1. Prepared by Dr. Hoda Abed El Azim
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. Poor or inadequate nutrition
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 Thin , lose of weight. Wasted extremities
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Behavioral changes: (irritable, lethargic, withdrawn and apathetic).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Apathetic, withdrawn and lethargic.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. Viruses cause 70%to 80% of infectious diarrhea.
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), 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. Maintenance of nutrition Rectal temperature are avoided .
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