The assessment consists of: initial assessment and follow-up assessment.
1. Initial assessment (for emergencies):
- Incidence of sunken eyes that had just appeared
- The duration and frequency of diarrhea and vomiting as well as the appearance of materials vomiting and diarrhea (watery / blood / mucus)
- When was the last urination
- Since when did the hands and feet felt cold.
2. Follow-up assessment (to find the causes and subsequent management of the plan, carried out after the emergency is handled):
- Diet / eating habits before the illness
- History of breastfeeding
- Intake of foods and beverages consumed the last few days
- Loss of appetite
- Contact with measles or tuberculosis patients
- Ever measles in the last 3 months
- Chronic cough
- Incidence and cause of death of siblings
- Birth weight
- History of growth and development: sitting, standing, talking, etc.
- Immunization history
- Does were weighed every month
- Family environment (to understand the social background of the child)
- Known or suspected HIV infection
Physical Examination for Marasmus
Is the child looked very thin,
Is there edema on both back legs.
- Determine the nutritional status.
- Signs of dehydration: thirst appears, sunken eyes, poor turgor (be careful to determine the status of dehydration).
- Are there any signs of shock (cold hands, capillary refill time is slow, weak and rapid pulse), decreased consciousness.
- Fever (axillary temperature ≥ 37.5 ° C) or hypothermia (axillary temperature <35.5 ° C). The frequency and type of respiratory: pneumonia or heart failure Very pale Enlarged liver and jaundice Is there abdominal distention, bowel sounds fell / rose, a sign of ascites, or a sound like a blow on the water surface (abdominal splash)
Treatment for Marasmus
1. Sign of vitamin A deficiency on the eye:
- Conjunctival or corneal dryness,
- Bitot spots; Corneal ulcers;
- Keratomalasia
3. Lesions in kwashiorkor:
- hypo / hyperpigmentation;
- desquamation;
- ulceration (legs, thighs, genitals, groin, behind the ears);
- exudative lesions (resembling severe burns) often with secondary infections (including yeast).
5. Signs and symptoms of HIV infection.
Note:
- Children with vitamin A deficiency is often photophobia. Important to examine the eye carefully to avoid tearing of the cornea.
- Laboratory examinations and hemoglobin or hematocrit, if the kids get very pale.
