Nutritional_Deficiency_Disorder

1. Presented By:-
Rashi
Bsc(Hons.) Nursing 3rd
year
Batch-2017
In Guidance Of:-
Mrs. Malar Kodi
Assistant professor,
AIIMS, Rishikesh

2. CONTENT
 Introduction
 Epidemiology
 Protein Energy Malnutrition
• Kwashiorkor
• Marasmus
 Vitamin C deficiency
• Scurvy
 Management
 Prevention

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Introduction
 An inadequate supply of essential
nutrients (as vitamins and minerals)
in the diet resulting in malnutrition or
disease.
 In India many children are suffering
with nutritional disorders. 2 million
children affected by nutritional
deficiency in every year.

4. FACTORS AFFECTING NUTRITIONAL
STATUS OF CHILD
 Nutritional intake of the child
 Health status
 Child feeding practice
 Food demand
 Family income/ Occupation
 Education of Mother etc.

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Epidemiology
 Global burden- more prevalent in
developing countries. "Often starts
in the womb and ends in the
tomb."

6.  1.9 billion adults are overweight or obese,
while 462 million are underweight.
 47 million children under 5 years of age are
wasted, 14.3 million are severely wasted and
144 million are stunted, while 38.3 million are
overweight or obese.
 Around 45% of deaths among children under 5
years of age are linked to undernutrition
WORLD SCENARIO

7. INDIAN SCENARIO
 Malnutrition caused 69 per cent of deaths of
children below the age of five in India,
according to a UNICEF
 The State of the World's Children 2019,
UNICEF said that every second child in that
age group is affected by some form of
malnutrition.

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Protein Energy Malnutrition
 Range of pathological conditions
arising from lack, in varying
proportions , of protein and calories.
• Marasmus: weight for age < 60%
expected
• Kwashiorkor: weight for age < 80% +
edema
• Marasmic kwashiorkor: wt/age <60%
+ edema

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• Only wt for age taken into account
• No comment about height
• All cases of edema in 3rd degree irrespective of wt for
age
Gomez Classification
Nutritional status Wt for Age(% Expected)
Normal > 90
1st Degree PEM 75-90
2nd Degree PEM 60-75
3rd Degree PEM < 60

11. RISK FACTORS
 LBW
 Multiple birth
 Closely spaced birth
 Early stoppage of breast
feeding
 Too early or late weaning
 Recurrent infections
 Illiteracy, poverty
 Secondary due to
malabsorption

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It refers as combination of
• Edema
• Lethargy
• Growth failure.
KWASHIORKOR

13. ETIOLOGY
 Non availability of suitable protein -rich
foods.
 Faulty feeding habits.
 Prolonged breast feeding.
 Infection and infestation
 Sudden loss of protein
 Seasonal incidence-July - august.
 Size of the family.

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CLINICAL FEATURES
Actually develops over a period of week or month.
 Growth retardation
 Apathy
 Diarrhea
 Edema.
 Hair changes
 Mental changes
 Wasting
 Anaemia
 Diarrhoea
 Dermatosis (flaky-paint)

15.  Skin Changes:- Dry & scaly skin,
Dermatosis
 Deep fissures- region of elbows, groins,
knees.
 Pinkish area over the legs.
 Hair Changes:-Scanty, Lusterless,
Brownish
 Hepatomegaly.
 Moon face
 Anemia
 Psycho motor changes
 Cardio vascular changes.

16.  Bio chemical changes:
• Reduced serum protein (less than 1.5g)
• Blood cholesterol reduced, low serum iron
and copper.
• Decreased water and electrolytes

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 Serum electrolytes
 Blood Urea Nitrogen
 Glucose, and
 Possibly levels of Ca, Mg, Phosphate,
Na should be measured.
 Urine culture,
 Blood cultures,
 Tuberculin testing, and
 A chest X-ray
DIAGNOSIS

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MARASMUS
There is loss of weight of more
than 50% or the expected
weight for given age.
Causes:
• Primary
• Secondary

19.  Primary:
• Artificial fed babies with over diluted
formula.
• Infection
• Poor socio economic background.
 Secondary:
• Chronic vomiting
• Chronic diarrhea
• Congenital disease Serious organic
disorders of heart, brain, kidney.
• Metabolic disorders.

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CLASSIFICATION
Grade 1: Wasting starts in axilla & groin
Grade 2: Wasting extended to thigh and buttocks
Grade 3: Chest and abdomen
Grade 4 : Wasting of buccal pad of fat also

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CLINICAL FEATURES
 Remarkable wasting of both muscles and
subcutaneous.
 Irritable
 In early stage Hungry and craving for food.
 In later stages apathetic, refusing to take anything
 Hair changes
 Face has prematurely aged look.
 Wrinkle skin with loss of elasticity
 Scaphoid abdomen.
 Visible intestinal peristalsis.

22. Biochemical changes:
 Plasma protein reduced
 Increases basal metabolic
rate.
Pathological changes:
 Decreased weight of many
organ.
 Reduced function of organ.

