NCM 116: Care Of Clients With

Problems In Nutrition, And Gastro-

intestinal, Metabolism And
Endocrine, Perception And
Coordination(acute And Chronic)
Objectives

 At at the end of the third year, given

individuals, families, population groups and
communities with physiologic and
psychological health problems and
maladaptive patterns of behavior in varies
healthcare settings, the learners demonstrate
safe, appropriate and holistic care utilizing
the nursing process and applying research
and evidence-based practice.
Objectives
1. Apply knowledge of physical, social, natural and health sciences, and humanities in the
practice of nursing.
2. Provide safe, appropriate and holistic care to individuals, families, population groups and
communities utilizing nursing process.
3. Apply guidelines and principles of evidence-based practice in the delivery of care.
4. Practice nursing in accordance with existing laws, legal, ethical and moral principles.
5. Communicate effectively in speaking, writing and presenting using culturally – appropriate
language.
6. Document to include reporting up-to-date client care accurately and comprehensively.’
7. Work effectively in collaboration with inter-, intra-, and multi-disciplinary and multi-cultural
teams.
8. Practice beginning management and leadership skills in the delivery of client care using a
systems approach.
9. Conduct research with an experienced researcher.
10. Engage in lifelong learning with a passion to keep current with national and global
developments in general, and nursing and health developments in particular.
11. Demonstrate responsible citizenship and pride of being a Filipino.
12. Apply techno-intelligent care systems and processes in health care delivery.
13. Adopt the nursing core values in the practice of the profession.
INTRODUCTION
INTRODUCTION

 Nutrition is the selection of foods and

preparation of foods, and their ingestion to
be assimilated by the body. By practicing a
healthy diet, many of the known health
issues can be avoided. The diet of an
organism is what it eats, which is largely
determined by the perceived palatability of
foods.
HEALTH

 It is the state of complete physical, mental

and emotional well being and not merely the
absence of disease or infirmity.
NUTRIENTS

 These are the components of food that help

to nourish the body.
 The basic nutrients are
 CHO,
 proteins,
 vitamins,
 lipids
Malnutrition

 defined as a pathological state resulting from

a relative or absolute deficiency or excess of
one or more essential nutrients
Undernutrition

 condition that results when insufficient food

is consumed over an extended period of time
Overnutrition

 pathological state resulting from the

consumption of excessive quantity of food
over an extended time
Imbalance

 pathological state resulting from

disproportion among essential nutrients with
or without the absolute deficiency of any
nutrient
Specific deficiency

 pathological state resulting from a relative or

absolute lack of specific nutrients
NUTRITIONAL PROBLEMS

 A nutritional deficiency occurs when the body

doesn’t absorb or get from food the
necessary amount of a nutrient.
 Deficiencies can lead to a variety of health
problems. These can include digestion
problems, skin disorders, stunted or defective
bone growth, and even dementia
PROTEIN ENERGY MALNUTRITION

 Protein–energy malnutrition (or protein–

calorie malnutrition)
 refers to a form of malnutrition where there is
inadequate protein and calorie intake
 It is considered as the primary nutritional problem
in India
 PEM is due to the “food gap” between the intake
and requirement
 Causes childhood morbidity and mortality
TYPES OF NUTRITIONAL PROBLEM UNDER
NUTRITION (MALNUTRITION) OVERNUTRITION

 Endemic fluorosis
 Endemic goiter (Iodine deficiency disorders)
 Lathyrism
 Nutritional anemia
 Keratomalcia
 Xerophthalmia
 Low birth weight
 Protein Energy Malnutrition
 UNDERNUTRITION
 Is defined as a pathological state resulting from an absolute
or relative deficiency of one or more essential nutrients.
PROTEIN ENERGY MALNUTRITION PEM
KWASHIORKOR MARASMUS
UNDERNUTRITION

 PROTEIN–ENERGY MALNUTRITION
 refers to a form of malnutrition where there is
inadequate protein and calorie intake
 It is considered as the primary nutritional problem
in India
 Causes childhood morbidity and mortality
 Condition and disease:
▪ Kwashiorkor
▪ Marasmus
CAUSES/ CONTRIBUTORY FACTORS

