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Supervising Professors : Madasih rottu, SS.

By :






5. NOFI PERMATASARI (201601046)





our Praise IS over the presence of the Almighty God WHO has given wisdom and
his guidance over the completion this paper writing entitled "NUTRITIONAL
DEFICIENCY” This paper is structured to fulfill courses" English nursing I ".
In writing this paper we experienced a lot of obstacles and difficulties. However,
thanks to the help of all support, SO we can complete this paper. We also thank the
various support who have helped and gave a briefing as well as support to us,
especially to:
1. Lecturer OF English nursing I courses in nursing i.e.rottu madasih, ss as the person in
charge of courses.
2. Our parents ' loyal support to complete this paper.
3. Friends who always give support in order to finish this paper.
We realize that in the writing of this paper there are many flaws and far from
perfection. Therefore, we accept all the criticisms and suggestions of improvement for
the sake of building handouts.
Finally, with all the limitations, we hope that this paper may be useful for readers in


Ponorogo, July 2017


COVER .............................................................................................................1
THE PREFACE..................................................................................................2
TABLE OF CONTENTS...................................................................................3
A. Background..............................................................................................4
B. problem formulation ...............................................................................4
C. purpose.....................................................................................................4
A. definition of nutritional deficiency..........................................................5
B. etiology of nutritional deficiency............................................................6
C. signs and symptoms of a nutritional deficiency......................................7
D. treatment according to HEALTH nutritional deficiency.......................10
E. Family duties on family who are nutritional deficiency........................12
A. Conclusion.............................................................................................16
B. Suggestion.............................................................................................16

Indonesia as a developing country has always strived to make improvements to public
health degrees, because the Government has a duty towards the welfare of society one
through improved health. An example of the efforts of increasing the degree of health is a
community nutrition improvement, because a balanced nutrition can improve the
robustness of the body, But instead, unbalanced nutrition poses a very difficult problem
once be solved by Indonesia. Unbalanced nutrition problem was like less energy Protein ,
lack of Vitamin A , Disorders due to Iodine Deficiency , iron and anemia. The problem of
Lacking the energy of the Protein or commonly known as nutritionals definitions
frequently found in older toddlers, it is still a very difficult problem be solved, even
though the cause of the malnutrition itself basically simple i.e. lack of food INTAKE OF
a person, But strangely enough in areas that have been self-sufficient, still often found
cases of malnutrition.
In fact, before the case of malnutrition that occurred has gone through several stages
ranging from weight loss from the ideal weight of a child until finally seen the child is
very bad. So the real problem is the community or the family is less to know how to
assess the weight status of children. Besides it is not yet know the pattern of weight
growth. With many parents who do not know the nutritional needs of toddlers therefore
the authors make this paper. To remember to parents about their nutritional needs.
1. How is the definition of a nutritional deficiency?
2. How is the etiology of the nutritional deficiency?
3. how the signs and symptoms of a nutritional deficiency?
4. how the treatment according to HEALTH nutritional deficiency?
5. How family tasks against the sick family members lacking nutritonal deficiency?
1. Describe definition of the nutritioal deficiency
2. Describe etiology of nutritional deficiency
3. Describe signs and symptoms of a nutritional deficiency
4. Describe treatment toodler nutritional deficiency according to healt
5. Describe family tasks against the sick family members nutritional deficien


Malnutrition is the State in which the body does not get enough nutrient intake,
malnutrition can also called a form caused by an inefficient provision between the
taking of food with nutritional requirements to maintain health. This bias occurs due to
the intake of eating too little or the taking of any food that is not balanced. In addition,
the lack of nutrition in the body also leads to the onset of malabsorption of food or
metabolic failures (Oxford medical dictionary 2007:524).
Malnutrition is actually the wrong nutrition, which includes nutrition less or
more. In Indonesia with the still high number of occurrence less nutrition,
malnutrition common term used for this State. In general nutrition less caused by
lack of energy or protein. But the situation on the ground indicates that the rare cases
suffering from pure defferentation
Malnutrition is the State in which the body does not get enough nutrient intake,
malnutrition can also called a form caused by an inefficient provision between the
taking of food with nutritional requirements to maintain health. This can happen due
to intake of eating too little or the taking of any food that is not balanced. In addition,
the lack of nutrition in the body also leads to the onset of malabsorption of food or
the failure ofojh the metabolic.
Malnutrition is generally a medical condition caused by the giving or packed
inappropriate or insufficient. The term is often more associated with undernutrition
(malnutrition less) caused by the consumption of food is lacking, absorption, or loss
of nutrients in excess. Malnutrition is actually the wrong nutrition, which includes
nutrition less or more. In Indonesia the figure less nutrition events still very high
malnutrition common term used for the situation where someone is malnourished.
Malnutrition is an issue of international concern and have a variety of
interrelated reasons. The causes of malnutrition, according to UNICEF conceptual
framework can be distinguished into the direct cause, not direct causes and basic

