CASE PRESENTATION ON:-PROTEIN ENERGY MALNUTRITION
BIOGRAPHICAL INFORMATION
Name
: Master Durga prasad
Age
: 3 years
Sex
: Male
Address
:Satna
Religion
: Hindu
IP No.
: 613!
Admission unit
: " #nit
Date o$ admission Diagnosis
: 11%&1%13 : Protein 'nergy Malnutrition (rade ) III
CHIEF COMPLAINTS
Patient *ad +omplains o$ ,e-er Sin+e days/ A0dominal Distention sin+e days/ 'dema in t*e lim0s sin+e days PR'S'N2 IN'SS Mas. Durga Prasad +ame to t*e *ospital 4it* t*e +omplaints o$ $e-er o$ intermittent type 4*i+* is moderate in nature asso+iated 4it* +*ills/ a0dominal distention and a0dominal girt* is 5&+m and s4elling o$ t*e lo4er extremities 4it* dry and s+aly sin. sin. Patient Patient 4as admitted 4it* t*e a0o-e a0o-e +omplain +omplaints ts 7 4as Diagnose Diagnosed d P'M and t*ere is no any surgi+al inter-ention 0eing done. PAST HEALTH HEALTH HISTORY HISTO RY
8HIDH99D ) IN'SS: 2*ere is no signi;+ant signi;+ant *istory o$ +*ild*ood illness/ illness/ trauma/ trauma/ or immuni
: HIS29R>: Patient is no4n +ase o$ de*ydration as diagnosed yrs 0a+. No Dia0etes/ or ot*er +*roni+ illness7 *as not undergone any surgi+al inter-entions. M'DI8A2I9N 7 A'R(I'S: As a no4n P'M/ *e regularly taes t*e medi+ation diet a++ording to standard 0ody re?uirement./ No *istory o$ any *a0itual 928 medi+ations/ not *a0ituated to any *er0al preparations or sel$ preparations. PERSONAL HISTORY PERSONAL STATUS: STATUS: *e
*olds up an +ute pla+e in *is $amily
along 4it* *is mot*er 7 $amily.
1
'A2IN( 'A 2IN( HA"I2S: He taes $ruit as 4ell as mil 7 in+ludes plenty o$ 4ater. 4ater. A89H9 HA"I2S: not a no4n al+o*oli+. SM9@IN( HA"I2S: not *a0ituated. I,' S2>': 4ell playing 4it* ot*er +*ildren. S''PIN( HA"I2S: Sleeps *rs%nig*t 7 *rs%day/ doesn=t *a-e any pro0lems in sleeping. R'I(I9N7,AI2H: He is a Hindu 0y religion and is in-ol-ed in traditional and +ultural a+ti-ities $re?uently. FAMILY HISTORY
3 years
1year
years
5years
3years
No *istory o$ any +ommuni+a0le diseases 7 geneti+ disoders/ patient=s $at*er *as a *istory o$ 0lood pressure. S.No
Name
Relation
Age
Healt*status
9++upation
1
S*ai*ar
,at*er
3yrs
Healt*y
mer+*ant
Sunita
Mot*er
yrs
Healt*y
*ouse4i$e
3.
SonBpatien tC Son
3 yrs
Admitted
nil
Durgapras ad s*it*il
1 yr
Died
5
mano
son
5 yrs
#g
studying
PSYCHO SOCIAL HISTORY
Patient maintains good relations 4it* $amily mem0ers/ relati-es and $riend. NUTRITIONAL HISTORY
Re+ent Eeig*t : g/'xpe+ted Eeig*t: 1g .Appetite: Poor Hours Diet Re+all: 8*ild taen only t4o meals in last *ours and ea+* meal +ontains idly 4it* +*atni. Eater intae approximately &&5&& ml. Degree o$ Malnutrition Malnutrition : Fa+tual 4eig*t%expe+ted 4eig*t G 1&&
F %1 G 1&& 5& III Degree malnutrition Menu plan $or Mas. Durgaprasad as per standard daily re?uirement 2ime Am
Item % +up milJ1 tsp g*eeJ 0is+uitsJ
8alorie
Protein
136 @+al
3gm
&@+al
gm
3&&@+al
gm
&@+al
gm
15&@+al
gm
&@+al
gm
1@+al
gm
16&@+al
35gm
1 tsp sugar
1&Am
1 +up +ooed ri+eJ spoon D*al sam0arJ1 tsp g*ee
1pm 1 eggJ1 8*apatiJ3 spoon sugarJ1 tsp g*ee pm 1 +up ri+eJ spoon d*al Sam0arJ 1 tsp g*ee 5pm 1 0readJ1% +up milJ 1 tsp sugar pm 1 +up ri+eJ1 tsp g*eeJ spoon d*al !pm 1 "ananaJ K +up ri+eJ1% spoon g*eeJ Sam0ar 2otal
ENVIRONMENTAL HISTORY
Patient li-es in rural area. 2*e *ousing +ondition is rural 0ut a++ording to t*e $amily mem0ers t*ey li-e in a *ygieni+ +ondition. Drainage system is present. 2*ey get 4ater $rom 0ore4ell supply. (R9E2H AND D'L'9PM'N2 8*ild=s gro4t* and de-elopment *as not a+*ie-ed to normal extent. (ross Motor de-elopment: +*ild 4as una0le to tae steps on tip o$ toe. ,ine motor de-elopment: not a0le to *old spoon properly to tae $ood.
