IDENTIFICATION DATA:
Name of the student – Neha Gupta
Roll Number - 2024M.SC040
Topic – Protein Energy Malnutrition (PEM)
Class - MSC 1st year
Date -
Group – MSC Nursing 1st year
Method of teaching – Lecture cum discussion
Name of the supervisor – Ms. Garima
Previous knowledge of group – The group have some knowledge regarding Protein Energy
Malnutrition.
Time – 20 Minutes
Venue – GNM 2nd Year Classroom
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
Sr. Time Specific Content Teaching Learning A.V. Aid
No. objective activity activity
INTRODUCTION-
The term malnutrition can be applied to any disorder
To introduce that prevents an individual from achieving an optimal Lecture cum Listen
1 2 min the concept discussion carefully
nutritional state.
of preventive PPT
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
1. SYNDROMAL CLASSIFICATION:
ü KWASHIORKAR
ü NUTRITIONAL MARASMUS Lecture cum Listen
2 3 min To classify
ü MARASMIC KWASHIORKAR discussion carefully PPT
the PEM.
ü PREKWASHIORKAR
ü NUTRITIONAL DWARFING
2. GOMEZ CLASSIFICATION
PARAMETER: WEIGHT FOR AGE
CHART GRADES:
ü (MILD) : 90-70
ü (MODERATE): 70-60
ü (SEVERE) : < 60
3. WELLCOME CLASSIFICATION
PARAMETER: WEIGHT FOR AGE + OEDEMA
GRADES:
ü 80-60 % WITHOUT OEDEMA IS UNDER
WEIGHT
ü 80-60% WITH OEDEMA IS KWASHIORKOR
ü < 60 % WITH OEDEMA IS MARASMUS-KWASH
ü < 60 % WITHOUT OEDEMA IS MARASMUS
4. INDIAN ACADEMY OF PAEDIATRIC
PARAMETER: WEIGHT FOR AGE
DEGREE:
ü ( FIRST ) : 80-70
ü (SECOND ) : 70-60
ü (THIRD) : <50
MARASMUS
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.
3 2 min Nutritional Marasmus is a nutritional disorder results due the
To define the gross deficiency of energy though protein deficiency Lecture cum Listen PPT
marasmus. discussion carefully
accompanies it.
KWASHIORKOR
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 to a
4 2min combination of edema, lethargy (mental apathy) and growth
To describe failure. Lecture cum Listen and
the discussion understand PPT
kwashiorkor. carefully
ETIOLOGY
• Unavailability of suitable protein rich foods
Describe the • Primary cause is the dietary cause. Inadequate diet both Lecture cum Listen
5 3 min
etiology of qualitatively and quantitatively. discussion carefully
PEM. PPT
• 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
• Family size
• Lack of Accessibility and availability of Health Services
MARASMUS
• Appearance of toothless old man and a monkey look.
• Growth retardation as evidenced by marked loss of
weight and subnormal height.
3min
6 To describe • Gross muscle wasting Lecture cum Listen PPT
the clinical discussion carefully
manifestation • Absence of edema.
of PEM. • 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
• Pavement dermatosis: Jet black, later exfoliate exposing
underlying and also there will be peeling.
• Petechiae and ecchymoses.
• Ariboflavinosis
• Hair changes: The hair is scanty, lusterless commonly
brownish. The light color hair is known as dyschromotrichia.
• Hepatomegaly with fatty infiltration.
Lecture cum Listen PPT
7 2min To Explain discussion carefully
the DIAGNOSTIC EVALUATION
diagnostic
evaluation of ü History collection
PEM. ü Physical examination
ü Biochemical Investigation
ü Pathological references
ü Anthropometric measurements
MANAGEMENT
To Explain MARASMUS Lecture cum Listen PPT
8 3 min
the discussion carefully
management v Calorie requirement of the undernourished infants are
of PEM. greater than those of normal infants it almost doubled.
v The aim of treatment is to provide sufficient proteins,
calories, and other nutrients for nutritional rehabilitation
and maintenance.
v 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.
v 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.
v Start with the concentrated food of about 200 Cal/kg body
weight gradually 2-3 weeks and continued till the weight
gain.
v Protein requirement should be 4gm/kg body weight /day.
v No of feeds should be increased usually 7 feeds a day.
v A patient who’s unwilling or unable to eat may require
supplementary feedings through a naso-gastric tube or
Total Parenteral Nutrition (TPN).
v Secondary causes should be treated
v 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.
