KWASHIORKOR

AND
MARASMUS
GROUP 6
KWASHIORKOR
-a disease caused by protein deficiency
-occurs most frequently in children ages 1 to 3 years, because this age group requires a high
protein intake
-a disease found almost exclusively in developing countries in Africa, Asia, and Latin America,
although it does occur in the United States
RISK FACTORS
• Diet -infants or children who have been weaned from breastmilk to a high-starch, protein-
deficient diet.
• Poverty
• Knowledge deficit
• Children ages 1 to 4 years
• Complication of chronic fever, tuberculosis, malignancy, digestive, and malabsorptive
disorders, and psychogenic illness. Radiation therapy and chemotherapy can also contribute to
this.
SIGNS AND SYMPTOMS

-Growth failure is a major symptom.

-Edema; May not appear light in weight until the edema is relieved.
-There is a severe wasting of muscles
- Generally irritable and uninterested in their surroundings.
- “zebra sign.”
-Also have diarrhea, iron-deficiency anemia, and enlarged livers.
 DIAGNOSTIC AND LABORATORY
TEST
LABORATORY NORMAL SIGNIFICANCE METHODS OF COLLECTION NURSING
TEST RANGE RESPONSIBILITIES
Serum   Visceral proteins below Obtaining venous blood Collect, maintain
Proteins   normal sample with the client in a sterility, then label
-Albumin 3.5-5 g/dl -Inc. w/dehydration; dec. fasting or non-fasting state. the specimen, and
    w/malnutrition,   to ensure their
    overhydration, trauma, delivery to the
protein loss, liver dse laboratory.
 
-Prealbumin 20-40 mg/dl -inc. w/nutrition intake and
    renal failure; dec.w/poor
    dietary intake
 
-Transferrin 200-400 -inc. w/pregnancy, iron
  mg/dl def.;dec. w/chronic
infection,cirrhosis
 SIGNS AND SYMPTOMS
Reported lack of food, inadequate intake less than RDA,
body weight 20% or more under ideal, evidence lack of
food, decreased muscle mass, abnormal lab studies,
diarrhea
inability to swallow food, inability to complete a meal,
inability to ingest sufficient food, inability to prepare food
for ingestion
Distractibility, cognitive dissonance, memory problems
 
Delay or difficulty of performing skills of age group,
altered physical growth, flat apec, decreased responses
NURSING DIAGNOSIS
Imbalanced nutrition less than body requirements
related to lack of information
 
 
Feeding selfcare deficit related to weakness
 
 
Disturbed body image and chronic low self-esteem
related to developmental changes
Delayed growth and development related to impaired
nutrition
Risk for infection related to malnutrition
 DISCHARGE PLANNING
Medication
There are no drugs proven to treat kwashiorkor.
Exercise
Physical rehabilitation will help prevent, minimize and effectively treat physical impairments and
motor delay. Children will be intervened by developmental stimulation (play therapy).
Treatment
Treatment depends on the severity of the condition. Patients who are in shock need immediate
treatment to restore blood and maintain blood pressure.
Many malnourished children will develop lactose intolerance. They need to be given supplements
with enzyme lactase, so that they can tolerate milk products.

 
Health teaching
For parents/guardian:
• They can be educated about an affordable nutritious diet plan.
• Teach the client or the guardian about the importance of nutritious foods such as high energy
milk feeds and diets, protein-rich foods, and also the essentials vitamins and minerals.
• Encourage them to strictly go to the hospital for follow-up check-ups.
• Let them know about the clinical manifestations of kwashiorkor and diseases related to it so
that they would know when a medical assistance is needed.
Out patient
Regular follow-up check-ups for children is strongly recommended since this reduces the risk of
getting kwashiorkor again, allows completion of immunization schedules and provides
opportunity for continuous health education.
Diet
For therapy, a diet rich in protein is essential. If kwashiorkor is found early, milk-based feeds or
ready-to-used therapeutic food (RUTF) can treat them. RUTF is typically made up of [peanut
butter, milk powder, sugar, vegetable oil, and added vitamins and minerals.
Many malnourished children will develop lactose intolerance. They need to be given supplements
with enzyme lactase, so that they can tolerate milk products.
Sexuality/Social activity
Kwashiorkor occurs most frequently in children ages 1 to 4 years and found almost exclusively in
developing countries. Thus, rich or poor, the parents or guardians of these children should be
aware and be responsible on giving the adequate nutrition because these children would simply
depend on their parents.
I. REFERENCES
www.emedicine.medscape.com
www.nhs.uk
www.medline.com
www.healthline.com
Understanding Pathophysiology, 3rd edition by S. Huether., McCance