3
Sensory de-elopment: a0le to identi$y geometri+ ;gures/ a++ommodation 4ell de-eloped. Lo+ali
"o4el
: 0o4el sounds are dull
"ladder
: 0ladder +ontrol not yet a+*ie-ed.
PH>SI8A 'GAMINA2I9N (eneral 90ser-ation Mas. Durgaprasad is a 3 years old male 0a0y/ poorly 0uilt/ undernouris*ed/ +ons+ious and oriented to time/ pla+e and person. Lital Signs 2emperature
: 1&&o ,
Pulse
: !0ts%min
Respiration
: 3&0reat*s%min
Sin And Mu+us Mem0rane 8olor
: Normal 0ro4n
'dema
: Present
Moisture
: Dry
2emperature 2urgor
: In+reased : Normal
Any A0normal Dis+*arges : No Head Sull%8ranium Si
: Normal
Mo-ements
: Normal mo-ements
,ore*ead
: No s+ars
8*anges in 2exture
: Hypopigmented
8*ara+teristi+s
: "ro4n in +olor/ sparse and not distri0uted densely
Hair
i+e
: A0sent
8*anges in Appearan+e
: 8lu00ing o$ nails
8yanosis
: A0sent
Nails
2exture
: So$tening o$ nails
,a+e Appearan+e
: Presen+e o$ $a+ial puness
8olor
: Normal 0ro4n
Symmetry
: Symmetri+al
Mo-ements
: Normal
'xpression
: Normal
'ye ids
: Normal
a+rimation
: Poor
8onun+ti-a
: Pale
S+lera
: 8lear
Pupil
: '?ually rea+ti-e and a++ommodate lig*t.
Appearan+e
: Symmetri+al
Dis+*arges
: Nil
esions
: Nil
Any A0normalities
: Nil
Appearan+e
: Normal
Dis+*arges
: Nil
Paten+y
: Patent
Sense o$ Smell
: Normal
'yes
'ars
Nose
Mout* And 2*roat ips
: Dry
2ongue
: Not +oated
2eet*
: De+iduous teet* are present 5
(ums
: Normal
"u++al Mu+osa
: Normal
Palate
: No +le$t palate
2onsils
: Not inamed
2aste
: Normal
Ne+ (eneral Appearan+e 2ra+*ea
: Normal : 8entrally lo+ated
ymp* Nodes
: No palpa0le lymp* nodes
2*yroid (lands
: No t*yroid enlargement
8ysts and 2umors
: Nil
(astroIntestinal System Diarr*ea
: A0sent
8onstipation
: A0sent
"leeding
: A0sent
Eorm In$estation
: Suspe+ted
Psy+*oso+ial History (eneral Status o$ t*e ,amily: Mas. Durga Prasad 0elongs to poor +lass $amily 4it* a mont*ly in+ome o$ 1&&&%. His $at*er is a daily 4ager. He is li-ing 4it* *is $at*er/ mot*er and t4o elder sisters. 2*ey are li-ing in t*eir o4n *ouse. 'le+tri+ity supply is a-aila0le in t*e *ouse. 2*ere is no proper sanitary $a+ility. A+ti-ities o$ Daily i-ing loos dull. Sl. No. 1. . 3. . 5. 6.
In-estigation Hemoglo0in 28 ymp*o+yte Mono+yte 'osinop*ils R"8
Play A+ti-ities si0lings.
: Mas. Durgaprasad lost *is interest in daily a+ti-ities and Results
Normal -alues
Remars
5.gm%dl 1/&&+ells%mm 6 & & 3.53mil +ells%mm
116gm%dl &&&11&&&+ell%mm &5 1& 1 3.55.5 mil +ell%m
Se-ere anemia Inammation present In+reased Normal Normal Normal
: 8*ild *as less interest to play 4it* peers and
6
Spe+ial in-estigations #ltrasonograp*y: 2*e ;ndings $rom t*e images o0tained t*roug* #ltrasonograp*y suggest t*at t*e li-er is in;ltrated 4it* ex+essi-e trigly+erides.
