Malnutrition disease and Gastroenteritis And Nursing Role

Malnutrition

Is a major health problems in children younger than 5 years of age.

– It is a protein and energy malnutrition

Factors Contributes Malnutrition?

– Lack of food intake.

– Diarrhea

– Bottle feeding

– Parental illiteracy regarding infant nutrition.

– Poor absorption of one or more components of food.

– In adequate knowledge of proper child care practice.

Common forms of malnutrition

– Kwashiorkor

– Marasmus

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Kwashiorkor

Is a primary a deficiency of protein with an adequate supply of calories.

Clinical manifestation

– Thin , lose of weight.

– Wasted extremities

– Prominent abdomen from edema (ascites).

– Generalized edema

– Hair change (thin, dry, depigmentation and patchy alopecia)

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– Skin changes ( dry, depigmentation, dermatoses (skin rash ).

– Diarrhea due to lowered resistance to infection.

– Behavioral changes: (irritable, exhausted, withdrawn and apathetic).

– Poor resistance.

– Deficiency of vitamin and minerals.

– Pale in severe cases gray to white

– Fetal deterioration.

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Marasmus

General malnutrition of both calories and protein.

– marasmus may be seen in infants as young as 3 months of age if breast feeding is not successful and there are no suitable alternatives.

– The main cause is an inadequate intake or a badly balanced diet.

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Clinical Manifestations of Marasmus

– Gradual wasting

– Atrophy of body tissue especially subcutaneous fat.

– The child appears to be very old.

– Flabby and wrinkled skin.

– The eyes are sunken.

– Recurrent of infections.

– Apathetic, withdrawn and lethargic.

Therapeutic Management

– Providing a diet with high quality (proteins, carbohydrates, vitamins and minerals).

– When PEM occurs as a results of diarrhea:

– Rehydration with an oral rehydration solution.

– Medication (antibiotics).

– Provision of adequate nutrition by breast feeding or a proper weaning diet.

– I.V fluid if dehydrated.

Nursing role

Dietary care

– It is a must to give high quality proteins and adequate carbohydrate in form of milk formula.

– Breast feeding is given.

– Feeding equipment must be sterile.

– Start with liquid food, and then semi food.

– Observe improvement in the appetite and weight progress.

– Protection from infection.

– Adequate hydration.

– Skin care

– Oral rehydration.

– Education concerning the importance of proper nutrition.

– Reinforcing healthy nutrition habits in parents of small children.

Prevention of Malnutrition

1.Nutrition education

– Continue breast feeding.

– Start eating solid food when he is about 4-6 months old.

– A good food is mixed food.

– A young child need at least 4 meals a day.

– Avoid prolonged breast feeding up to 3 years.

– Immunization of children.

– Teaching about family planning or birth spacing, so as to allow sufficient time for satisfactory breast feeding.

– Prevention of emotional disturbances.

Gastroenteritis ( Diarrhea)

– It is an increase in frequency, fluidity or volume of stools relative to the usual habit of each individual.

– Bacterial pathogens (Salmonella, Shigella, Giardia).

Classification of Diarrhea

Acute diarrhea : sudden increase in frequency and a change in consistency of stools, often caused by an infectious agent in the GIT.

Chronic diarrhea : increase stool frequency and increased water content with a duration of more than 14 days.

Chronic Nonspecific Diarrhea (CNSD) irritable colon of childhood and toddlers.

– Children with CNSD grow normally and have no:

– evidence of malnutrition.

– blood in their stool.

– enteric infection.

Etiology

– Infectious agents (viruses, bacteria, and parasites).

– Lack of clean water.

– Crowding.

– Poor hygiene.

– Nutritional deficiency.

– Poor sanitation.

– Administration of antibiotics.

– Viruses cause 70%to 80% of infectious diarrhea.

Diagnostic evaluation

1. History about :

– Recent travel.

– Exposure to untreated drinking.

– Contact with animals or birds.

– recent treatment with antibiotics.

– Recent diet changes.

2. Symptoms such as:

– Fever, vomiting, abdominal pain

– Frequency and character of stools.

– Urine output.

Therapeutic Management  of Diarrhea

The major goals in the management of acute diarrhea include:

– Assessment of fluid and electrolyte imbalance.

– Rehydration.

– Maintenance fluid therapy.

– Reintroduction of an adequate diet.

1. Oral rehydration therapy (ORT)

– More effective.

– Safe, less painful.

– Less costly than IV rehydration.

Oral rehydration solutions (ORS)

– Enhance and promote the re-absorption of sodium and water.

– Reduce vomiting, volume loss from diarrhea.

– Continuing breast feeding for infant.

– Diet of easily digestible foods ( cereals, cooked vegetable and meats) for old child.

– Rehydration by IV is indicated in :

– Severe dehydration

– Uncontrollable vomiting

Drug therapy

– Antimicrobial drugs

– Anti diarrheal agents.

– Anti emetic agents

Complication of Diarrhea

– Electrolytes and acid base disturbances ( hypo and hypernatremia, hypokalemia).

– Malnutrition

– Shock due to severe dehydration.

– Bronchopneumonia due to spread of some organism.

– Convulsions due to fever, severe dehydration.

Prevention of Diarrhea

– Encourage breast feeding.

– Personal hygiene, hygienic food.

– Protecting the water supply from contamination.

– Careful food preparation.

– Prevent traveler’s diarrhea

Nursing role In managing Diarrhea

Assessment

– Observe general appearance and behavior.

– Physical assessment include:

– Vital signs , weighing

– History taken

Assessment of signs of dehydration

– Decreased urine output

– Decreased weight

– Dry mucous membranes.

– Poor skin turgor Sunken of eyes

– Pale , cool, dry skin

– With severe dehydration increase pulse, respiration, decrease BP

For acute diarrhea without dehydration

– Monitor signs of dehydration.

– Monitor amount of fluids taken by mouth to assess the frequency and amount of stool losses.

– Administration of maintenance fluids.

– ORS administered in small quantities at frequent intervals.

– Vomiting is not contraindicated to ORT unless it is sever.

– Continuation of a normal diet.

– Ensure adherence to the treatment plan.

The following amount of ORS after each diarrheal stool:

– In mild diarrhea 10 ml ORS/kg body weight each diarrheal stool.

– In severe diarrhea ( more than one stool every 2 hours), 10-20 ml ORS/kg body weight / hours each diarrheal stool.

Management of the child with acute diarrhea and dehydration.

– Hospitalized

– Accurate weight must be obtained.

– Monitoring of intake and output

– Parenteral fluid therapy with NPO for 12 to 48 hours.

– Monitor IV infusion for ( correct fluid, electrolyte concentration is infused , flow rate).

– Skin care.

– Maintenance of nutrition

– Rectal temperature are avoided .

– Parents are kept informed of the child’s progress and instructed about:

– Frequency and proper hand washing.

– Disposal of soiled diapers, clothes and bed linen.

Guidelines for Rehydration Therapy

– ORS can be given to infant using a cup and a spoon, a cup alone or feeding bottle, syringe.

– A reasonable rate is one spoonful of ORS/min.

– ORS can be given via NGT.

– The average recommended rate is 15ml/kg/hours.

– To reduce vomiting and to improve absorption of ORS give it slowly.

– If the infant vomits wait 5-10min. Than start again.

– When severe vomiting shift to IV therapy.

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