Assessment, Nursing Diagnosis and Interventions for Marasmic - Kwashiorkor
Assessment of Marasmic - Kwashiorkor
History of Nursing Now
In general, children admitted to hospital with complaints of impaired growth (weight progressively down), swelling in the legs, frequent diarrhea and other complaints that indicate the occurrence of malnutrition disorders.
History of Nursing Previous
Assessment includes a history of prenatal, natal and post natal, hospitalization and surgery ever experienced, allergies, behavioral patterns, growth and development, immunization, nutritional status (over, well, lacking, bad), psychosocial, psychose.ual, interaction and others. Data focus that needs to be studied in this case is a history of meeting the needs of the child nutrition (protein and calorie deficiency history in a relatively long time).
Family Health History
Includes assessment of the composition of the family, home and community environment, education and employment of family members, family members functions and relations, culture and beliefs, which may affect health behaviors, perceptions of client families about the disease and others.
Physical assessment
The assessment is generally carried out by the method head to too which include: general condition and status of consciousness, vital signs, the area of the head and face, chest, abdomen, extremities, and genito-urinary.
The focus of assessment in children with marasmic - Kwashiorkor is anthropometric measurements (weight, height, upper arm circles and thick folds of skin). Signs and symptoms that may be obtained are:
Decrease the size of the anthropometric
Hair changes (depigmentation, dull, dry, smooth, sparse and easily removed).
Facial features such as the elderly (lose fat cheeks), palpebral edema.
Signs of respiratory system disorders (cough, shortness, ronchi, intercostal muscle retraction).
Stomach appeared distended, palpable enlarged liver, bowel sounds can be increased if there is diarrhea.
Edema of the legs.
Dry skin, hyperpigmentation, scaly and presence crazy pavement dermatosis, especially on the part of the body that are often depressed (buttocks, popliteal fossa, knees, knuckles leg, thigh and groin).
Nursing Diagnosis for Marasmic - Kwashiorkor
- Imbalanced Nutrition: less than body requirements relatd to inadequate intake, anorexia and diarrhea.
- Fluid Volume Deficit related to a decrease in oral intake and increased loss due to diarrhea.
- Altered Growth and Development related to caloric and protein intake is not adequate.
- Risk for aspiration related to the provision of food / beverages per-sonde and increased tracheo-bronchial secretion.
- Ineffective airway clearance related to increased secretion of tracheo-bronchial secondary to respiratory tract infections.
Nursing Interventions for Marasmic - Kwashiorkor
1. Imbalanced Nutrition: less than body requirements relatd to inadequate intake, anorexia and diarrhea. (Carpenito, 2000, p. 645-655).
Goals :
- The client will show an increase in nutritional status.
- Family clients can explain the cause of nutritional deficiencies experienced by the client, the needs of recovery nutrition, menu structure and processing of a healthy balanced diet.
- With the help of the nurse, the client can demonstrate provision of family diet suitable dietetic program.
Interventions:
- Explain to the family about the causes of malnutrition, nutritional needs recovery, menu structure and a healthy balanced food processing, show an example of the type of food sources by major socio-economic status of clients.
- Implement the provision of appropriate treatment programs.
- Measure weight, measure the circumference of the upper arm and the thick folds of skin every morning.
Rational:
- Improve understanding of the family, about the causes and nutritional requirements for the client so that it can continue the recovery efforts of dietetic therapy given during hospitalization.
- Increased appetite, absorption process and meet the deficits that accompany malnutrition.
- Assessing the development of a client problem.
2. Fluid Volume Deficit related to a decrease in oral intake and increased loss due to diarrhea. (Carpenito, 2000, hal. 411-419).
Goal:
- The client will show the state of adequate hydration.
- Adequate fluid intake as needed plus deficits.
- No signs / symptoms of dehydration (vital signs within normal limits, with the consistency of defecation solid / semi-solid).
Interventions:
- Perform / observations fluid administration by intravenous / oral rehydration programs appropriate.
- Explain to the family of rehydration efforts and the expected participation of the family in maintaining the patency of the infusion.
- Assess the state of development of dehydration.
- Calculate the fluid balance.
- Rehydration efforts need to be done to address the problem of lack of fluid volume.
- Increase understanding of the family and family roles rehydration efforts in the implementation of rehydration therapy.
- Assessing the development of a client problem.
- It is important to establish subsequent rehydration program.