M'DI8A2I9NS Medi+ation name 1. In. Amia+in
. 2a0. " +omplex
Dosage ,re?ueRoute n+y 5mg
"d
IL
5& mg
9d
9ral
A+tions
"inds to 3&s ri0osomal su0units o$ sus+epti0le 0a+teria/ t*us in*i0its protein synt*esis. Litamin " +omplex and Litamin 8 supplement
Side eOe+ts
2innitus/ -ertigo/ ataxia and dea$ness Nausea and -omiting
Nursing responsi0ilities Per$orm test $or *earing a+uity. A-oid +on+urrent use o$ ototoxi+ drugs Monitor $or t*e signs o$ *yper-itaminosis.
D'S8RIP2I9N 9, DIS'AS' PR92'IN 'N'R(> MAN#2RI2I9N 2*e term malnutrition +an 0e applied to any disorder t*at pre-ents an indi-idual $rom a+*ie-ing an optimal nutritional state.Protein energy malnutrition is t*e state o++urs due to insu+ient or im0alan+ed +onsumption o$ protein and energy. IN8ID'N8': Malnutrition is t*e one o$ t*e maor *ealt* pro0lem in t*e 4orld in +*ildren 4it* in 5 years o$ age.It is estimated t*at & o$ pres+*ooler suOer $rom -arious degrees o$ malnutrition.At any gi-en time t*ere are million +*ildren suOering $rom -arious degrees o$ malnutrition. N9RMA PR92'IN AND 'N'R(> R'#IR'M'N2 9, 8HIDR'N Age group &6 mont*s 61 mont*s 13years 6years
'nergy Bin +al%dayC 1&% g !%g 1& 16!&
Protein Bin grams%dayC .&%g 1.65%g 3&
2>P'S 9, PR92'IN 'N'R(> MAN#2RI2I9N 1.Marasmus: Eeig*t less t*an 6& o$ expe+ted 4eig*t to t*e age. It is a +lini+al syndrome +*ara+teri MAN#2RI2I9N aC (ome< 8lassi;+ation: (rade I
6!& o$ a-erage o$ 4eig*t. (rade II
615 o$ a-erage 4eig*t.
(rade III 6& and 0elo4 6& o$ a-erage 4eig*t. 0C 2*e Eater oo +lassi;+ation • • •
Nutritional Marasmus 0elo4 6& o$ a-erage 4eig*t 4it*out edema @4as*ioror 6&& o$ re$eren+e 4eig*t 4it* edema. Marasmi+ @4as*ioror 0elo4 6& o$ re$eren+e 4eig*t and edema
+C Indian A+ademy o$ Pediatri+s:
• • • • •
A0o-e & o$ expe+ted 4eig*t Normal && o$ expe+ted 4eig*t (rade I 6&& o$ expe+ted 4eig*t (rade II 5&6& o$ expe+ted 4eig*t (rade III ess t*an 5& o$ expe+ted 4eig*t (rade IL
MARASM#S A se-ere $orm o$ malnutrition +aused 0y inade?uate intae o$ protein and +alories/ and it usually o++urs in t*e ;rst year o$ li$e/ resulting in 4asting and gro4t* retardation. Marasmus a++ounts $or a large 0urden on glo0al *ealt*. Nutritional Marasmus is a nutritional disorder results due t*e gross de;+ien+y o$ energy t*oug* protein de;+ien+y a++ompanies it. It is t*e +ommon pro0lem in de-eloping +ountries in t*e time o$ draug*t. It o++urs +*iey in ;rst year o$ li$e. '2I99(>: aC Primary 8ause: Primary +ause is t*e dietary +ause. Inade?uate diet 0ot* ?ualitati-ely and ?uantitati-ely. 0C Se+ondary 8auses: •
Age: Marasmus is more +ommon in in$ant t*an in ot*er ages. It is 0e+ause o$ *ig* nutritional re?uirement o$ in$ant BProtein: 3gm%g%dayQ 8alorie: 1&& @+al%dayC and *en+e Marasmus de-elops soon in in$an+y
•
8ongenital Disease: 8ongenital disease 4*i+* limits t*e intae and digestion o$ $ood.
•
8*roni+ Lomiting: Disease lie pylori+ stenosis and relaxed +ardia+ sp*in+ter/ 4*i+* in+rease t*e ris o$ -omiting t*ere 0y/ de+reases t*e a0sorption o$ t*e nutrients $rom t*e (I tra+t.
•
8*roni+ In$e+tion: 8*roni+ in$e+tions lie 8ongenital syp*ilis/ tu0er+ulosis and respiratory in$e+tion 4*i+* results in protein loss.
!
•
Repeated episodes o$ +*roni+ diarr*ea 4ill impair t*e digestion and a0sorption o$ nutrients $rom t*e mu+osa o$ t*e (astro Intestinal tra+t and results in de;+ien+y o$ t*e nutrients.
•
Serious organi+ disorders o$ *eart/ 0rain and idney and some meta0oli+ disorders and u-enile dia0etes mellitus.
•
9t*er +auses in+lude 2ransition $rom 0reast$eeding to nutrition/ poor $oods in in$an+y.