23. Enter titleDIAGNOSIS
 Care dietetic history of
the infant.
 Physical examination
 Lab investigation
 X-ray

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TREATMENT
Principles:
 Liberal protein must be offered.
 Carbohydrates and fat must also be supplied.
 Take care of their total calorie needs
 Treat underlying causes.

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LIBERAL PROTEIN
(MILD & MODERATE DEGREE)
 wheat-50gm
 Bengal gram-16.5gm
 Groundnuts-8.5gm
 Dry skimmed milk-8.5grams or
defatted soya-8.5gms
 In that total protein is-16.8grams
Calories-370 gms. total calories
requirement is - 120-150 cal/kg/day

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CONTINUED
(FOR SEVERE DEGREE)
 Hospitalization
 Parenteral therapy
 N.G tube feeding (2-3gms/kg)
 Control the infection
 Correction of metabolic derangement and
deficiencies

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MANAGEMENT
Mild and moderate malnutrition
 Mainstay of treatment is to give
adequate amounts of protein and
energy.
 At Least 150 kcal/kg/day, protein
intake of 3g/kg/day.
 Best measure of efficacy of the
treatment is weight gain.

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WHO Steps Of Recovery
STEP 1
Prevent/Treat Hypoglycemia
STEP 2
Prevent/Treat Hypothermia
STEP 3
Prevent/Treat Dehydration
STEP 4
Correct Electrolyte Imbalance
STEP 5
Prevent/Treat Infection

30. STEP 6
Correct Micronutrient Deficiency
STEP 7
Initiate Re-feeding
STEP 8
Achieve Catch-up Growth
STEP 9
Provide Sensory Stimulation And Emotional
Support
STEP 10
Prepare For Follow Up After Recovery

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VITAMIN C DEFICIENCY
Disease result from severe vitamin
C deficiency:
 Scurvy
 Cardiovascular Disease
 Stroke
 Cataract
 Lead toxicity

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SCURVY
ETIOLOGY:-
 Diet lacking in vitamin C-rich foods
 Destruction of vitamin C in foods by
overexposure to air or by overcooking
 PEM
 Malabsorption
 Artificial feeding
 Illness and infection
 Daily requirement 40 mg/ kg/day

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CLINICAL FEATURES
Infantile scurvy:
 Irritability
 Excessive crying
 Tenderness to touch
 Frog position
 Hemorrhages (skin and mucus membranes,
gums)
 Hemorrhages in gums (result in spongy,
swollen, bluish purple gums)

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CONTINUED
Childhood scurvy:
 Minute hemorrhages at the root of the hair
 Follicles.
 Bleeding to skin leads to petechiae or large
purpuric swelling, gums

35. Enter titleDIAGNOSIS
 History Collection
 Physical Examination
 Ascorbic Acid level in the serum usually less
than 0.1 mg/100 ml
 Excretion Ascorbic acid
 X ray

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TREATMENT
 Administer 500mg of single dose of
vit c Followed by daily dose of 100
to 300 mg for several week.
 Vitamin c rich diet

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SPECIAL CONSIDERATION
HOSPITAL
 Administer ascorbic acid orally or by slow I.V. infusion, as
ordered.
 Avoid moving the child unnecessarily, to avoid irritating
painful joints and muscles.
 Encourage child to drink orange juice.
 Explain the importance of supplemental ascorbic acid.
 Counsel the child and family about good dietary sources of
vitamin C.
 Advise against taking too much vitamin C.
 Explain that excessive doses of ascorbic acid may cause
nausea, diarrhea, and renal calculi formation and may also
interfere with anticoagulant therapy.

38. PREVENTION
At national level
1. Nutrition supplementation - Fortification,
iodination
2. Nutritional surveillance- define the character
and magnitude of nutritional problems and
strategies to tackle.
3. Nutritional planning- formulation of nutrition
policy, improve food production and supplies,
ensure distribution.

39. At community level
 Health and nutritional education
 Promotion of education and
literacy in the community
 Growth monitoring
 Integrated health package
 Vigorous promotion of family
planning programs
PREVENTION

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PREVENTION
At family level
 Exclusive breast feeding
 Complementary feeds at 6
months
 Vaccination
 Spacing between
pregnancies

41. GOVT INITIATIVE TO PREVENT
MALNUTRITION
 National Rural Health Mission Of India
 Mid-day meal Scheme
 Integrated Child Development Scheme
 National Children's Fund
 United Nations Children's Fund

42. REFERENCE
S
 1. Paul Vinod, Bagaa Arvind. Ghai Essential
Pediatrics: Nutrition.8th Edition.New Delhi:CBS
publishers,2013
 2. Datta Parul. Pediatric Nursing: Nutritionl
Deficiency Disorder. 3rd Edition. New
Delhi:Jaypee,2014
 3. Healthline. Nutritional Deficiencies: Symptoms
and Treatment[online].2018(cited 2020 May 28).
Available from:
www.healthline.com/health/malnutrition

43. THANK YOU