationSkin infection2) Hemorrhage3) Heart failure4) Chest infection5) Permanent mental and physicaldisabilityCause of death KWO1. Recurrent infection2. Hypoglycemia3. Heart failure
MANAGEMENT OF KWO Getting more calories and protein will correctkwashiorkor. Treatment depends on the severity of thecondition. children who are in shock needimmediate treatment to restore blood volume andmaintain blood pressure. Calories are given first in the formof carbohydrates, simple sugars, and fats. Vitamins and mineral supplements areessential. Food must be reintroduced slowly.Carbohydrates are given first to supply energy,followed by protein foods.
MARASMUS The term marasmus is derived from theGreek marasmos, which means wasting orStarvation.
MARASMUS Definition It is a clinical;syndrome resulting mainlyunder nutrition due to severdeficiency of protein,fat,andCarbohydrates inadequatecalorie supply(starvation)
ETIOLOGYETIOLOGY OF MARASMUSOF MARASMUS Dietic causes Scanty milk Improper weaning and overdiluted formula Feeding difficulties as cleft lip Vomiting, diarrheas, Anorexia Stomatitis Malabsorption syndrome Cardiac abnormality Prematurity
CLINICAL FEATURES OFMARASMUScharacterized by: Sever wasting weight less than 60% Loss of subcutaneous fat Severe wasting of muscle & s/c fats Severe growth retardation Child looks older(old man) than hisage or senile face. No edema or hair changes Alert but miserable &Hungry Temperature is usually sub-normal
Emaciation Skin wrinkled Subcutaneous fat disappears fromabdomen first,Buttocks, thenextremities, and finally face
MARASMUS A thin “old man “face or Monkey Facies• “ Baggy pants “ (the loose skin of the buttockshanging down).• There is no oedema (swelling that pits onpressure) of the lower extremities.
INVESTIGATIONSFOR PEM Full blood counts Blood glucose profile Septic screening Stool & urine for parasites & germs Electrolytes, Ca, Ph &, serum proteins CXR & Mantoux test
MANAGEMENT OF MARASMUS Constant monitoring. Patients with marasmus should be isolated fromother patients, especially children withinfections. Treatment areas should be as warm as possible,and bathing should be avoided to limithypothermia. Therefore, the hospital structure is best adaptedfor the treatment of severe malnutrition.
MANAGEMENT OF MARASMUS In cases of shock, intravenous (IV) rehydration isrecommended using a Ringer-lactate solutionwith 5% dextrose or a mixture of 0.9% sodiumchloride with 5% dextrose. The following rules should be implemented inthe initial phase of rehydration: (1)Use an nasogastric (NG) tube; (2)Continue breastfeeding, except in case ofshock or coma; and (3) Start other food after 3-4 hours ofrehydration
NURSING DIAGNOSIS FORMARASMUS Alteration in nutrition less than body requirementsrelated to inadequate food intake (decreased appetite Impaired skin integrity related to impaired nutritional /metabolic status• High risk of infection associated with damage to thebodys defense• Lack of knowledge related to its lack of information Changes in growth and development associated withphysical melemahnyakemampuan and dependencesecondary to caloric intake or inadequate nutrition. Intolerance activities associated withimpaired oxygen transport systemsecondary to malnutrition. (
NURSING MANAGMENT Lack of knowledge related to its lack ofinformation to increased knowledge ofpatients and. Determine the level ofknowledge of the patients parents. Assess dietary needs and answer questions asindicated. Encourage the consumption of foodshigh in fiber and fluid intake is adequate.