(RADIN( 9, 2H' MARASM#S: (rade I
: oss o$ $at in axillae and groin
(rade II
: (rade I J loss o$ $at in a0domen and gluteal region.
(rade III
: (rade I J (rade II J loss o$ $at in +*est and Para spinal area.
(rade IL
: (rade I J (rade II J (rade III J loss o$ $at in 0u++al pad.
8INI8A MANI,'S2A2I9NS •
•
Appearan+e o$ toot*less old man and a money loo. (ro4t* retardation as e-iden+ed 0y mared loss o$ 4eig*t and su0normal *eig*t.
•
(ross mus+le 4asting
•
A0sen+e o$ edema.
•
'yes 4ill 0e sunen
•
Disappeared su0+utaneous $at.
•
,a+e 4ill 0e round/ till t*e loss o$ su0+utaneous $at.
•
Sin o-er t*e 0utto+s 0e+omes 4rinled and saggy due to loss o$ adipose tissue.
•
"ones 4ill 0e prominent.
•
Anemia
•
Su0normal temperature.
•
Sin 0e+omes as*en gray 0e+ause o$ anemia
1&
•
•
•
Atrop*y and 4asting o$ 0ody tissues espe+ially su0+utaneous $at. 2*e +*ild 4ill 0e apat*eti+ and let*argi+. Re+urrent in$e+tions
DIA(N9SIS History +olle+tion
: Regarding t*e dietary *a0its and re+urrent atta+s o$
diseases. P*ysi+al examination
: 2o rule out t*e signs o$ t*e Marasmus.
"io+*emi+al In-estigation
: "io+*emi+al in-estigation to estimate t*e plasma
protein le-el. Plasma protein le-els 4ill not 0e noti+ea0ly redu+ed. Pat*ologi+al re$eren+es : i-er does not s*o4 pat*ologi+al $atty in;ltration. Redu+ed organ 4eig*t o$ lung and *eart MANA('M'N2:
8alorie re?uirement o$ t*e undernouris*ed in$ants are greater t*an t*ose o$ normal in$ants it almost dou0led.
2*e aim o$ treatment is to pro-ide su+ient proteins/ +alories/ and ot*er nutrients $or nutritional re*a0ilitation
and maintenan+e.
In +ase o$ se-ere P'M/ restoring uid and ele+trolyte 0alan+e parentally is t*e initial +on+ern. A patient 4*o s*o4s normal a0sorption may re+ei-e enteral nutrition a$ter anorexia *as su0sided.
E*en possi0le/ t*e pre$erred treatment is oral $eeding. ,oods are introdu+ed slo4ly. 8ar0o*ydrates are gi-en ;rst to supply energy/ and t*en *ig*?uality protein $oods/ espe+ially mil/ and protein+alorie supplements/ are gi-en.
Start 4it* t*e +on+entrated $ood o$ a0out && 8al%g 0ody 4eig*t gradually 3 4ees and +ontinued till t*e 4eig*t gain.
Protein re?uirement s*ould 0e gm%g 0ody 4eig*t %day.
No o$ $eeds s*ould 0e in+reased usually $eeds a day. 11
A patient 4*o=s un4illing or una0le to eat may re?uire supplementary $eedings t*roug* a nasogastri+ tu0e or 2otal Parenteral Nutrition B2PNC.
Se+ondary +auses s*ould 0e treated
A++ompanying in$e+tion must also 0e treated/ pre$era0ly 4it* anti0ioti+s t*at don=t in*i0it protein synt*esis.
@EASHI9R@9R @4as*ioror is one o$ t*e more se-ere $orms o$ protein malnutrition and is +aused 0y inade?uate protein intae. It is/ t*ere$ore/ a ma+ronutrient de;+ien+y. It is type o$ se-ere proteinenergy malnutrition re$ers to a +om0ination o$ edema/ let*argy Bmental apat*yC and gro4t* $ailure. IN8ID'N8': It is a maor pro0lem in Sout* India BAndra Prades*C and 9rissa/ "engal and some parts o$ Ma*aras*tra. In India it is estimated t*at a0out 1 o$ pres+*ooler suOer $rom @4as*ioror. '2I99(>:
•
"oo Pi+ture #na-aila0ility o$ suita0le protein ri+*
Patient Pi+ture
$oods •
,aulty $eeding *a0its
•
Super imposition o$ in$e+tion and
Suspe+ted +ase o$ 4orm in$estation
in$estations •
Age In+iden+e
Age is 3y/ pea age o$ in+iden+e
Hig*er in+iden+e is $ound 0et4een 1 to 3 years. •
Prolonged 0reast $eeding
•
Seasonal In+iden+e
•
,amily si
•
a+ o$ A++essi0ility and a-aila0ility
"reast $eed till years o$ age. a+ o$ a4areness o$ *ealt* ser-i+es
o$ Healt* Ser-i+es 1
8INI8A MANI,'S2A2I9N "oo Pi+ture 9nset: Insidious in onset o-er periods o$ 4ees and mont*s.