Poor nutrition causes factor consists of direct and indirect causes. As for the
indirect causes such as lack of amount and quality of food consumed, suffer from
infectious diseases, congenital defects, suffering from cancer and a direct cause, namely
the availability of household food, behavior and health services. While factors other
than health factors, but is also a major issue of malnutrition is poverty, low education,
availability of food and employment. Therefore, to address malnutrition required the
cooperation of the various parties concerned.
1. The direct cause
 Infectious diseases
2. Indirect Causes
 Family Poverty
 The level of education and knowledge of the elderly is low
 A bad Environmental Sanitation
 Inadequate health services
In addition there are several causes of malnutrition such as:
1. Toddlers don't get food companion Breast milk at the age of 6 months or
2. Toddler act gets exclusive Breast milk or have got food besides BREAST
MILK before age 6 months
3. Toddler food companion Breast milk not got at the age of 6 months or more
4. Breast milk nutrition defisiensi
5. After 6 months of toddlers rarely feedings
6. Toddler illness for a long time, such as diarrhea, measles, tuberculosis,
cough and cold
7. Self Hygiene and less dirty environment.


Clinically a toddler looks skinny and or edema in both legs back until the
entire body, and Anthropometry measurements with indicator w/TB or PB <-3SD
or LLA < 11, 5 cm for toddlers 6 – 24 months. On a toddler who suffered severe
edema (whole body) may w/TB or PB >-3SD.

This type of malnutrition can be divided into multiple criteria by using the
assessment Score Mclaren, namely:
Clinical symptoms/ laboratorium Numbers
Edema accompanied dermatosis 3
Changes in hair 2
Hepatomegaly 6
Albumin Serum SERUM or serum total 1
protein SERUM (g%) 1
Albumin 7
Total serum
Serum 6
1.00 < < 3.25 5
1.0 3.25 – 3.99 4
1.50 – 1.99 4.00 – 4.74 3
2.00 – 2.49 4.75 – 5.49 2
2.50 – 2.99 5.50 – 6.24 1
3.00 – 3.49 6.25 – 6.99 0
3.50 – 3.99 7.00 – 7.74
> 4.00 > 7.75

Assessment criteria:
 0 – 3 numbers: marasmus
 4 – 8 numbers: kwarshiorkor marasmik
 9 – 15 figures: kwarshiorkor

1. Marasmus
Marasmus is malnutrition in patients who suffer a loss of more than 10%
of body weight with clinical signs of dwindling deposits of fat and protein are
accompanied by physiological disorders occur, and without injury or damage to
tissue or sepsis. Marasmus generally occurS in the first 12 months because of
delays in the granting of MP-ASI. Marasmus is starving and disease found in the
low socio-economic groups (Almatsier, 2004). Marasmus occurs due to lack of
energy intake or CARB in long period so that the body fat reserves are used to
produce energy that is causing a toddler be thin (wasting). One of the causes of
the occurrence of successive pregnancies is marasmus – hardness, with a distance
of pregnancy that is too early. Marasmus can also be caused due to additional
feeding is not hygienic as well, infant formula that is too dilute, and the numbers
are insufficient because of the limitations of cost, so that the protein content and
calories in the foods being low. The State of the housing and environment are less
healthy can also lead to the presentation of the less healthy and less clean. Like
wise with the infectious disease particularly the digestive tract. On the State of the
environment that are less healthy, recurrent that infections can occur causing the
child to lose body fluids and substances – nutrients so that it becomes thin and his
weight decreased (of health, 1999).
Signs symptoms of marasmus are: (Supariasa et al, 2012) :
 The child looked very thin, living bone wrapped in leather
 The face as a parent
 Skin wrinkles, fatty tissue subcutis very little, even
 Often accompanied by chronic diarrhea or constipation, as well as
other chronic diseases
 Blood pressure, heart rate, respiratory rate and reduced
 ribs and concave belly
 Thigh muscles slack off (baggy pant)
 Whiny, cranky, having fed the children still feel hungry
2. Kwarshiorkor – Marasmik
Kwarshiorkor – marasmik occurs due to the energy and protein intake a
day – the day of adekuat within the period not long that is not sufficient for
normal growth. The clinical picture of kwarshiorkor-marasmik is a combination
of some clinical symptoms of kwarshiorkor and marasmik, accompanied with
edema are not striking. Toddler kwarshiorkor – marasmik shows the weight
reduction or weight < 60% of normal weight and shows sign – the sign of