 Inadequate intake of food

 Diarrhea
 Respiratory infections
 Measles
 Poor environmental Hygiene
 Large family size
 Poor maternal health
 Failure of lactation
 Premature termination of breast feeding
 Delayed supplementary feeding
 Use of over diluted cow’s milk
KWASHIORKOR

 is the most common and widespread

nutritional disorder in developing countries. It
is a form of malnutrition caused by not
getting enough protein in the diet.
MARASMUS

 is a severe form of malnutrition that consists

of the chronic wasting away of fat, muscle,
and other tissues in the body.
 Malnutrition occurs when the body does not
get enough protein and calories.
 This lack of nutrition can range from a
shortage of certain vitamins to complete
starvation.
A COMPARATIVE CHART
KWASHIORKOR
 Acute illness/infections
prolonged starvation
 measles,trauma,sepsis
 Protein is principal nutrient
 18 months to 3 years
 Rapid, acute onset
 Some weight loss
 High mortality
MARASMUS
 Severe prolonged
 chronic/recurring
 calories and protein
principal nutrients
 6months to 2 years
 chronic and slow onset
 severe weight loss
 low mortality unless
COMPARISON OF CLINICAL
FEATURES
KWASHIORKAR
 Edema, pot belly, swollen
legs
 Mild to moderate growth
retardation
 Weight masked by edema
 Low subcutaneous fat
 Muscle atrophy
MARASMUS
 Weight loss up to 40%
edema
 Severe growth failure
 Severe emaciation
 Severe loss of
subcutaneous fat
 Severe muscle atrophy
COMPARATIVE CHART
KWASHIORKOR
 Anemia, diarrhea, infection
 Mildly enlarged liver
 Common hair changes
 Rare skin changes
 Wrinkled face (old man’s face)
 Severe muscle atrophy
 Severe loss of subcut fat
 Severe emaciation
 Severe growth failure
 Weight loss upto 40%
 Anemia, diarrhea, infection
MARASMUS
 No edema
 Xerophthalmia
 Enlarged liver
 Thin dry easily plucked hair
 Dry, flaky peeling skin
 Round face (moon face)
 Muscle atrophy
 Low subcutaneous fat
 Weight masked by edema
 Mild to moderate growth
retardation
 Edema, pot belly, swollen legs
MARASMIC KWASHIORKOR
 A malnutrition disease, primarily
of children, resulting from the
deficiency of both calories and
protein.
 The condition is characterized by
severe tissue wasting,
dehydration, loss of
subcutaneous fat, lethargy, and
growth retardation
Assessment of PEM Gomez
Classification
 Weight for age (%) = Weight of child X 100
Wt. of normal child of same age
 Between 90 – 110% Normal Nutritional
Status
 Between 75 – 89% Mild malnutrition (1st
degree)
 Between 60 – 74% Moderate Malnutrition
(2nd degree)
PREVENTION

 Oral rehydration therapy helps to prevent

dehydration caused by diarrhea
 Exclusive breast feeding for 6 months thereafter
supplementary foods may be introduced along
with breast feeds
 Immunization for infants and children
 Nutritional supplements
 Early diagnosis and treatment
 Promotion and correction of feeding practices
 Family planning and spacing of birth
WEIGH CALCULATION FORMULAE

Infant
 Weight (Kg) = Age in months + 9 2
Pre schooler
 Weight (Kg) = 2 x (Age in years) + 5
PREVENTION

 Identification of mothers at risk

 malnutrition, heavy work load, infections, disease
and high BP
 Increasing food intake of mother, supplementary
feeding, distribution of iron and folic acid tablets
 Avoidance if smoking
 Improved sanitation methods
 Improving health and nutrition of young girls
 Controlling infections – UTI, rubella, syphilis,
malaria
PREVENTION
 Oral rehydration therapy helps to prevent dehydration
caused by diarrhea
 Exclusive breast feeding for 6 months there after
supplementary foods may be introduced along with breast
feeds
 Immunization for infants and children
 Nutritional supplements
 Early diagnosis and treatment
 Promotion and correction of feeding practices
 Family planning and spacing of birth
 Periodic surveillance
 Nutritional rehabilitation
LOW BIRTH WEIGHT

 An LBW newborn is any newborn with a birth

weight of less than 2.5kg (including 2.499kg)
regardless of gestational age.
 CAUSES/RISK FACTORS
 Illness/infections
 Short maternal stature
 Very young age
 High parity
 Close birth intervals
 Intrauterine growth restriction (IUGR)
RISK FACTORS

 LOW BIRTH WEIGHT

 PRE TERM BABIES
 SGA BABIES
 SPONTANEOUS PRE TERM BIRTH
 PROVIDER INITIATED PRE TERM BIRTH
PREVENTION
 Identification of mothers at risk
 malnutrition, heavy work load, infections, disease and high
BP
 Increasing food intake of mother, supplementary feeding,
distribution of iron and folic acid tablets
 Avoidance if smoking
 Improved sanitation methods
 Improving health and nutrition of young girls
 Early detection and treatment of medical disorders –
DM HTN
 Controlling infections – UTI, rubella, syphillis, malaria
MICRONUTRIENT
DEFICIENCY
Micronutrients

 can be divided into four categories:

 water-soluble vitamins:
 fat-soluble vitamins: Vitamin ADEK
 microminerals, and
 trace minerals.
VITAMIN A DEFICIENCY