Patient Pi+ture Insidious in onset Has less interest in play a+ti-ities.
•
Apat*y: (radually loss o$ interest and a+ti-ity. 2*e degree unresponsi-eness 4ill 0e proportional to se-erity o$ t*e disease. Diarr*ea: Nearly %3 rd o$ @4as*ioror +ases 4ill 0e presenting 4it* t*e +omplaints o$ loose stools 4it* in$e+ti-e in origin. 'dema: 'dema is a +onstant $eature and is extremely -aria0le in degree. Inspite o$ gross edema/ as+ites 4ill 0e minimal. Mus+le 4asting: Due to degeneration and redu+tion in t*e anterior *orn +ells may lead to 4eaness and *ypotonia as suggested 0y one postulate B@4as*ioror myelopat*yC. Protein de;+ien+y also +auses mus+le 4asting. Sin +*anges: & to 6& o$ t*e orid 4as*ioror 4ill *a-e sin +*anges. Dry and s+aly sin: 8ommon o-er sin Pa-ement dermatosis: et 0la+/ later ex$oliate exposing underlying and also t*ere 4ill 0e peeling. Peti+*ae and e++*ymoses.
•
Ara0inoa-inosis
A0sent Hairs are s+anty and 0ro4n in +olor
•
Hair +*anges: 2*e *air is s+anty/ lusterless +ommonly 0ro4nis*. 2*e lig*t +olor *air is no4n as dys+*romotri+*ia. Hepatomegally 4it* $atty in;ltration.
•
,a+e: Moon $a+e due to edema
•
Asso+iated A-itaminosis
Moon $a+e is present
•
Anemia o$ moderate degree.
No symptoms
•
(ro4t* retardation
H0 5.gm%dl
Psy+*omotor +*anges: 'arlier t*e onset o$ t*e malnutritionQ se-ere 4ill 0e t*e psy+*omotor +*anges Bmental depri-ationC
A0sent
• •
•
•
•
•
•
•
•
A0sent
Pedal edema 4it* as+ites No mus+le 4asting
Sin is dry and s+aly
A0sent A0sent
i-er is enlarged +m 0elo4 t*e R8M
Irrita0le and restless
@4as*ioror suOerers s*o4 signs o$ t*inning *air/ edema/ inade?uate gro4t*/ and 4eig*t loss. 2*e stomatitis on t*e pi+tured in$ant
13
indi+ates an de;+ien+y
a++ompanying
Litamin
"
DIA(N9SIS:
"oo Pi+ture •
History and P*ysi+al examination
•
Ant*ropometri+ measurements
•
•
"io+*emi+al in-estigation o4 serum al0umin B3.55gm%dlC o o A%( ratio 4ill 0e re-ersedB1:1.5C o De+reased serum amino a+id le-el. De+reased 0lood +*olesterol le-el. o o De+reased pan+reati+ en
Atrop*y o$ a+inary +ells o$ pan+reas Atrop*i+ +*anges in stoma+* and intestinal -illi.
Patient Pi+ture Done MA81+m Not done Not done Not done Not done Not done Not done Present and enlarged +m 0elo4 R8M Not eli+ited Not eli+ited.
MANA('M'N2 1. Dietary modi;+ations . 8ontrol and 2reatment o$ in$e+tions "oo Pi+ture
Patient Pi+ture
Management: 1.Dietary modi;+ations Dietary Management: i0eral protein ri+* $oods to 0e gi-en 4it* ade?uate +alories. Proteins:
Hig* protein diet 4it* $eeds a da
A0out 5 to 6 gms o$ protein%g%day. 2*e total a-erage protein intae o$ +*ild is 5&6&gm%day. 8alories: 8alories s*ould 0e in range o$ 1&15& @+al%g%day.
1
1.
8ontrol and 2reatment o$ in$e+tions
.
8orre+tion o$ Litamin de;+ien+ies
9n anti0ioti+ 5mg "DC
t*erapy
BIn.
9n "e+osule +apsule $or Lit" and 8 Supplementation
3. 8orre+tion o$ Litamin de;+ien+ies
15
Ami
N#RSIN( 8AR' PAN SR.N9 . 1
ASS'SSM'N2
N#RSIN(
Su0e+ti-e data:
DIA(N9SIS Im0alan+ed
Mot*er says TMy
nutritionQ less
9"'82IL'
PANNIN( IN2'RL'N2I9NS
8*ild 4ill
- Assess t*e
a+*ie-e and
nutritional status
IMP'M'N2A2I9N
'LA#A2I9N
8*ild is se-erely
Nutrition o$ +*ild
malnouris*ed. i.e.
is impro-ed to
rd
son is not
t*an 0ody
maintain normal
and degree o$
3 degree
some extent as
gaining 4eig*t
re?uirement
nutritional
malnutrition.
malnutrition.
e-iden+ed 0y
ade?uatelyU
related to
status as
de+reased
e-iden+ed 0y
90e+ti-e data:
utili
4eig*t gain.
