1slide share malnutrition modify
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Manutrition in children is major problemsTRANSCRIPT
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MALNUTRITION IN CHILDREN OBJECTIVES
To understand meaning of Malnutrition To understand the etiology of Malnutrition. To list the Causes KWO and Marsmus in
children. Diagnose Malnutrition To identify the treatment and prevention for
KWO and marasmus.
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HUMAN NUTRITIONNutrients are substances that are crucial for human life, growth & well-being.
•Macronutrients (carbohydrates, lipids, proteins & water)•Micronutrients are trace elements & vitamins, which are essential for metabolic processes.
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MALNUTRITIONMALNUTRITION
improper and / or inadequate food intake
inadequate absorption of food
Deficient supply of food
poor dietary habitsfood faddism
emotional factors metabolic abnormalities
diseases
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WHO IS AFFECTED BY MALNUTRITION?
Infants, children, the elderly, prisoners) Mentally disabled or ill because they are
not aware of what to eat. People who are suffering from tuberculosis, eating disorders, HIV/AIDS, cancer, or who have undergone surgical procedures
are susceptible to interferences with appetite or food uptake which can lead to malnutrition.
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MALNUTRITION Malnutrition: Is defined as pathological state
resulting from relative or absolute deficiency of one or more essential nutrients( Malnutrition…..Kwashiorkor)
Kwashiorkor :is a form of malnutrition caused by inadequate Protein intake in the presence of fair to good energy (total calories) intake.
Malnutrition is common in children between age of above one year 2 years
Under nutrition It is the outcome of insufficient food. It is caused primarily by an inadequate intake of dietary or food energy.
Under nutrition…….Marasmus
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DEFINITIONS OF MALNUTRITION
Kwashiorkor: protein deficiency Marasmus: energy deficiency Marasmic/ Kwashiorkor: combination of
chronic energy deficiency and chronic or acute protein deficiency
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PROTEIN MALNUTRITIONPROTEIN MALNUTRITION
))PCM or PEM, Protein-Calorie (Energy) MalnutritionPCM or PEM, Protein-Calorie (Energy) Malnutrition , ,
KwashiorkorKwashiorkor((
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Clinical syndrome resulted from a severe deficiency of protein & inadequate caloric intake
KWASHIORKORKWASHIORKOR
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FACTORS THAT EFFECT PROTEIN NEED
1) Age -- child needs more protein 2) Size -- bigger person needs more
protein.3) Sex -- male needs more than
female.4) Danger -- increases need due to
stress hormones5) Exercise -- increases need for
alanine6) Fever -- increases need7) Growth -- increases need
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Deficient intake of protein Impaired absorption of protein, as in
chronic diarrheal states Abnormal losses of protein in proteinuria Infection(TB) Hemorrhage or burns Failure of protein synthesis, as in chronic
liver diseases
ETIOLOGYETIOLOGY
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DIAGNOSIS OF KWO
The physical examination may show an enlarged liver (hepatomegaly) and general swelling.
Tests may include: Arterial Blood Gas. Complete Blood Count CBC Creatinine Clearance. Serum Creatinine. Serum Potassium. Total Protein Level. Urinanalysis
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CLINICAL MANIFESTATION
Constant or cardinal manifestation
Usual manifestation
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CONSTANT OR CARDINAL MANIFESTATION
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
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CONSTANT OR CARDINAL MANIFESTATION3-Muscle Wasting Disturbed muscles fat ratio Generalized muscle waste determined
by mid arm circumference which is diminished
The children is weak hypotonic Unable to stand or walk4- PSYCHOMOTOR CHANGES Apathy Lack interest in surrounding Look sad and never smile His cry is weak(Moon Face)
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USUALLY PRESENT SIGNS1-HAIR CHANGES sparse, hair lose its color become reddish or
grayish
2-Gastrointestinal manifestation
Anorexia-Vomiting- Diarrhea
3-SKIN DEPIGMENTATION (dermatosis-rash appear in the back of
thigh and axillary Hyopigmentation lead to skin damage
4-MOON FACE
5-Hepatomegalycaused
6-Poor resistance and liability to infection
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KWASHIORKOR
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COMPLICATIONS
1) DehydrationSkin infection
2) Hemorrhage3) Heart failure4) Chest infection5) Permanent mental and physical
disabilityCause of death KWO1. Recurrent infection2. Hypoglycemia 3. Heart failure
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MANAGEMENT OF KWO Getting more calories and protein will correct
kwashiorkor. Treatment depends on the severity of the
condition. children who are in shock need immediate treatment to restore blood volume and maintain blood pressure.
Calories are given first in the form of carbohydrates, simple sugars, and fats.
Vitamins and mineral supplements are essential.
Food must be reintroduced slowly. Carbohydrates are given first to supply energy, followed by protein foods.
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MARASMUS The term marasmus is derived from the
Greek marasmos, which means wasting or Starvation.
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MARASMUSMARASMUS(Infantile Atrophy, energy-deficiency (Infantile Atrophy, energy-deficiency
or energy-protein deficiency)or energy-protein deficiency) -
LACK OF CALORIES
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MARASMUS
Definition It is a clinical; syndrome resulting mainly under nutrition due to sever deficiency of protein,fat,and Carbohydrates inadequate calorie supply(starvation)
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ETIOLOGY ETIOLOGY 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
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CLINICAL FEATURES OF MARASMUScharacterized 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 his
age or senile face. No edema or hair changes Alert but miserable &Hungry Temperature is usually sub-normal
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Emaciation Skin wrinkled Subcutaneous fat disappears from
abdomen first,Buttocks, then extremities, and finally face
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MARASMUS
A thin “old man “face or Monkey Facies• “ Baggy pants “ (the loose skin of the
buttocks hanging down).
• There is no oedema (swelling that pits on pressure) of the lower extremities.
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INVESTIGATIONS FOR PEM Full blood counts Blood glucose profile Septic screening Stool & urine for parasites & germs Electrolytes, Ca, Ph &, serum proteins CXR & Mantoux test
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MANAGEMENT OF MARASMUS
Constant monitoring. Patients with marasmus should be isolated
from other patients, especially children with infections.
Treatment areas should be as warm as possible, and bathing should be avoided to limit hypothermia.
Therefore, the hospital structure is best adapted for the treatment of severe malnutrition.
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MANAGEMENT OF MARASMUS
In cases of shock, intravenous (IV) rehydration is recommended using a Ringer-lactate solution with 5% dextrose or a mixture of 0.9% sodium chloride with 5% dextrose.
The following rules should be implemented in the initial phase of rehydration:
(1)Use an nasogastric (NG) tube; (2)Continue breastfeeding, except in case of
shock or coma; and (3) Start other food after 3-4 hours of
rehydration
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NURSING DIAGNOSIS FOR MARASMUS
Alteration in nutrition less than body requirements related to inadequate food intake (decreased appetite
Impaired skin integrity related to impaired nutritional / metabolic status•
High risk of infection associated with damage to the body's defense•
Lack of knowledge related to its lack of information Changes in growth and development associated with
physical melemahnyakemampuan and dependence
secondary to caloric intake or inadequate nutrition. Intolerance activities associated with
impaired oxygen transport system secondary to malnutrition. (
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NURSING MANAGMENT
Lack of knowledge related to its lack of information to increased knowledge of patients and. Determine the level of knowledge of the patient's parents.
Assess dietary needs and answer questions as indicated. Encourage the consumption of foods high in fiber and fluid intake is adequate.