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# Protein, Protein-Calorie, and Mixed Protein-Calorie Malnutrition The following are types of malnutrition: ## Protein (kwashiorkor or hypoalbuminemia) - Inadequate protein but adequate fats and carbohydrates. - Can result from chronic diarrhea, renal disease, infection, hemorrhage, burns, trauma...

# Protein, Protein-Calorie, and Mixed Protein-Calorie Malnutrition The following are types of malnutrition: ## Protein (kwashiorkor or hypoalbuminemia) - Inadequate protein but adequate fats and carbohydrates. - Can result from chronic diarrhea, renal disease, infection, hemorrhage, burns, traumatic injuries or other illnesses. - Onset is usually rapid with loss of visceral protein while skeletal muscle mass is retained, so it may be difficult to detect on a physical exam. - Symptoms: - Hypoalbuminemia and anemia - Edema - Delayed healing of wound, immuno-incompetence ## Protein-calorie (marasmus) - Inadequate protein and calories. - Usually more obvious. - Visceral protein is usually intact as is immune function because weight loss is gradual. - However, children are often very thin or emaciated from loss of skeletal muscle mass. - Symptoms: - Decreased basal metabolism, hypothermia - Lack of subcutaneous fat, decreased tissue turgor - Bradycardia ## Mixed protein-calorie - Combination malnutrition common in hospitalized patients and has an acute onset with low visceral protein as well as rapid loss of weight, skeletal muscle mass, and fat. # Signs of Neglect and Lack of Supervised Care in Children While some children may not be physically or sexually abused, they may suffer from profound neglect or lack of supervision that places them at risk. Indicators include: - Appearing dirty and unkempt, sometimes with infestations of lice, and wearing ill fitting, torn clothing and shoes - Being tired and sleepy during the daytime - Having excessive medical or dental problems, such as extensive dental caries - Missing doctor’s appointments and not receiving proper immunizations - Being underweight for their current stage of development Neglect can be difficult to assess, especially if the nurse is serving a homeless or very disadvantaged population. Home visits may be needed to ascertain if there is adequate food, clothing, or supervision, and this may be beyond the scope of care provided by the nurse. Thus, suspicions should be reported to child protective services so that social workers can arrange a follow-up assessment of the home environment