Eeig*t:g
nutrients
Bexpe+ted 4t 1
se+ondary to
gC
in+reased
- Assess t*e +auses De+reased
interest to tae
utili
$ood and mild
nutrients due to
in+rease in
and edu+ate
$atty in;ltration o$
4eig*t. i.e.
$atty in;ltration
mot*er to ser-e
li-er.
.g.
o$ t*e li-er.
$ood a++ordingly.
Prepared diet menu
$or malnutrition.
- Prepare diet plan
(rade III
- Identi$y $or t*e
malnutrition:
signs o$ -itamin
plan 0ased on t*e +*ild +ondition.
de;+ien+ies
- Administer Litamin
Litamin de;+ien+y present.
Supplements Pro-ided oral Litamin Supplements.
16
SR N9. .
ASS'SSM'N2
N#RSIN( DIA(N9SIS
PANNIN( 9"'82IL' IN2'RL'N2I9NS
IMP'M'N2A2I9N
'LA#A2I9N
Su0e+ti-e data:
Hypert*ermia
8*ild 4ill
Monitor -ital
"ody 2emperature
8*ild=s 0ody
Mot*er says TMy
related to
a+*ie-e and
signs
is
temperature is
son=s sin is
inammatory
maintain
1&&o,.
4it*in normal
some4*at *otU
rea+tion
normal 0ody
oosen t*e
limits
se+ondary to
temperature
Hepatomegally.
as e-iden+ed
90e+ti-e data: 2emperature: 1&&o, Pulse: !0ts%min
oosen t*e +lot*ing and s4it+* on t*e
0y
$an. Pro-ide plenty
temperature
o$ uids to drin
4it*in normal limits.
Apply +old +ompress
+lot*ing and pro-ided proper -entilation. Ad-ise t*e mot*er to pro-ide plenty o$ 4ater and uids. Ad-ised mot*er to
2emperature: !.6,
SR
ASS'SSM'N2
N9. .
N#RSIN( DIA(N9SIS
PANNIN( 9"'82IL' IN2'RL'N2I9NS
IMP'M'N2A2I9N
'LA#A2I9N
Su0e+ti-e data:
Hypert*ermia
8*ild 4ill
Monitor -ital
"ody 2emperature
8*ild=s 0ody
Mot*er says TMy
related to
a+*ie-e and
signs
is
temperature is
son=s sin is
inammatory
maintain
1&&o,.
4it*in normal
some4*at *otU
rea+tion
normal 0ody
oosen t*e
limits
se+ondary to
temperature
Hepatomegally.
as e-iden+ed
90e+ti-e data: 2emperature: 1&&o, Pulse: !0ts%min
oosen t*e +lot*ing and s4it+* on t*e
0y
$an. Pro-ide plenty
temperature
o$ uids to drin
4it*in normal limits.
Apply +old +ompress
+lot*ing and pro-ided proper -entilation.
2emperature: !.6,
Ad-ise t*e mot*er to pro-ide plenty o$ 4ater and uids. Ad-ised mot*er to
Pro-ide tepid
eep 4et +lot* on
sponge. Administer
$ore *ead to
pres+ri0ed antipyreti+s
redu+e t*e temperature.
Administered In
1
Para+etamal Intramusularly.
SR N9. 3.
ASS'SSM'N2 Su0e+ti-e data: 2*e mot*er
N#RSIN( DIA(N9SIS ,luid -olume
9"'82IL'
PANNIN( IN2'RL'N2I9NS
2o maintain
Assess t*e +*ild
IMP'M'N2A2I9N 8*ild
*a-ing 8*ild=s edema
is
ex+ess related
uid -olume
$or sites o$
$a+ial
+omplaint t*at
to uid
in t*e 0ody
edema.
perior0ital
*er son is *a-ing
a++umulation
and to redu+e
s4elling o$ $a+e.
in tissues as
t*e edema.
e-iden+e 0y
o$ as+ities and
puness o$
measure
$a+e/
a0dominal girt*.
*a-ing puness
perior0ital
Assess t*e
o$ $a+e/
and pedal
dietary pattern
90e+ti-e data: 2*e +*ild is
puness/ *as redu+ed as edema/ e-iden+ed 0y
7 pedal edema. Assess t*e signs
'LA#A2I9N
a0dominal
A0dominal girt* is girt* redu+ed !+ms
Ad-ised mot*er to
to 5 +ms.
Para+etamal Intramusularly.
SR N9. 3.