kwarshiorkor, such as oedema, abnormalities in the hair, skin, and Biochemistry
(Health RI, 2000).

3. Kwarshiorkor
Kwarshiorkor may occur due to the intake of protein does not adequate in
a prolonged period of time. Depletion of proteins in the body can cause edema.
Kwarshoirkor can be found on the children after receiving BREAST MILK in a
prolonged period of time, then weaned and instantly given foods such as other
family members. The food provided is generally low in protein. A less good
eating habits were reinforced by the existence of such taboos belief children
banned from eating fish and prioritize food source of animal protein for the man's
family members – the older man can cause the onset of kwarshiorkor. In addition
to the low level of education can also cause kwarshiorkor because of the
nutritional knowledge of mothers related to the low (Health, 1999).
Kwashiorkor is generally occurs at the age of 2 – 3 years with causes that
often happens is too late weaning BREAST MILK so that unbalanced food
nutritional composition, especially in terms of protein. Kwashiorkor may occur at
a fairly energy consumption or more (Almatsier, 2004).
Signs symptoms of kwarshiorkor include:
o Odema generally throughout the body and especially on the feet (dorsum
pedis) which if suppressed curve, no pain, and tender
o Rounded Face and swollen
o Muscles – muscles shrink (hypotrophy) , more real in a promptly sent in
standing position and sit down, son of lying continue – constant
o Mental status changes: a whiny, cranky, sometimes apathy
o Children often refuse any kind of food (anorexia)
o Enlarged liver (hepatomegaly), which can easily be touched and tasted rubbery
on the touch surface is sleek and sharp edge
o Often accompanied by infection, anemia, and diarrhea
o Thin hair like hair reddish colored corn, dull and easily repealed without pain,
o Skin disorders in the form of blotches that extends and transforms into a black
chipped (crazy pavement dermatosis)
o The views of the child looks glazed

D. Treatment according to HEALTH nutritional deficiency

1. preventing and overcoming hypoglycemia .
Hipoglikemi if blood sugar levels < 54 mg/dl or marked very low body
temperature, decreased consciousness, weakness, seizures, out cold sweats,
pale. The management gave soon liquid sugar: 50 ml dextrose ,10% or 1
teaspoon sugar mixed into water 3.5 tablespoons, sufferers are fed every 2
hours, antibiotics, if sufferers are not aware, via the sonde . The evaluation is
done after 30 minutes, if you still encountered signs of hipoglikemi then
redesigned the granting of liquid sugar.
2. prevent and overcome hypothermia..
Hipotermi if the child < body temperature of 35oC, rectal axilla,3
minutes or 1 minute. The operations room of the PATIENTS must be warm,
no wind and clean holes, often fed, children were given clothing, headgear,
gloves and socks, children warmed in mother Cuddles (Kangaroo method),
quickly replace wet diapers, antibiotics. Rectal temperature measurements are
done every 2 hours until the temperature > 36, 5oC, make sure your child is
wearing the clothes, headgear, socks.
3. prevent and overcome dehydration.
Management has given liquid Resomal (Rehydration Solution for
Malnutrition) 70-100 ml/kg in 12 hours or start with 5 ml/kgBB orally every
30 minutes in 2 hours first. Next 5-10 ml/4-10 for the next hour kgBB,
customised number how many children want a stool out and puke.
Reimbursement of the amount of Resomal at 4, 6, 8, 10 with the F75 if
rehydration is still continued at the time. Monitoring vital signs, diuresis, the
frequency of diarrhea and vomiting, the granting of a liquid are evaluated if
RR and the pulse becomes rapid, jugular venous pressure increases, if the
child is with the edem, added.
4. the correction of disorders electrolyte. Give extra
Potassium 150-300 mg/day, extra kg/0.4-0.6 Mg/mmol/day and kg
rehydration fluid low salt (Resomal)

