Management of Malnutrition

Kwashiorkor

Kwashiorkor is brought on by a lack of protein in comparison to energy in the diet. When there is a strong need for protein, it is typically seen in children aged 1-4.

The Major Features Includes:

• Lack of growth,
• Lethargy,
• Apathy,
• Irritability,
• Edema,
• Decrease in appetite,
• Muscular tone loss,
• The liver is larger,
• Dermatitis,
• Skin pigmentation,
• Hair that is sparse and simple to remove,
• Brownish hair color,
• Vitamin deficits and anemia,
• No desire for toys,
• Oral feeding of a child is difficult,
• The youngster frequently experiences repeated bouts of diarrhea, lung infection, and skin infection.

Marasmus

Marasmus is a condition brought on by an imbalance in nutrition between protein and energy. It typically affects infants and is characterized by severe muscle and subcutaneous tissue loss, which causes emaciation and pronounced stunting. It explains the significant cost on world health. The WHO estimates that almost to half of the additional ten million deaths of children under the age of five from PEM are attributed to marasmus.

The Major Signs and Symptoms Includes

• The body weight is around 60% of what is expected for the age, and height is also somewhat impacted.
• Skin that is wrinkled as a result of muscle loss and subcutaneous fat loss.
• Stomach discomfort and a history of diarrhea.
• Subnormal height and a noticeable weight decrease.
• A ravenous, insatiable appetite.
• Anemia.
• His inner thighs have a noticeable skin fold that hangs loosely.
• Skin seems to be inelastic, dry, scaly, and susceptible to infection.
• Emaciation makes the bony points appear too prominent.
• Baby seems to be awake.

Marasmic Kwashiorkor

Nutritional deficiencies of protein and energy display the signs and symptoms of both.

Diagnosis

• History
  • Dietary history, a child's medical history, family history, etc.
• Physical examination presentation
  • General appearance, skin, muscle tone, degree of boy fat, eating patterns, etc.
• Assessment of nutritional status:
  • A growth graph
  • Measurements of height and weight
  • Upper mid-air circumference measurement
• A lipid profile, complete blood count, albumin, total protein, iron tests, vitamin and mineral tests are examples of possible laboratory examinations.
• X-rays, CT scans, and MRIs are used to assess the condition of the internal organs and the healthy skeletal and muscular development.

Management and Treatment of Malnutrition

Protien Energy Malnutrition

Mild PEM

• A demonstration of how to prepare food, like litto, is included in nutrition instruction.
• By eating small, frequent meals throughout the day, you can increase your diet's protein and calorie intake. If you have problems choosing the correct foods to eat, consume a nutritional supplement.
• Controlled feeding
• Food additive

Moderate PEM

• Treatment is similar to that for moderate PEM in addition to infection and deficient status management. However, if the child has moderate PEM, an infection, and a feeding issue, hospitalization and additional management with antibiotic medication and food therapy are required.

Severe PEM

• Hospitalization of Child
  • Admission to the hospital is required if a patient loses less weight than 60% of their expected weight for age or 70% of their expected weight for height, has edema, severe dehydration, diarrhea, hypothermia, shock, a systemic or localized infection, jaundice, bleeding, persistent appetite loss, or is under one year old.
• Ten Essential Steps of Management of Severe Malnutrition with Phase
  • The first week of stabilization and the rehabilitation phase (2-6 weeks)

