Prepared by Dr. Hoda Abed El Azim

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.

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

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.

Kwashiorkor

Marasmus

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)

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Behavioral changes: (irritable, lethargic, withdrawn and apathetic).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.

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.

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Apathetic, withdrawn and lethargic.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.

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.

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.

1. 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.

Immunization of children. Teaching about family planning or birth spacing, so as to allow sufficient time for satisfactory breast feeding.

Prevention of emotional disturbances.

It is an increase in frequency, fluidity or volume of stools relative to the usual habit of each individual.

Bacterial pathogens

(Salmonella, Shigella, Giardia).

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.

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

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.

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.

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.

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

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.

Encourage breast feeding.

Personal hygiene, hygienic

food.

Protecting the water supply

from contamination.

Careful food preparation.

Prevent traveler’s diarrhea

Assessment

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.

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. 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).

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.

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.