ASS'SSM'N2 Su0e+ti-e data: 2*e mot*er
N#RSIN( DIA(N9SIS ,luid -olume
9"'82IL'
PANNIN( IN2'RL'N2I9NS
2o maintain
Assess t*e +*ild
IMP'M'N2A2I9N 8*ild
*a-ing 8*ild=s edema
is
ex+ess related
uid -olume
$or sites o$
$a+ial
+omplaint t*at
to uid
in t*e 0ody
edema.
perior0ital
*er son is *a-ing
a++umulation
and to redu+e
puness/ *as redu+ed as
s4elling o$ $a+e.
in tissues as
t*e edema.
edema/ e-iden+ed 0y
A0dominal girt* is girt* redu+ed
e-iden+e 0y
o$ as+ities and
puness o$
measure
$a+e/
a0dominal girt*.
*a-ing puness
perior0ital
Assess t*e
o$ $a+e/
and pedal
dietary pattern
perior0ital edema
edema/ and
o$ t*e +*ild.
gi-e
and edema at
a0dominal
Pro-ide small
$re?uent meals.
$eets.
distension.
and $re?uent
90e+ti-e data: 2*e +*ild is
a0dominal
7 pedal edema. Assess t*e signs
meals.
'LA#A2I9N
to 5 +ms.
!+ms
Ad-ised mot*er to small
and
Pro-ided t*e list o$ protein ri+* $oods to mot*er.
In+rease $ood
Instru+ted
mot*er
1
items t*at
to
ser-e $ood
in
+ontain protein.
utensils 4*i+* t*e +*ild used to *a-e
8onsider lies
$ood.
and dislies o$ t*e +*ild.
SR N9. .
Su0e+ti-e data
N#RSIN( DIA(N9SIS De;+ient
9"'82IL' Parents 4ill
Mot*er says t*ey
no4ledge o$
gain no4ledge
ASS'SSM'N2
*a-e not taen
t*e parents
PANNIN( IN2'RL'N2I9NS - Assess t*e le-el
'LA#A2I9N
#nderstanding
Parents gained
o$
le-el o$ t*e parents
no4ledge
understanding
is poor.u+ated
regarding t*e
+*ild $or
related to
immuni
nutrition and
o$ parents. regarding t*e - 'du+ate t*e nutritional parents
immuni
re?uirement
regarding t*e
need o$ +*ild
o$ t*e +*ild
+auses and
90e+ti-e data
IMP'M'N2A2I9N
mot*er regarding t*e +ondition o$ t*eir +*ild.
nutritional re?uirements o$ t*e +*ild/
'du+ated parents
and its
items t*at
to
ser-e $ood
in
+ontain protein.
utensils 4*i+* t*e +*ild used to *a-e
8onsider lies
$ood.
and dislies o$ t*e +*ild.
SR N9. .
Su0e+ti-e data
N#RSIN( DIA(N9SIS De;+ient
9"'82IL' Parents 4ill
Mot*er says t*ey
no4ledge o$
gain no4ledge
ASS'SSM'N2
*a-e not taen
t*e parents
PANNIN( IN2'RL'N2I9NS - Assess t*e le-el
Parents gained
o$
le-el o$ t*e parents
no4ledge
understanding
is poor.u+ated
regarding t*e
+*ild $or
related to
immuni
nutrition and immuni
re?uirement
regarding t*e
need o$ +*ild
o$ t*e +*ild
+auses and
and
symptoms o$
8*ild not re+ei-ed
-a++ines and $ood pattern 4as inappropriate
mot*er regarding t*e +ondition o$ t*eir +*ild.
nutritional re?uirements o$ t*e +*ild/
'du+ated parents
and its
regarding t*e
management
measures to
and
impro-e t*e
immuni
regarding t*e
nutrition status and
need o$ +*ild.
daily nutritional
pres+ri0ed menu
re?uirement o$
plan. 'xplained t*e
malnutrition. immuni
immuni
'LA#A2I9N
#nderstanding
o$ parents. regarding t*e - 'du+ate t*e nutritional parents
90e+ti-e data
IMP'M'N2A2I9N
t*e +*ild. - 'du+ate t*e
importan+e and 1!
parents
s+*edule o$
regarding t*e
-a++ination and
importan+e o$
en+ouraged $or
immuni
$uture
t*e under;-e
immuni
+*ild. - 'du+ate regarding t*e
regarding t*e pre-ention and
measures to
management o$
pre-ent
+ompli+ations.
+ompli+ations o$ malnutrition. SR N9. 5.
ASS'SSM'N2 Su0e+ti-e data:
N#RSIN( DIA(N9SIS Hig* ris $or
9"'82IL'
PANNIN( IN2'RL'N2I9NS
IMP'M'N2A2I9N
'LA#A2I9N
8*ild 4ill
Assess t*e ris
,a+ial puness
impaired sin
a+*ie-e and
$a+tors $or t*e
and pedal edema
sin display no
+omplaint t*at my
integrity
maintain
impairment o$
present.
e-iden+e o$
son is *a-ing
related to
good sin
sin integrity.
edema.
uid o-erload.
texture and
2*e mot*er
2*e +*ildVs
redness and irritation. 2*e
parents
s+*edule o$
regarding t*e
-a++ination and
importan+e o$
en+ouraged $or
immuni
$uture
t*e under;-e
immuni
+*ild. - 'du+ate regarding t*e
regarding t*e pre-ention and
measures to
management o$
pre-ent
+ompli+ations.