5. Preventing and tackling infections.
Antibiotics (if no complications: kotrimoksazol 5 days, when there are
complications amoxicillin, 15 mg/kg every 8 hours 5 days. Monitoring the
complications of infection (hypoglycemia or hipotermi).
6. Start feeding.
As soon as thetreated, to prevent hipoglikemi, hipotermi Mandala of
Health. Volume 4, number 1, January 2010 Krisnansari, nutrition and
malnutrition 67 and sufficient energy and protein needs. Stabilization phase
feeding principles i.e. small portions, often, orally or sonde, energy 100
kcal/kg/day, 1-1.5 g protein/kg/day, 130 ml liquid/kg/day for sufferers of
marasmus or kwashiorkor, kwashiorkor by edem 1.2 degrees, ifdegree 3 give
it fluid 100 ml/kg/day.
7. micro nutrient deficiencies Correction.
Give each day a minimum of 2 weeks supplement multivitamins, folic
acid (5 mg day 1,next 1 mg), zinc 2 mg/kg/day, cooper 0.3 mg/kg/day, iron 1-
3 Feelemental/kg/day after 2 weeks of treatment, vitamins A day 1 (< 6
months of 50,000 IU, 6-12 month 100,000 IU, > 1 year 200,000 IU).
8. Give food to grow a Chase
One-week treatment phase of rehabilitation, give F100 containing 100
kcal and 2.9 g protein/100 ml, modification of family meals with energy and
protein comparable, small portions, often and nutrient dense, enough oil and
9. Provide stimulation to grow flowers.
Toys used as stimulation, vary depending on the condition, age and
previous child development. Expected to occur the psychological stimulation,
whether mental, cognitive and motor impairments.

10. Prepare for follow-up at home.

After w/PB reach-1SD said cured, indicate to parents the frequency
and amount of food, provide children's play therapy, make sure the grant
boster immunization and vitamin A every 6 bulan10.

The role of the family include:
1. Gives:
a. BREAST MILK exclusively and MP-ASI
Exclusive BREAST MILK (breast feeding with BREAST MILK alone
until a 6 month old baby) is a form of infant nutrition for breast milk without
giving extra food, liquids, or other food, up to 6 months.
The Benefits Of BREAST MILK:
a) Breast feeding is a method of feeding babies the best, especially in infants
aged less than 6 months, as well as beneficial to the mother. BREAST
MILK contains all the nutrients and fluids needed to fulfill the entire
infant nutrition in the first 6 months of life
b) The composition of the BREAST MILK is ideal for baby
c) Doctors agree that BREAST MILK reduces the risk of infection of the
stomach-intestines, constipation, and allergies
d) Baby BREAST MILK has a higher immunity against the disease. For
example, when the mother of contracting the disease (e.g. through food
such as gastroentretis or polio), antibodies against the disease, her mother
passed on to the baby through the BREAST MILK
e) Baby BREAST MILK more could face the effects of yellow (jaundice).
The level of bilirubin in the baby's blood is much reduced in line with the
assumption of colostrum and overcome the yellowish, as long as the baby
is breast fed as often as possible and without a replacement for breast
f) BREAST MILK is always ready at any moment the baby wanted it,
always in a State of sterile milk temperature and fitting
g) With the presence of eye contact and body, breast feeding also gives the
closeness between mother and child. Baby feel safe, comfortable and
protected, and this affects the emotional establishment in the future.
h) Some of the more rare diseases appear in infants BREAST MILK, such
as: colic, SIDS (sudden death in infants), eczema, Chron's disease, and
Ulcerative Colitis.