 
MARASMUS
-caused by deficiency of all food groups
-a form of starvation
-seen most commonly in developing countries
RISK FACTORS
-diet deficiency of all food groups
-poverty
-children most commonly younger than 1 year of age
-contaminated water supply
SIGNS AND SYMPTOMS
-invariably hungry
-sucks at any object offered to them
-growth failure
-muscle wasting
-irritability
-iron deficiency anemia
-diarrhea
 LABORATORY NORMAL SIGNIFICANCE METHODS OF NURSING
RESPONSIBILITIES
TEST RANGE COLLECTION
Serum   Visceral proteins below normal Obtaining venous Collect,
Proteins   blood sample with maintain
-Albumin 3.5-5 g/dl -Inc. w/dehydration; dec. w/malnutrition, the client in a sterility, then
    overhydration, trauma, protein loss, liver dse fasting or non- label the
    fasting state. specimen, and
-Prealbumin 20-40 mg/dl -inc. w/nutrition intake and renal failure; to ensure their
    dec.w/poor dietary intake delivery to the
      laboratory.
-Transferrin 200-400 mg/dl -inc. w/pregnancy, iron def.;dec. w/chronic
  infection,cirrhosis
   
Hemoglobin -hemoglobin less than 40 g/t or packed cell
packed cell volume of less than 12% is indicative of severe
volume anemia
   
Blood Glucose -glucose concentration less than 54 mg/dl is
indicative of hypoglycemia
 SIGNS AND SYMPTOMS
Poverty (increased social problems), community
powerlessness
Reported lack of food, inadequate intake less than
RDA, body weight 20% or more under ideal, evidence
lack of food, decreased muscle mass, abnormal lab
studies, diarrhea
Distractibility, cognitive dissonance, memory problems
 
Delay or difficulty of performing skills of age group,
altered physical growth, flat apec, decreased
responses
inability to swallow food, inability to complete a meal,
inability to ingest sufficient food, inability to prepare
food for ingestion
NURSING DIAGNOSIS
Ineffective community coping related to inadequate
resources for problem solving
Imbalanced nutrition less than body requirements related to
economic factors
 
 
Delayed growth and development related to impaired
nutrition
Risk for infection related to malnutrition
 
 
Feeding Self-Care Deficit related to weakness
 
 
DISCHARGE PLANNING
Medications
There are no drugs proven to treat kwashiorkor. However, there are certain studies on some
drugs exhibiting a pharmacological effect on kwashiorkor such as the potential role for routine
antibiotics.
Exercise
Developmental stimulation through play therapy to develop motor and language skills.
Treatment
Nutritional therapy, a diet rich in all nutrients. Treatments involves special feeding and
rehydration plan. IV fluids, oral rehydration solutions and NG feeding may be used.
Health Teaching
For parents/guardian:
Educate them about the importance of all food groups, vitamins and minerals that a child needs to
consume in order to facilitate normal growth and development. Affordable yet nutritious food plan or
food choices can be presented. A nutritionist can help in teaching or giving these food plans.
Out Patient
Regular checkups is recommended to monitor the progress of the child, to complete immunizations
and to have continuous health education
Diet
Diet rich in all nutrients.
Sexuality/Social Activity
Children with marasmus need interaction with family and other children. Activities should be
selected to develop both motor and language skills. Duration of activities should be increased
progressively as the nutritional status improves.
REFERENCES
www.emedicine.medscape.com
www.nhs.uk
www.medline.com
www.healthline.com
Understanding Pathophysiology, 3rd edition by S. Huether., McCance