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Protein Energies and malnutrition 01.pptx
- 1. 𝐓.𝐇𝐚𝐫𝐢𝐩𝐫𝐢𝐲𝐚
- 2. Introduction ⚫Protein-energy Malnutrition (PEM) is the terminology used for all kind of malnutrition as result of lack of proteinand energy foods. ⚫Majorpublic health problem in India ⚫Particularly in children younger than 5 yearsold ⚫The most extreme forms of malnutrition, or (PEM), are Kwashiorkorand Marasmus
- 3. Definition A group of clinical conditions that may result from varying degree of protein deficiency and energy (calorie) inadequacy. ⚫Previously it was known as protein calorie malnutrition.
- 4. Incidence ⚫Leading causeof mortalityand morbidity ⚫Susceptible to infectiousdiseases ⚫Incidence of malnutrition in Indiaand Africaare high ⚫30-40% children younger than 5 years ⚫7.6% have severe malnutrition ⚫
- 5. Causes and risk factors ⚫Age ⚫ Children between 6 months-4 yearsare in risk ⚫Sex ⚫ Boys are more ⚫Too manychildren in the same family (neglect) ⚫Lack of spacing between children ⚫Low birth weight baby ⚫Twin and multiple births ⚫Poorgrowth in the first few months ⚫ Mother’s failure to beast feed ⚫ Systemic disordersor GI structural disorders
- 6. Causes and risk factors ⚫Failureorstoppageof breast feeding ⚫Delay in weaning ⚫Infectiousdiseases ⚫Diarrhea ⚫ARI ⚫Measles ⚫Chronic diseases and certain congenital disorders ⚫Failure to thrive, CHD, Growth Retardation ⚫Lack of adequatecare for the pregnant women ⚫Acute illnessorsurgery
- 7. Risk factors ⚫LBW ⚫Multiple birth ⚫Not breast fed ⚫High birthorder ⚫Congenital defects poorsocioeconomic background ⚫Single parents / orphans/ foster home ⚫Maternal deprivation
- 10. Syndromal classification ⚫Kwashiorkor ⚫Nutritional marasmus ⚫Prekwashiorkor ⚫Nutritional dwarfing
- 11. KWASHIORKOR ⚫Term ‘Kwashiorkor’ was introduced in 1935 ⚫‘Red boy’ due tocharacteristics of pigmentary changes ⚫Mainly found in preschool children or mayatanyage ⚫Infection precipitates ⚫Deficient intakeof both proteinand calories ( proteindeficiency are more predominant)
- 12. Features Essential •Marked growth retardation •Musclewasting •Psychomotorchanges •Pitting edema Non essential •Hairchange (f lag sign) •Skin changes •Superadded infections
- 13. Grading Grade I:Pedal oedema Grade II: grade I+ facial puffiness Grade III: grade II + oedemaof thechestwall and the paraspinal area Grade IV: grade III + ascites
- 14. MARASMUS ⚫Also termed as infantile atrophyorathrepsia ⚫Common infants may found in toddlers and even in later life ⚫Deficient intakeof both proteinand calories ( calorie deficiency are morepredominant) ⚫Looks likes looks likeold person with wizened and shrivelled facedue to loss of buccal pad of fat. ⚫Initially thechild is irritable, hungry and craves for food ⚫Laterstages may become miserable, aptheticand refusal to takeanything orally.
