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.
– 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
Is a primary a deficiency of protein with an adequate supply of calories.
– Thin , lose of weight.
– Wasted extremities
– Prominent abdomen from edema (ascites).
– Generalized edema
– Hair change (thin, dry, depigmentation and patchy alopecia)
– 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– Behavioral changes: (irritable, exhausted, withdrawn and apathetic).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.
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.
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– Apathetic, withdrawn and lethargic.
– 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.
– 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
– 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.
– Infectious agents (viruses, bacteria, and parasites).
– Lack of clean water.
– Poor hygiene.
– Nutritional deficiency.
– Poor sanitation.
– Administration of antibiotics.
– Viruses cause 70%to 80% of infectious diarrhea.
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.
– 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
– Antimicrobial drugs
– Anti diarrheal agents.
– Anti emetic agents
Complication of Diarrhea
– Electrolytes and acid base disturbances ( hypo and hypernatremia, hypokalemia).
– 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
– 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.
– 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.