+ompli+ations o$ malnutrition. SR N9. 5.
ASS'SSM'N2 Su0e+ti-e data:
N#RSIN( 9"'82IL'
DIA(N9SIS Hig* ris $or
PANNIN( IN2'RL'N2I9NS
IMP'M'N2A2I9N
'LA#A2I9N
8*ild 4ill
Assess t*e ris
,a+ial puness
impaired sin
a+*ie-e and
$a+tors $or t*e
and pedal edema
sin display no
+omplaint t*at my
integrity
maintain
impairment o$
present.
e-iden+e o$
son is *a-ing
related to
good sin
sin integrity.
redness and
edema.
uid o-erload.
texture and
Pro-ide
irritation. 2*e
integrity.
meti+ulous sin
Pro-ided t*e sin
mot*er is
90e+ti-e data:
+are.
+are.
applying
8*ild *a-ing $a+ial
A-oid tig*t
puness and pedal
+lot*ing.
2*e mot*er
edema.
2*e +*ildVs
+ream to t*e Ad-ised mot*er to
+*ild
a-oid tig*t 8leanse and
+lot*ing.
&
po4der opposing
8leansed and
sin sur$a+es
po4dered sin
se-eral times
sur$a+es.
per day. 8*ange t*e
Ad-ised mot*er to
position
+*ange t*e
$re?uently.
position $re?uently.
#se pressure relie-ing mattresses as needed to pre-ent ul+er. H'A2H 'D#8A2I9N • • •
I edu+ate t*em Bpatient 7 $amily mem0erC to ) 2ae *ig* +alori+ diet and iron ri+* diet. 2o a-oid a+ti-ities 4*i+* +auses $atigue.
po4der opposing
8leansed and
sin sur$a+es
po4dered sin
se-eral times
sur$a+es.
per day. 8*ange t*e
Ad-ised mot*er to
position
+*ange t*e
$re?uently.
position $re?uently.
#se pressure relie-ing mattresses as needed to pre-ent ul+er. H'A2H 'D#8A2I9N • • • • • •
I edu+ate t*em Bpatient 7 $amily mem0erC to ) 2ae *ig* +alori+ diet and iron ri+* diet. 2o a-oid a+ti-ities 4*i+* +auses $atigue. 2o tae proper rest and sleep. Do not per$orm any *ea-y 4or. 2ae t*e medi+ine on time and +are $or t*e $ollo4 up.
1
"I"I9(RAPH>: 1. Marlo4 DR/ Redding "A. 2ext "oo o$ Pediatri+ Nursing. 6 t* ed. Ne4 Del*i: 'lse-ier India Pri-ate imitedQ &&6. . Eilson D 7 Ho+en0erry M. Nursing 8are o$ In$ants and 8*ildren. t* ed. Ne4 Del*i: 'lse-ier Pri-ate tdQ &&. 3. *ttp:%%en.4iipedia.org%4ii%Marasmus . *ttp:%%444.$a?s.org%nutrition%@4aMen%Marasmus.*tml 5. *ttp:%%4rongdiagnosis.+om%m%marasmus%intro.*tm 6. *ttp:%%so+ial.ran.org%pages%3%Marasmus.*tml . *ttp:%%en.4iipedia.org%4ii%@4as*ioror . *ttp:%%444.umm.edu%en+y%arti+le%&&16&.*tm !. *ttp:%%444.4rongdiagnosis.+om%%4as*ioror%intro.*tm
"I"I9(RAPH>: 1. Marlo4 DR/ Redding "A. 2ext "oo o$ Pediatri+ Nursing. 6 t* ed. Ne4 Del*i: 'lse-ier India Pri-ate imitedQ &&6. . Eilson D 7 Ho+en0erry M. Nursing 8are o$ In$ants and 8*ildren. t* ed. Ne4 Del*i: 'lse-ier Pri-ate tdQ &&. 3. *ttp:%%en.4iipedia.org%4ii%Marasmus . *ttp:%%444.$a?s.org%nutrition%@4aMen%Marasmus.*tml 5. *ttp:%%4rongdiagnosis.+om%m%marasmus%intro.*tm 6. *ttp:%%so+ial.ran.org%pages%3%Marasmus.*tml . *ttp:%%en.4iipedia.org%4ii%@4as*ioror . *ttp:%%444.umm.edu%en+y%arti+le%&&16&.*tm !. *ttp:%%444.4rongdiagnosis.+om%%4as*ioror%intro.*tm