- 15. Features Essential •Marked growth retardation •Musclewasting •Marked stunting and absence of edema Non essential •Hairchange (hypopigmented) •Skin changes : dry, scaly •Livershrunk •Crave forfood •Psychomotorchanges •Mineral deficiencies
- 16. Grading of marasmus ⚫Grade I: lossof subcutaneous fat in the axillaand groin ⚫Grade II: grade I + lossof abdominal fat and fat in the gluteal region ⚫Grade III: grade II + lossof fat in thechestwall and the praspinal region ⚫Grade IV : grade III + lossof the buccal pad of fat
- 19. Marasmic kwashiorkor ⚫It is condition where thechild manifested both the featuresof marasmusand kwashiorkor. ⚫The presence of edema is essential for thediagnosis and other featursof kwashiorkor mayor may not present
- 20. Prekwashiorkor ⚫It is a condition when thechild is having featuresof kwashiorkorwithoutedema. ⚫If theearly management is initiated byearlydiagnosis of thecondition ⚫Thechild may be protected from full-blown kwashiorkor
- 21. Nutritional dwarfing ⚫It is condition when thechild is having significant low weightand height for theage withoutanyovert featuresof kwashiorkoror marasmus ⚫It is usuallyseen when the PEM continueover a numberof years
- 22. Assessment ⚫Nutritional assessment ⚫History ⚫Clinical findings ⚫24 hourretrospectivedietary recall ⚫Societal and environmental assessment ⚫Growth chart ⚫Anthropometric measurementcomparewith populationstandard
- 23. ⚫Lab findings ⚫ Serumalbumin ⚫ Blood glucose level ⚫ Blood urineand rectal swabcultures ⚫ Microscopicexaminationof urineorstool
- 24. Management of PEM ⚫Multidisciplinary approach ⚫Aim ⚫ To supplywhat has been lacking in diet ⚫ Topreventand treat infectionsand otherdiseases ⚫ To teach parents how to preventrelapse
- 25. Management of PEM ⚫Domiciliary management ⚫Managed at home ⚫Parents areeducated aboutdietary management ⚫ Nutritional counselling and demonstration ⚫ Less expensive locallyavailable food ⚫ Communitysupportsystem ( supervision) ⚫ Homevisit ⚫ Medical follow up ( weight monitoring )
- 26. ⚫Managementat hospital ⚫Needed atadvance cases ⚫Mild PEM ⚫Ruleout infections ⚫Provide nutritional counselling to parents ⚫Replace nutrientsand breast feed till 2 yearsof age, with the introduction of supplementary feeding at 4-5 months ⚫Immunization ⚫Parents counselling and education
- 27. Moderate PEM ⚫Admit to hospital ⚫Treat underlying causeor problems ⚫Diet is the most importantpartof treatment ⚫Providea reinforced milk diet ⚫Teach preparation of milk diet
- 28. Severe PEM ⚫ Hospitalization ⚫ Watch for complications ⚫ Dietary treatment ⚫ 4 gm /kg protein ⚫ Marsmus 150-200 kcal/kg per day ⚫ Kwashiorkor 100 kcal /kg per day ⚫ Reinforced milk or high calorie cereal milk can be given ⚫ Children should be Fed with milk diet at the ratio of 125 ml/kg/ day ⚫ Prevent hypoglycemia ⚫ NG tube feeding ⚫ Gradually increase the feed ⚫ Schedule 8 feeds per day ⚫ Supplement minerals and vitamin ⚫ Treat infections
- 29. Complications ⚫Acute ⚫Systemic local infections ⚫Severe dehydration ⚫Shock ⚫Hypoglycemia ⚫Hypothermia ⚫Bleeding disorders ⚫Hepatic dysfunction ⚫Long term ⚫Growth retardation ⚫Mental sub normalities ⚫Visual and learning disabilities
- 30. Prevention ⚫Health promotion ⚫Specific protection ⚫Earlydiagnosis and treatment ⚫Rehabilitation
- 31. Nursing management ⚫Assessment ⚫History ⚫Physical examination ⚫Assessmentof G&D ⚫Nutritional assessment ⚫Lab investigations
- 32. Nursing diagnosis ⚫Imbalanced nutrition less than body requirement ⚫Fluid and electrolyte imbalance ⚫Risk for infection ⚫Potential forcomplications ⚫Knowledgedeficit ⚫Parental anxiety ⚫Body imagedisturbances