SATYA COLLEGE OF NURSING SISAR KHAS, MEHAM
(HARYANA)
LESSON PLAN
ON
PROTEIN ENERGY MALNUTRITION
SUBMITTED TO: SUBMIITED BY :
Mrs. Om Devi Anil jain
Principal of Satya College Of Nursing MSc.N1 st year
Sr. Time Specific Content Teaching Learning A.V. Aid Evaluation
No objective activity activity
.
INTRODUCTION-
The term malnutrition can be applied to any
1 To introduce disorder that prevents an individual from achieving Lecture cum Listen
2 min the concept discussion carefully
an optimal nutritional state.
of preventive
pediatrics. Protein energy malnutrition is the state occurs
due to insufficient or imbalanced consumption of
protein and energy.
The term protein energy malnutrition, refers to a class
of clinical conditions that may result from varying
degree of protein lack and energy (calorie)
inadequacy.
CLASSIFICATION Lecture cum Listen
To classify discussion carefully
3 min 1. SYNDROMAL CLASSIFICATION:
2 the PEM.
KWASHIORKAR
NUTRITIONAL MARASMUS
MARASMIC KWASHIORKAR
PREKWASHIORKAR
NUTRITIONAL DWARFING
2. GOMEZ CLASSIFICATION
PARAMETER: WEIGHT FOR AGE
CHART GRADES:
(MILD) : 90-70
(MODERATE): 70-60
(SEVERE) : < 60
3. WELLCOME CLASSIFICATION
PARAMETER: WEIGHT FOR AGE +
OEDEMA
GRADES:
80-60 % WITHOUT OEDEMA IS UNDER
WEIGHT
80-60% WITH OEDEMA IS
KWASHIORKOR
< 60 % WITH OEDEMA IS MARASMUS-
KWASH
< 60 % WITHOUT OEDEMA IS
MARASMUS
4. INDIAN ACADEMY OF PAEDIATRIC
PARAMETER: WEIGHT FOR AGE
DEGREE:
( FIRST ) : 80-70
(SECOND ) : 70-60
(THIRD) : <50 Lecture cum Listen
To define the discussion carefully
marasmus.
3
MARASMUS
2 min
A severe form of malnutrition caused by inadequate
intake of protein and calories, and it usually occurs
in the first year of life, resulting in wasting and
growth retardation.
Nutritional Marasmus is a nutritional disorder results
due the gross deficiency of energy though protein Lecture cum Listen and
To describe discussion understand
deficiency accompanies it.
the carefully
kwashiorkor.
KWASHIORKOR
4 2min Kwashiorkor is one of the more severe forms of
protein malnutrition and is caused by inadequate
protein intake. It is, therefore, a macronutrient
deficiency.
It is type of severe protein-energy malnutrition refers
Lecture cum Listen
to a combination of edema, lethargy (mental apathy)
Describe the discussion carefully
etiology of and growth failure.
PEM.
ETIOLOGY
5 Unavailability of suitable protein rich foods
3 min
Primary cause is the dietary cause. Inadequate diet
both qualitatively and quantitatively.
Faulty feeding habits
Super imposition of infection and infestations
Age Incidence
Higher incidence is found between 1 to 3 years.
Prolonged breast feeding
Seasonal Incidence Lecture cum Listen
To describe Family size discussion carefully
the clinical
menifestation Lack of Accessibility and availability of Health
of PEM.
Services
MARASMUS
6 3min Appearance of toothless old man and a
monkey look.
Growth retardation as evidenced by marked
loss of weight and subnormal height.
Gross muscle wasting
Absence of edema.
Eyes will be sunken
Disappeared subcutaneous fat.
Face will be round, till the loss of
subcutaneous fat.
Skin over the buttocks becomes wrinkled and
saggy due to loss of adipose tissue.
Bones will be prominent.
Anemia
Subnormal temperature.
Skin becomes ashen gray because of anemia
Atrophy and wasting of body tissues
especially subcutaneous fat.
The child will be apathetic and lethargic.
Recurrent infections.
KWASHIORKOR
Onset: Insidious in onset over periods of weeks and
months.
Apathy: Gradually loss of interest and activity. The
degree unresponsiveness will be proportional to
severity of the disease.
Diarrhea: Nearly 2/3rd of Kwashiorkor cases will be
presenting with the complaints of loose stools with
infective in origin.
Edema: Edema is a constant feature and is
extremely variable in degree. Inspite of gross
edema, ascites will be minimal.
Muscle wasting: Due to degeneration and reduction
in the anterior horn cells may lead to weakness and
hypotonia as suggested by one postulate
(Kwashiorkor myelopathy). Protein deficiency also
causes muscle wasting.
Skin changes: 40% to 60% of the florid
kwashiorkor will have skin changes. Dry and scaly
skin: Common over skin
Explain the Pavement dermatosis: Jet black, later exfoliate Lecture cum Listen
diagnostic exposing underlying and also there will be peeling. discussion carefully
evaluation of
PEM. Petichae and ecchymoses.
Arabinoflavinosis
Hair changes: The hair is scanty, lusterless
commonly brownish. The light color hair is known
as dyschromotrichia.
