Prepared by Dr. Hoda Abed El Azim

1. Malnutrition disease and Gastroenteritis Prepared by Dr. Hoda Abed El Azim

2. Objectives: • Define malnutrition • Identify factors Contributes Malnutrition. • Differentiate between two types of Malnutrition. • Identify the classification of Diarrhea. • State the etiology of Diarrhea. • Discus the therapeutic Management of Diarrhea. • Discus complication of diarrhea. • Recognize preventive measures of diarrhea. • Explain nursing role of diarrhea.

3. Malnutrition Is a major health problems in children younger than 5 years of age. • It is a protein and energy malnutrition Malnutrition Poor or inadequate nutrition

4. Factors Contributes Malnutrition? • Lack of food intake. • Diarrhea • Bottle feeding • Parental illiteracy regarding infant nutrition. • Poor absorption of one or more components of food. • Lack of adequate food for children. • In adequate knowledge of proper child care practice.

5. Common forms of malnutrition • Kwashiorkor • Marasmus

6. 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)

7. Clinical manifestation cont. • Skin changes ( dry, depigmentation, dermatoses (skin rash ). • Diarrhea due to lowered resistance to infection. • Behavioral changes: (irritable, lethargic, withdrawn and apathetic). • Poor resistance. • Deficiency of vitamin and minerals. • Pale in severe cases gray to white • Fetal deterioration.

8. Kwashiorkor

9. 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.

10. Clinical Manifestations • 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 • Apathetic, withdrawn and lethargic.

11. 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.

12. 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.

13. Nursing role cont. • 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.

14. Prevention of Malnutrition • 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.

15. Prevention of Malnutrition cont. • Immunization of children. • Teaching about family planning or birth spacing, so as to allow sufficient time for satisfactory breast feeding. • Prevention of emotional disturbances.

16. 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).

17. 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. • Acute infectious diarrhea : is caused by a variety of viral, bacterial, parasitic pathogens. • Chronic diarrhea : increase stool frequency and increased water content with a duration of more than 14 days.

18. 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 and • enteric infection

19. 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.

20. Diagnostic evaluation 1. History about : • Recent travel. • Exposure to untreated drinking. • Contact with animals or birds. • recent treatment with antibiotics. • Recent diet changes.

21. 2. Symptoms such as: • Fever, vomiting, abdominal pain • Frequency and character of stools. • Urine output.

22. Therapeutic Management 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.

23. Therapeutic Management cont. 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.

24. Therapeutic Management cont. • 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

25. Drug therapy • Antimicrobial drugs • Anti diarrheal agents. • Anti emetic agents

26. 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.

27. Prevention of Diarrhea • Encourage breast feeding. • Personal hygiene, hygienic food. • Protecting the water supply from contamination. • Careful food preparation. • Prevent traveler’s diarrhea

28. Nursing role Assessment • Observe general appearance and behavior. • Physical assessment include: • Vital signs , weighing • History taken

29. 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

30. Nursing Role cont. 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.

31. 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.

32. 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.

33. Nursing role cont. 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).

34. 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.

35. 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.

36. 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.

37. Thank You