i) IQ in infants BREAST MILK are higher IQ than point 7-9 non-baby
breast milk. According to a study in the year 1997, the intelligent children
who drank BREAST MILK at the age of 9 1/2 year reached 12.9 points
higher than children who drank milk formula.
j) Breastfeeding is not merely to feed, but also educating the child. While
breastfeeding, the baby take it. This action can cause a sense of security in
infants, so that in the future he will have emotional and spiritual level.
This became the basis for the growth of a human being towards good
human resources and easier to care for others.
At the age of 6 to 12 months, BREAST MILK is still the main food
the baby, because it contains more than 60% of the needs of the baby. In order
to meet all the needs of infants, needs to be coupled with Complementary
Food ASI (MP-ASI) tailored to the age of a toddler.
2. Balanced Nutrition
Balanced Nutrition is the order of daily food containing nutritional
substances in the type and number of corresponding to the needs of the body,
having regard to the principle of diversity or variety of food, physical activity,
proper hygiene, and ideal body weight. A mother as Manager or organizer of
food in the family had a large role in the improvement of nutritional status of
family members. Therefore a mother should provide enough knowledge about
the behavior of good nutrition and the right for every Member of his family,
as well as being able to prepare as the application main message balanced
3. Parenting
1) Parenting's mom
In order for a pattern of children's lives can be in compliance
with health standards, besides must set the correct diet is also not
less importance set up parenting right anyway. The parenting right
is give full attention and affection in children, giving her enough
time to enjoy being with the whole family.
In times of environmental upbringing, the first related to the
child are his parents. Children grow and develop under the care and
treatment of older people therefore parents are the basis for the

formation of the child's personal first. Through parents, children
adapt to their environment to get to know the surrounding world as
well as the pattern of life that applies to be the lingua franca. Thus
the basis of the development of an individual has been placed by
parents through childcare practice since he was a baby (Supanto,
2) Attention /support Mothers against Feeding Practices in Children
All parents should give the right of the child to grow. All
children must obtain the best in order to be able to grow according
to what might be achieved and in accordance with the ability of the
body. For that need attention/support parents. To grow well enough
to not feed him, choosing food menu and child feeding rice origin.
But children need parents ' attitude in feeding. During the baby,
only to swallow anything provided his mother. The devour was not
enough and less nutritious. Similarly, until the children have started
to wean. Children do not know where the food is the best and
which foods may be eaten. Children still need a mother's guidance
in choosing the food so that the growth is not interrupted. Forms of
attention/support mothers against children include attention when
eating, bathing and pain (Nadesul, 1995).
The woman's status as a housewife has a dual role in the
family, especially if you have an activity outside the home such as
working or doing other activities in social activities. Women who
work outside the home are usually in terms of putting together a
menu not too mindful of the circumstances of its nutrition value,
but tend to emphasize the large number or amount of food. While
nutrition has enough influence or contribute to the growth and
development of the child's physical or mental. For working
mothers tended to entrust their children supervised by other family
members who usually is a grandmother, a sister or a child who's
been great even others who are given the task to take care of his
son (Sunarti, 1989).
3) Psychosocial Stimulation

Psychosocial stimulation is stimulation in the form of the
person's behavior towards others that is around their environment
such as parents, siblings and friends play (Atkinson et al, 1991).
Fahmida (2003) which cites the opinions of Myers argued
that the concept of health and nutritional status is not only decisive
but also defined by psychosocial conditions.
This concept is in line with previous research by Zeitlin et
al (1990) who examine when children who are still growing and
growing well in an environment where the limitations of most of
the other children suffered malnutrition. In the study revealed that
such conditions and psychosocial care of attachment between
mother and child is one of the important factors that explain why
the kids grow and develop properly. It is estimated that
psychosocial conditions can negatively Affect against the use of
nutrients in the body, otherwise a good psychosocial condition will
stimulate growth hormone while stimulating the child to train
organs of its development. In addition, a good psychosocial care
closely related to nutrition and health care of anyway so indirectly
positive effect against nutritional status, growth and development


Malnutrition is the State in which the body does not get enough nutrient
intake, malnutrition can ALSO BE called a form caused by an inefficient
provision between the taking of food with nutritional requirements to maintain
health. This happenS due to intake of eating too little or the taking of any food

that is not balanced. In addition, the lack of nutrition in the body also leads to the
onset of malabsorption of food or the failure of the metabolic. The causes of
malnutrition, according to UNICEF conceptual framework can be distinguished
into the direct cause, not direct causes and underlying causes.

Parents should discuss the notethe toddler, consumption to support daily
activities so as to avoid, besides lacking nutritional hygiene and
Toddler health also needs to be attentive to prevent various diseases that can attack the


httpdigilib. unila. air conditioning id23838BAB% 20I. pdf

httpswww. unicef. orgindonesiaidA6 _-_ B_Ringkasan_Kajian_Gizi. pdf
Pudjiadi, Professorpinch. 1990. the science of clinical nutrition in children.
Jakarta:Balai Publishers Of MEDICINE.