Easy availability for people to search about malnutrition..... Kwashiorkor and Marasmus condition heavenly disturbed child's health by the fact of under nutrition. It is easy to read about the differences of malnutrition and protein energy malnutrition.

1. MALNUTRITION
PRESENTEDBY
SHIVANI BHARDWAJ
ASSISTANTPROFESSOR
GNCON

2. INTRODUCTIONOF NUTRITION
Nutrition (also called nourishment) is the provision, to
cells and organism, of the materials necessary (in the
form of food) to support life. Many common health
problems can be prevented or alleviated with a healthy
diet. A poor diet can have an injurious impact on health,
causing deficiency diseases such as scurvy,
kwashiorkor, protein energy malnutrition etc.

3. DEFINITION OF MALNUTRITION
It is the condition that occurs when
body does not get enough nutrients.

4. DEFINITION OF OVERNUTRITION
It is a form of malnutrition, in which nutrients
are oversupplied in relation to the amounts
required for normal growth, development, and
metabolism.

5. INTRODUCTION OF PROTEIN ENERGY
MALNUTRITION
The term protein energy malnutrition refers to a
group of related disorders that include
marasmus, kwashiorkor and marasmic-
kwashiorkor.

7. DEFINITION OF KWASHIORKOR
This word means ‘sickness of weaning’.
Kwashiorkor involves inadequate intake of
proteins and is characterized by presence of
edema.

8. DEFINITION OF MARASMUS
This term is derived from Greek word
‘Marasmos’ which means withering or wasting.
Marasmus occurs due to inadequate intake of
proteins and calories and is characterized by
emaciation.

9. CLASSIFICATION OF MALNUTRITION
WEIGHT FOR AGE BY GOMEZ
Weight for age(%)=weight of the child×100
Weight of the normal child of same age

10. WATERLOW’S CLASSIFICATION OF
MALNUTRITION
Height for age(%)= height of the child ×100
Height of normal child of same age

12. ETIOLOGY OF MALNUTRITION

13. PATHOPHYSIOLOGY OF
MALNUTRITION

15. CLINICAL FEATURES OF
MALNUTRITION

17. DIFFERENCE BETWEEN
SYMPTOMS OF KWASHIOKOR AND
MARASMUS

19. DIAGNOSTIC EVALUATION OF MALNUTRITION
a. Health history
b. Physical examination
c. Anthropometric assessment reveals reduce weight for
age, weight for height and height for age. Body mass index
d. Stool examination for presence of ova and parasites.
e. Blood glucose estimation.
f. Serum albumin estimation.
g. Blood haemoglobin
h. Serum electrolytes estimation.
i. Blood Ph
j. Urine examination

20. MANAGEMENT OF MALNUTRITION
Management divided in two phases:
a. Initial phase
b. Rehabilitation phase
I. Treatment in initial phase (1-2 weeks)
• Treatment of complications
• Correction of nutritional deficiencies
• Reversal of metabolic abnormalities
• Beginning of feeding

21. 1. Treatment of complications
• The acronym ‘shielded’ represents the
complications which may arise because of PEM.
S- SUGAR LEVEL OF BLOOD IS LOW
H- HYPOTHERMIA
I-INFECTIONS
EL-ELECTROLYTE DISTURBANCES
DE-DEHYDRATION
D-DEFICIENCY OF NUTRIENTS

22. a. Hypoglycaemia
The child may have seizures or becomes
unconscious due to hypoglycaemia (<54
mg/dl).
b. Hypothermia
Infants under 1 year of age, who are marsamic
are prone to hypothermia due to extensive loss
of subcutaneous fat. Kangaroo mother
technique may be useful for such infants.

23. c. Electrolyte disturbances
Children with PEM develop several electrolyte
disturbances like hypernatremia, hypokalemia ad
hypocalcemia. Salt intake is prevent sodium
overload and water retention leding to edema. I
must be treated with potassium supplementation in
dose of 30-40meq/L.
d. Dehydration
Dehydration should be corrected slowly over a
period of 12 hours. Rehydration solution is given in
dose of 70-100ml/kg to restore hydration, over a
period of 12 hours.

24. • e. Initiation of feeding
• Feeding must be started, after the fluid and
electrolyte balance is restored and infection is
under control.
• B-BEGINNING OF FEEDING
• E-ENERGY DENSE FEEDING
• S-STIMULATION OF EMOTIONALAND
SENSORIAL DEVELOPMENT
• T-TRANSFER TO HOME BASED DIET
BEFORE DISCHARGE

25. II. Rehabilitative phase (2-6 weeks)
Recovery of lost weight.
Emotional and physical stimulation to the child
Training the mother for domiciliary care.
Preparation for discharge
Therapeutic diet to be given 175-200kcal/kg/day, 4-5
gm protein/kg/day and 150 ml fluid/kg/day.
Recovery and discharge
• Return of appetite
• Disappearance of hepatospleenomegaly
• Gain in body weight
• Absence of edema
• Rising serum albumin level.
It may take about 6-8 weeks for a child to recover. The child
must be reviewed from 8 to 36 weeks after discharge.

26. NURSING MANAGEMENT
1. Imbalanced nutrition less than body requirements related to reluctance to consume
meals, secondary to malnutrition as evidenced by reduction in the level of protein.
2. Fatigue related to diminished metabolic energy production and state, secondary to
malnutrition as evidenced by inability to perform desired activities.
3. Deficit fluid volume related to restriction on fluids as evidenced by inadequate
hydration, diarrhea.
4. Risk for impaired skin integrity related to loss of subcutaneous fat as evidenced by
inadequate dietary intake, nausea, vomiting.
5. Deficit knowledge related to unreliable information on under nutrition and over
nutrition as evidenced by verbalized weight loss issues.

27. PREVENTION OF MALNUTRITION
a. Prevention at family level
Exclusive breast feeding for first age of 6
months.
Weaning diet must be started at age of 6
months.
Milk, egg, meat and food items o high
biological value must be given.
Immunization must be done to prevent
children from communicable diseases.

28. b. Prevention at community level
Early detection of malnutrition.
Growth monitoring.
Family planning services
Income generation activities.
Promotion of education and literacy in community
c. Prevention at national level
Provision of nutritional supplements for infants
and children.
Nutritional surveillance.
Iodization of common salt
Fortification of food.
Nutritional rehabilitation services.