 Vitamin A deficiency (VAD) or hypovitaminosis A

 is a lack of vitamin A in blood and tissues. It is
common in poorer countries but rarely seen in more
developed countries.
 Nyctalopia (night blindness) is one of the first signs
of VAD.
 Xerophthalmia i.e., dry eyes refers to all the ocular
manifestations of vitamin A deficiency
 It is the most widespread and serious nutritional
disorder
VITAMIN A DEFICIENCY
CLINICAL FEATURES

 Reduced vision in the night or dim light

 Dry eyes which could also lead to Xerophthalmia
 corneal inflammation
 The child or adult may experience susceptibility
towards respiratory infection and urinary
infections.
 Growth can be halted in children
 Skin might also show signs of Vitamin A
deficiency. For example it may get rough and/or
dry
XEROPHTHALMIA

 Xerophthalmia
 dry eyes refers to all the ocular manifestations of
vitamin A deficiency in man It is the most
widespread and serious nutritional disorder
leading to blindness
RISK FACTORS

 Bitot spot
 Keratomalacia
 Softening of cornea
 Corneal ulcers
 1-3 years CLINICAL FEATURES
 Infections
 PEM
 Weaning
 Faulty feeding practices
 Poor socio-economic status
PREVENTION AND CONTROL

 Fortification of certain food with vitamin A –

sugar, salt, tea and skimmed milk
 Regular and adequate intake of vitamin A
 Administering large doses of vitamin A orally
on a periodic basis 
PREVENTION AND CONTROL

 Administering large doses of vitamin A orally

on a periodic basis
 Regular and adequate intake of vitamin A
 Fortification of certain food with vitamin A
 sugar, salt, tea and skimmed milk
VITAMIN B12 DEFICIENCY
VITAMIN B12 DEFICIENCY
Vitamin B12

 Also known as cobalamin

 is a nutrient that helps keep the body's nerve
and blood cells healthy and helps make DNA,
the genetic material in all cells.
 also helps prevent a type of anemia called
megaloblastic anemia that makes people
tired and weak.
 Two steps are required for the body to absorb
vitamin B12 from food.
sources

 meat.
 fish.
 milk.
 cheese.
 eggs.
 some
fortified brea
kfast cereals.
NUTRITIONAL ANEMIA

 is a condition where the hemoglobin content

of blood is lower than normal as a result of a
deficiency of one or more essential nutrients,
regardless of the cause of such deficiency.
CAUSES / RISK FACTORS
 Inadequate diet
 Insufficient intake of iron
 Iron mal-absorption
 Pregnancy
 Excessive menstrual bleeding
 Hook worm infestation
 Malaria
 Close birth intervals
 GI bleed
 Infants and children
 Pregnant women
 Pre menopausal women
EFFECTS OF ANEMIA
 Pregnancy
 Increases risk of maternal and fetal morbidity and
mortality
 Abortions, premature births, PPH, low birth weight are
associated with anemia during pregnancy Infection
 Anemia can be aggravated by parasitic infections
like malaria, intestinal parasites
 Iron deficiency may repair cellular response and
immune functions Work capacity
 More severe the anemia, greater the reduction in
work performance
Management

 Blood transfusion in severe cases of anemia

 Estimation of Hb to assess degree of anemia
PREVENTION

 Nutritional education and awareness

 Control of parasites
 Changing dietary habits
 Food fortification with iron
 Iron and folic acid supplements 8g/dL
IODINE DEFICIENCY
DISORDERS (IDD)
IODINE DEFICIENCY DISORDERS
(IDD)
 leads to a much wider spectrum of disorders
commencing with the intrauterine life and
extending through childhood to adult life
with serious health and social implications
IODINE DEFICIENCY DISORDERS
(IDD)
 DISORDERS
 Intrauterine death
 Goiter
 Hypothyroidism / Endemic cretinism
 Subnormal intelligence
 Delayed motor milestones
 Mental deficiency
 Hearing defects
 Speech defects
 Mental retardation
 Neuromuscular weakness
 Endemic cretinism
PREVENTION

 Iodized salt
 Iodine monitoring
 Public awareness and education
COMPLICATIONS
 Thyrotoxicosis
 Iodide goiter
 Iodinism
 Lymphocytic thyroiditis
ENDEMIC FLUOROSIS

 In many parts of the world where drinking

water contains excessive amounts of fluorine
(3- 5mg/L), endemic fluorosis has been
observed.
SKELETAL FLUOROSIS

 Associated with life time daily intake of 3-

6mg/L or more
 Heavy deposition of fluoride in skeleton
 Crippling occurs leading to disability
DENTAL FLUOROSIS

