Question

1. What is kwashiorkor?

2. What is ADIME for kwashiorkor? Write a PES statement ?

Answer 1

1. Kwashiorkor: It is the type of malnutrition caused by protein deficiency. It is also known as edematous malnutrition as the kwashiorkor patients looks emaciated except their ankles, feet and belly which swell with fluid. Otherwise called as mucocutaneous lymph node syndrome which is a febrile, multi system exanthematous illness that has an acute onset. Although seen in children up to 8 years of age, the preschool child is generally affected. It occurs more commonly in males than females.

2. ADIME for kwashiorkor:

A. Assessment

a. Anthropometr measurements- under weight, reduced skin fold thickness.

b. Physical assessment

Acute phase- acute onset of fever greater than 37.8°c for more than 5 days, erythematous rash, lymphadenopathy, conjunctival infection, swelling of the hands and feet, and changes in lips and mouth.

Subacute phase- extreem irritability, anorexia, desquamation of the hands and feet, arthritis and arthralgia, insufficient myocardial function.

C. Dietary assessment- 24 hours recall. Lack of protein intake.

d. Laboratory studies- elevatsd WBClevel, C reactive protein level, platelet count, and sedimentation rate, renal function test to know muscle wasting, ultrasound to rule out hepatomegally, myocardial function tests.

B. Diagnosis

Inadequate intake of protein related to poor economic status as evidenced by emaciated body appearance with swelling of hands and feet.

C. Interventions

1. Minimize the effect of illness mainly cardiac monitoring, correction of hypoglycemia by 10% dextrose, correction of dehydration, correction of electrolytes and minerals.

2. Reducing the fever- aspirin therapy. Should give after a meal or with milk to decrease possible gastric irritation.

3. Providing comfort and rest- a dimly lit room with minimal noise to promote sleep. Small frequent feeding of soft, non textured foods and avoiding citrus fruits.

4. Preventing skin breakdown- tepid baths, application of Vaseline and other lubricant.

5. Promoting growth and development- provide security items from home in addition to age appropriate toys. Place family picture beside the child's bed, encouraging visiting by family and friends, telephone calls and tape recorded messages.

6. Providing education and support for family members.

D. Monitor

Monitor laboratory values to identify worsening of the condition in initial stage and reduce it.

Monitor growth and development by Anthropometric measurements and daily nutritional pattern assessment.

E. Evaluation

Acute physical signs and symptoms should be disappeared. The time taken for this disappearance is called convalescent phase. It takes 6 to 8 weeks.

3. PES for kwashiorkor

Problem:

Inadequate protein intake

Etiology:

Physiological cause, e.g., increased nutritient need due to prolonged catabolic illness, malabsorption, age or condition.

Lack of access to food, e.g., economic constraints, cultural or religious practices, restricting food given to children.

Food and nutrition related knowledge deficit

Psychological causes, e.g., depression or disordered

Signs and symptoms:

Fever persisting for more than 5 days

Conjunctival infection

Changes in the mouth consisting of,

a. Erythema. Assuring, and crusting of the lips

b. Diffuse oropharyngeal erythema

c. Strawberry tongue

Changes in the peripheral extremities consisting of

a. Induration of the hands and feet

b. Erythema of the palms and soles

c. Desquamation of the tip of the fingers and toes approximately two weeks from onset

d. Transverse groove across the finger nails two to three months after onset.

Erythematous rash

Enlarged lymph node mass greater than 1.5 cm in diameter.