3. OVERALL OBJECTIVE:
– At the end of the class students will be able to gain
knowledge about protein energy malnutrition and apply
nursing process for the same in the clinical area.
4. SPECIFIC OBJECTIVE:
Students will be able to;
– Define Protein energy malnutrition
– List the classification of PEM
– Discuss the etiology of PEM
– Explain the pathophysiology of PEM
– Interpret the clinical manifestations of PEM
– Enumerate the management of PEM
– Articulate nursing process for PEM
5. INTRODUCTION:
– Malnutrition develops when the body does not get the
right amount of the vitamins, minerals and other nutrients
it needs to maintain healthy tissues and organ function.
6. MALNUTRIRION:
DEFINTION
– WHO defines malnutrition as the cellular imbalance
between the supply of nutrients and energy and the
body’s demand for them to ensure growth, maintenance
and specific functions.
7. PROTEIN ENERGY
MALNUTRITION:
– It is a group of body depletion disorders which includes
marasmus, kwashiorkor and the intermediate changes
8. EPIDEMIOLOGY:
– According to UNICEF 2016 Global nutritional report US
had 0.5% OF OVERALL PREVAENCE OF
MARASMUS
– Primary nutritional problem in India
– 44% of children <5 yrs. of age
– 72% of infants and 52% of married women have anemia
11. MARASMUS:
DEFINITION:
– Derived from a Greek word
– ‘marasmus’, which means withering or wasting
– It results from general malnutrition of both calories and
protein.
– It is characterized by gradual wasting and atrophy of
body tissues, especially of subcutaneous fat.
12. ETIOLOGY:
– Usually between the age of 6months to 1year
– Children who have been weaned from breast milk
– Children with chronic diarrhea
14. CLINICAL MANIFESTATIONS:
– Severe growth retardation
– Loss of s/c fat
– Severe muscle wasting
– Shriveled body
– Child looks thin and limbs appear as skin and bone
– Wrinkled skin
18. KWASHIORKOR:
DEFINITION:
– Taken from Ga language
– (Ghana) which means the sickness the older child gets
when the next baby is born.
– It has been defined as primarily a deficiency of protein
with an adequate supply of calories.
19. ETIOLOGY:
– Micro nutrient and antioxidant defiencies( calcium 71%,
iron 50%, vitamin A 90%)
– A diet consisting mainly of starch, grains or tubers
– Infectious outbreak of measles and dysentery
22. MARASMIC KWOSHIORKOR:
– A severely malnourished child with features of both
marasmus and kwashiorkor
23. NUTRITIONAL DWARFING OR
STUNTING
– Some children adapt to prolonged insufficiency of food-
energy and protein by a marked retardation of growth.
– Weight and height are both reduced and in the same
proportion so they appear superficially normal .
24. UNDERWEIGHT CHILD:
– Children with sub-clinical PEM can be detected by their
weight for age or weight for height, which are
significantly below normal
– They may have reduced plasma albumin. They are at risk
for respiratory and gastric infections.
25. TREATMENT:
– Provide a diet with high quality proteins, carbohydrates,
vitamins and minerals.
IN CASE OF DIARRHEA:
– ORS( to replace electrolytes)
– Antibiotics( to prevent infections)
– Provision of adequate calorie intake( either breast feeding
or weaning diet)
26. TREATMENT 3 STAGES:
– Resolving life threatening conditions
– Restoring nutritional status
– Ensuring nutritional rehabilitation
IN HOSPITAL:
– Correction of hypothermia, hypoglycemia, infection,
dehydration, electrolyte imbalances, anemia and other
vitamin and mineral deficiencies
27. DIETARY MANAGEMNT:
– Locally available staple foods,
– inexpensive, easily digestible,
– evenly distributed throughout the body,
– Increased number of feedings to increase the quantity of
food
28. REHABILITATION:
– The concept is based on practical nutritional training for
mothers in which they learn by feeding their children
back to health under supervision and using local foods.
29. PREVENTION:
– Promotion of breast feeding
– Development of low cost weaning
– Nutritional education and promotion of correct feeding practices
– Family planning and spacing of births
– Immunizations
– Early diagnosis and treatment
30. NURSING MANAGEMENT:
– Imbalanced nutrition less then body requirement r/t lack
of knowledge and inadequate food intake
– Risk for infection r/t PEM
– Ineffective breathing pattern r/t dyspnea, fatigue and
decreased energy
– Fluid volume deficit r/t muscle wasting
– Impaired skin integrity r/t emaciated skin
– Activity intolerance r/t decreased energy
31. NURSING MANAGEMENT
CONT.,
– Risk for fall r/t decreased energy
– Risk for injury r/t muscle weakness
– Ineffective therapeutic regimen management
– Risk for complications r/t deficiency in micronutrients
and decreased energy