 It occurs when excess fluoride is ingested

during the years of tooth calcification – first 7
years of life
 Characterized by molting of dental enamel
which has been reported above 1.5mg/L
intake
 Fluorosis seen on the incisors of upper jaw
PREVENTION

 Changing the water sources

 Chemical defluorination
 Preventing use of fluoridated toothpaste
 Fluoride supplements not prescribed for
children consuming fluoridated water
LATHYRISM

 It is a paralyzing disease of human and animals

 Also referred to as Neurolathyrism as it affects
the nervous system
 Lathyrus Sativus is commonly known as
‘khesari dhal’, a good source of protein but its
toxins affects the nerves
 The toxin present in lathyrus seed has been
identified as BETA OXALYL AMINO ALANINE
(BOAA) which has blood brain barrier
STAGES OF LATHYRISM

Latent stage
No stick stage
One stick stage
Two stick stage
Crawler stage
INTERVENTIONS

 Vitamin C prophylaxis
 Banning the crop
 Removal of toxin
 Education and awareness
 Genetic approach – producing low toxin
variety of crop
 Socio economic changes
NUTRITIONAL PROGRAMS

 Vitamin A Prophylaxis Program

 Prophylaxis against Nutritional Anemia
 IDD Control Program
 Specific Nutrition Program
 Balwadi Nutrition Program
 Integrated Child Development Scheme
 Mid – day Meal Program
 Mid – day Meal Scheme
CHRONIC DISEASES
OBESITY

 is an epidemic diseases, which consists of

body weight that is in excess of that
appropriate for a person’s height and age
standardized to account for differences,
leading to an increased risk to health related
problems
Overweight and obesity

 are defined as abnormal or excessive fat

accumulation that presents a risk to health.
 A crude population measure of obesity is the
body mass index (BMI), a person’s weight (in
kilograms) divided by the square of his or her
height (in metres).
 A person with a BMI of 30 or more is generally
considered obese.
 A person with a BMI equal to or more than 25 is
considered overweight.
BODY MASS INDEX

 BMI = (Weight in Kilograms / (Height in Meters

x Height in Meters)
Anorexia Nervosa
Bulimia Nervosa
EATING DISORDERS
ANOREXIA NERVOSA

 is an eating disorder characterized by

 immoderate food restriction,
 inappropriate eating habits or rituals,
 obsession with having a thin figure, and
 an irrational fear of weight gain,
 as well as a distorted body self- perception.
BULIMIA NERVOSA
 is an eating disorder characterized
 by binge eating and purging, or
 consuming a large amount of food in a short amount
of time followed by an attempt to rid oneself of the
food consumed (purging),
 typically by vomiting,
 taking a laxative,
 diuretic, or stimulant, and/or excessive
 exercise, because of an extensive concern for body
weight.
Manifestations
 Bradycardia or tachycardia
 Depression: may frequently be in a sad, lethargic state
 Solitude: may avoid friends and family; becomes
withdrawn and secretive
 Swollen joints
 Abdominal distension
 Halitosis (from vomiting or starvation-induced ketosis)
 Dry hair and skin, as well as hair thinning
 Fatigue
 Rapid mood swings
CLINICAL MANIFESTATIONS
 Amenorrhea
 rapid, dramatic weight loss at least 15% under normal
body weight
 May engage in frequent, strenuous, or compulsive
exercise
 Perception of self as overweight despite being told by
others they are too thin
 Intolerance to cold and frequent complaints of being
cold. Body temperature may lower in an effort to
conserve energy
 Hypotension and/or orthostatic hypotension
Treatment modalities

 Anorexia Nervosa
 Pharmacotherapy
 Psychological therapies
 Bulimia Nervosa Bulimia Nervosa
 Psychotherapy
 TCA’s or SSRI’s
OVERNUTRITION

 Is defined as a pathological state resulting

from an absolute or relative excess of one or
more essential nutrients.
Nursing management

 Nursing diagnosis:
 Imbalanced nutrition less than body requirement
 Muscle weakness
 Activity intolerance
 Impaired fluid and electrolyte balance
 Impaired skin integrity
 Fatigue
 Risk for infection
 Risk for injury
Proteins/fats/carbohydrates

Protein malnutrition
 Kwashiorkor
 Marasmus
Dietary vitamins and minerals

 Calcium  Keshan disease

 Osteoporosis  Iron deficiency
 Rickets  Iron deficiency
 Tetany
anemia
 Iodine deficiency  Zinc
 Goiter  Growth
 Selenium
retardation
deficiency
Dietary vitamins and minerals

 Thiamine (Vitamin  Vitamin D

B1)  Osteoporosis
 Beriberi  Rickets
 Niacin (Vitamin B3)  Vitamin A

 Pellagra  Night Blindness

 Vitamin C  Vitamin K

 Scurvy  Haemophilia