Hepatomegally with fatty infiltration. Lecture cum Listen
discussion carefully
Explain the
management DIAGNOSTIC EVALUATION
7 2min of PEM.
History collection
Physical examination
Biochemical Investigation
Pathological references
Anthropometric measurements
MANAGEMENT
MARASMUS
8
Calorie requirement of the undernourished
3 min infants are greater than those of normal infants
it almost doubled.
The aim of treatment is to provide sufficient
proteins, calories, and other nutrients for
nutritional rehabilitation and maintenance.
In case of severe PEM, restoring fluid and
electrolyte balance parentally is the initial
concern. A patient who shows normal
absorption may receive enteral nutrition after
anorexia has subsided.
When possible, the preferred treatment is oral
feeding. Foods are introduced slowly.
Carbohydrates are given first to supply energy,
and then high-quality protein foods, especially
milk, and protein-calorie supplements, are
given.
Start with the concentrated food of about 200
Cal/kg body weight gradually 2-3 weeks and
continued till the weight gain.
Protein requirement should be 4gm/kg body
weight /day.
No of feeds should be increased usually 7 feeds
a day.
A patient who’s unwilling or unable to eat may
require supplementary feedings through a naso-
gastric tube or Total Parenteral Nutrition (TPN).
Secondary causes should be treated
Accompanying infection must also be treated,
preferably with antibiotics that don’t inhibit
protein synthesis.
KWASHIORKOR
Management:
1. Dietary modifications
Dietary Management:
Liberal protein rich foods to be given with adequate
calories.
Proteins:
About 5 to 6 gms of protein/kg/day.
The total average protein intake of child is 50-
60gm/day.
Calories:
Calories should be in range of 120-150
Kcal/kg/day.
2. Control and Treatment of infections
3. Correction of Vitamin deficiencies
SUMMARY
Protein energy malnutrition is the major problem
among the children. It is a condition maily depend
upon the nutritional level of the child.
Poverty and low socio economic condition main
factor for PEM.
In this lesson we discuss the definition of protein
energy malnutrition, and classification of PEM.
We discuss the marasmus and kwashiorkor and its
etiology , clinical manifestation and management of
marasmus and kwashiorkor.
BIBLIOGRAPHY
1. Dutta Parul , pediatric nursing,
jaypee publisher, edition-second,
page number-143-144.
2. Park K., textbook of preventive and
social medicine, bhanot
publications, jabalpur, 18th edition,
page number-408.
3. Internet source: google.com.
4. Sharma Rimple , essentials of
pediatric nursing, jaypee brothers
medical publishers (P) LTD , first
edition , page no.135-139.
IDENTIFICATION DATA:-
NAME OF INSTITUTION :- SONI NURSING COLLEGE , JAIPUR.
NAME OF INSTRUTOR :- Mr. ANKUR SHARMA
DESIGNATION :- PEDIATRIC NURSING (HOD)
SUBJECT OF TEACHING :- PEDIATRIC NURSING
TOPIC FOR TEACHING :- PROTEIN ENERGY MALNUTRITION
NUMBER OF STUDENTS :- 100
LANGUAGE :- ENGLISH
A.V.AID :- FLASH CARD , CHART , OHP SHEET , BLACK BOARD , PPT
DATE/TIME OF CLASS :- DECEMBER 9 , 2015
METHOD OF TEACHING :- LECTURE CUM DISCUSSION
GENERAL OBJECTIVE:
At the end of teaching the group should be able to explore various aspects of protein energy malnutrition.
SPECIFIC OBJECTIVE:
At the end of teaching group will be able to:-
Introduce the topic.
Enlist the types of PEM.
Explain about the MARASMUS and KWASHIORKOR .
Explain about the etiology of MARASMUS and KWASHIORKOR
Describe clinical manifestation of MARASMUS and KWASHIORKOR.
Explain the diagnostic evaluation of the MARASMUS and KWASHIORKOR.
Explain the management of the MARASMUS and KWASHIORKOR
BIBLIOGRAPHY
Wong’s. ESSENTIALS OF PEDIATRIC NURSING.7TH Edition. Elsevier Publications. 2005.
Marlow’s. A TEXT BOOK OF PEDIATRIC NURSING. 6TH Edition. Elsevier publications.LTD. 2005.
Page No: 593-596.
B T Basavanthappa. COMMUNITY HEALTH NURSING. 5TH Edition. Reprint 2005. Jaypee Publishers.
Page No: 300-366
Klossner and Hatfield. INTRODUCTORY MATERNITY AND PEDIATRIC NURSING. Lippincott
Williams $ Wilkins Publiccations.2006.Page No: 358-360; 583-584.
www.wikipedia.com
www.thebirthclinic.co.uk
SONI NURSING COLLEGE, JAIPUR
MICRO TEACHING
ON
PROTEIN ENERGY MALNUTRITION
SUBMITTED TO:- SUBMITTED BY:-
MR.ANKUR SHARMA SUNITA MAWLIYA
PEADIATRIC NURSING (HOD) M.SC.NURSING (PREV.)
SONI NURSING COLLEGE, JAIPUR PEADIATRIC NURSING
