1. Islamic University of Gaza Faculty of Nursing Pediatric Nursing Dr. Areefa Albahri

2. Nutritional Disorder Malnutrition: refers to protein and energy malnutrition. Malnutrition: refers to protein and energy malnutrition. 1. Kwashiorkor: 1. Kwashiorkor:  A deficiency of protein with low or inadequate supply of calories. Occurs between 1 - 4 years of age when infant weaned from the breast, once the second child is born.  A deficiency of protein with low or inadequate supply of calories. Occurs between 1 - 4 years of age when infant weaned from the breast, once the second child is born.

3. Causes: Causes: Neglect, poverty, severe diarrhea and burns Neglect, poverty, severe diarrhea and burns  Clinical Manifestations:-  Clinical Manifestations:- Dry and scaly skin and has depigmentation area. Dry and scaly skin and has depigmentation area. Permanent blindness due to vitamin A deficiencies. Permanent blindness due to vitamin A deficiencies. Thin and dry hair, coarse and dull, depigmentation and patchy alopecia Thin and dry hair, coarse and dull, depigmentation and patchy alopecia Loss of weight, failure of growth, the weight and height of the child are too low for the age. Loss of weight, failure of growth, the weight and height of the child are too low for the age. Edema (ascites) from hypoalbuminemia and sever muscular atrophy. Edema (ascites) from hypoalbuminemia and sever muscular atrophy. Behavioral changes such as irritable, lethargic, withdrawn, and apathetic. Behavioral changes such as irritable, lethargic, withdrawn, and apathetic. Diarrhea due to lowered resistance to infection. Diarrhea due to lowered resistance to infection. Mineral deficiencies, iron, calcium and zinc Mineral deficiencies, iron, calcium and zinc

5. Marasmus: Marasmus:  Is a condition primarily caused by a deficiency in calories and energy. Marasmus is a form of severe protein-energy malnutrition characterized by energy deficit. A child with marasmus looks emaciated. Body weight may be reduced to less than 80% of the average weight that corresponds to the height.  Is a condition primarily caused by a deficiency in calories and energy. Marasmus is a form of severe protein-energy malnutrition characterized by energy deficit. A child with marasmus looks emaciated. Body weight may be reduced to less than 80% of the average weight that corresponds to the height.  Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. The prognosis is better than it is for kwashiorkor.  Marasmus occurrence increases prior to age 1, whereas kwashiorkor occurrence increases after 18 months. The prognosis is better than it is for kwashiorkor.

6.  Clinical manifestation:-  Clinical manifestation:- Gradual wasting and atrophy of body tissues, (subcutaneous fat). Gradual wasting and atrophy of body tissues, (subcutaneous fat). Child appears old, child always hungry. The child appears underweight and very thin. Child appears old, child always hungry. The child appears underweight and very thin. Flabby skin and wrinkled. Flabby skin and wrinkled. Apathetic, withdrawn and lethargic. Apathetic, withdrawn and lethargic. Sever and chronic malnutrition lead to decrease brain growth. Sever and chronic malnutrition lead to decrease brain growth.  Treatment:  Treatment: Providing a diet high quality in protein and carbohydrate as well vitamins and minerals. Providing a diet high quality in protein and carbohydrate as well vitamins and minerals. Correction of electrolyte imbalance. Correction of electrolyte imbalance. Parenteral fluid replacement to correct dehydration and restore renal function. Parenteral fluid replacement to correct dehydration and restore renal function. Fluid replacement since oral fluid is not tolerated in the initial stage of management. Fluid replacement since oral fluid is not tolerated in the initial stage of management. Treat problems such as infection, diarrhea, parasitic infestation, and anemia. Treat problems such as infection, diarrhea, parasitic infestation, and anemia.

7. Nursing consideration:- Nursing consideration:- Rest Rest protection from infection. protection from infection. proper method of feeding. proper method of feeding. hygiene to prevent decubitus ulcers. hygiene to prevent decubitus ulcers. daily weight. daily weight.

8. Thank You All Any Question ??????