Steps of Management

• Hypoglycemia
  • Hypoglycemia treatment and prevention ought to go hand in hand. If the child is conscious and the dextrose level is below 3 mmol, administer a 50 ml bolus of 10% dextrose orally or through an NG tube, and then begin feeding the child every 30 minutes for two hours throughout the day and night. If the child is unconscious, administer an IV of 10% glucose (5 ml/kg), followed by 50 ml of 20% glucose, and then continue feeding the child as above while monitoring the child's blood glucose level.
• Hypothermia
  • Keeping an eye on the infant's axilla to see if it is rising
• Dehydration
  • All severely malnourished children are assumed to have watery diarrhea and possibly some dehydration; they should be treated accordingly. If the kid is cognizant and able to drink, administer a specific rehydration solution for malnutrition (ribosomal 5ml/kg every 30 minutes for 2 hours via oral intake or NG, followed by 5-10 ml/kg/hr for the following 4–10 hours). However, if the kid is in shock, dehydration should be treated with a gradual infusion of RL or N/2 in 5% dextrose (30ml/kg in 2 hours), then N/6 saline in 5% dextrose (100ml/kg) at a rate of 10mg/kg in the following 10 hours, and the same solution at a rate of 5ml/kg in the following 12 hours. If the child is breastfeeding, keep feeding them while you check their hydration level, monitor their vital signs, and watch out for any vomiting or diarrhea.
• Electrolytes
  • Magnesium and potassium must be corrected. Therefore, if the child has excessive edema, treat them appropriately by giving them potassium (3–4 mmol/kg/d) and magnesium (0.4–0.6 mmol/kg/day). Foods with a low salt content ought to be chosen.
• Infection Prevention Treatment
  • Assuming that every malnourished youngster has numerous diseases, doctors will treat them with broad-spectrum antibiotics and administer the measles vaccine if the child is older than six months.
• Correction of Micronutrient Deficiency
  • After weight gain, give a multivitamin, folic acid 1 mg/kg (5 mg on day 1), zinc 2 mg/kg/day, copper 0.3 mg/kg/day, and iron 3 mg/kg/day along with vitamin A orally on day 1.
• Caution Feeding
  • Orally, with little to no parental care, and with little to no osmolality and lactose.
  • 130 ml/kg/day of fluid, 100 kcal, 1–1.5 gm of protein, and severe edema require 100 ml/kg/day of fluid.
  • Encourage nursing mothers to continue
  • Keep an eye on and take note of your daily body weight, vomiting, and stool passing.
• Catch-up Growth
  • Begun with a ferocious feeding strategy to produce a quick weight increase of >10g/kg/day. that I attained by suggesting milk-based f-100, which has 100 calories and 2.9 grams of protein per 100 milliliters. In a similar vein, family dishes or customized oatmeal can also be served. A child is prepared for rehabilitation when their appetite returns. Change the beginning, then, to update the formula.
  • For 48 hours, swap out f-75 for the same quantity of f-100; after that, increase each subsequent feed by 10 ml until more feed is finished or when intake reaches 30 ml/kg/feed.
  • Keep an eye on the child's pulse, respiration, and other vital signs, and alter feeding if a problem is found.
  • Assess your progress by keeping an eye on your weight gain.
• Provide Sensory Stimulation and Emotional Support
  • By giving a child with gentle, loving care, a happy, stimulating atmosphere, play therapy, age-appropriate physical activities, and maternal involvement in feeding, soothing, and caring for the child, you may stimulate and support them.
• Prepare For a Follow-up Visit
  •  A child is considered recovered if their weight-to-height ratio is 90%. So educate parents on proper eating techniques, sensory input, and play therapy. Encourage parents to bring their children in for routine medical checkups so that their growth can be monitored, and to make sure booster immunizations are provided, including vitamin A.

                                                                   Management of Malnutrition and Anemia According to IMCI Approach

REFERENCE

Ambika Rai, Kabita Dahal. Community Health Nursing-II. Kathmandu: Makalu Publication House, 2011.

Adhikari, R. K., & Krantz, M. E. (1997). Child nutrition and health (2nd ed.). Kathmandu: HLMC.

Assuma Beevi, T.M (2009). Textbook of pediatric nursing Reed Elsevier (P) Ltd.

Datta, P. (2007). Pediatric nursing (1st ed.). New Delhi: Jaypee brothers (P) LTD.

Mandal, G.N. A textbook of adult nursing. Kathmandu: Makalu publication house, 2013.

Marlow, D. R, & Pedding, B. A. (1988). Textbook of pediatric nursing.Philadelphia: W.B. Saunders.

Tuitui, Roshani. Community Health Nursing. Kathmandu: Vidyarthi Prakashan (P.) LTD., 2067.