Health Assessment FHP - Nutrition and Metabolism

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Cebu Normal University
College Of Nursing - Graduate Studies [S.Y 2015-2016, 1ST SEMESTER]
MSN 4005 HEALTH ASSSESSMENT
SUBMITTED BY:
ALBARO , JERAFLOR
CABRILLOS , JAKE CYDE S.
DAJAO , NIKKO P.
RUBI, RESSA LEA
VILLANUEVA , GELLIANN
SUBMITTED TO:
MRS. NORMA A. HINOGUIN RN, MN, PhD.
JULY 2015
CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

GRADUATE STUDIES [S.Y 2015-2016, 1ST SEMESTER]
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NUTRITION AND METABOLIC PATTERN
Assess for Height and weight Rationale

What are your height and usual weight? Answer provides a baseline for comparing clients perception
with actual and current measurements. Answer also indicates
clients knowledge of own health status.
Have you lost or gained a considerable amount of weight Weight changes may point to changes in nutrition or
recently? How much? Over what period of time? hydration status or to an illness causing weight changes.
Have you now or have been on a diet recently? How did you Whether or not the client is following his or her own diet or a
decide which diet you to follow? medically prescribed diet, the answer to the question helps to
identify chronic dieters and clients with eating disorders.
HISTORY How much fluid do you drink each day? How much of it is Answers to these questions identify clients in terms of
water? How many sugary, caffeinated, or alcoholic beverages adequate, moderate, or excessive consumption of various
do you have each day? kinds of fluids, they also identify those at risk for dehydration.
Can you recall what you ate in the last 24hrs? in the last The clients typical daily diet indicates his or her level of
72hrs? nourishment, likes and dislikes, and dietary habits. As such, it
provides basis for planning healthful menu choices.
Any recent changes in appetite, taste, or smell? Any recent Changes to taste and smell and difficulty in chewing or
difficulties chewing or swallowing? swallowing may reduce the clients intake of food.
Have you had any recent occurrences of vomiting, diarrhea, Each of these affects nutritional status.
or constipation?

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Past Health History Rationale
Do you have any chronic illnesses? Chronic Illnesses such as diabetes, may impact clients
nutritional status.
Have you experienced any recent trauma, surgery, or serious Each of these may increase the clients nutritional needs but
illness? decrease the clients ability to meet these needs.
Family History
Are any members of your family obese? Obesity often runs in families. In addition, families may have
unhealthy eating patterns that contribute to obesity.
HISTORY
Do any members have heart disease or diabetes? Heart disease and diabetes run in families.
Lifestyle and Health Practices
Does your religion or culture have diet restrictions or Some cultures and religions dictate diet.
requirements?
What current medications/vitamins/supplements are you Some medications may decrease the clients absorption of
taking? nutrients.
Do you prepare your own meals? What do you eat on a A daily account of dietary fluid intake provides insight into the
typical day? What fluids and how much do you drink? clients nutrition and hydration.
Do you have sufficient income for food? Low income may compromise the clients ability to purchase
food or make healthy food choices(i.e., foods high in fat and
low in nutrients are often inexpensive).
Do you follow an exercise regimen?
Physical exercise is important to maintaining health

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Anthropometric Measures
Height, weight, and body mass index

Height should ideally be measured with a stadiometer. However, it is possible to estimate height by arm span or knee-height
measurement in some subjects who are unable to stand.
Serial weight measurements to assess trends of weight gain or loss are particularly useful in providing objective insight into changes over
time. Sustained weight loss from baseline (over 6 months) can be categorized into mild (< 5%), moderate (5%-10%), or severe (>10%).
Weight is proportional to height, and this relationship, known as the BMI, is one of the most commonly used and simplest
anthropometric measures. BMI is calculated with the following equations:
BMI = weight (kg)/height2 (m2) BMI = (weight [lb] X 703)/height2 (in2)
PHYSICAL BODY MASS INDEX

NORMAL ABNORMAL
EXAMINATION 18.5-24.9 Underweight - < 18.5
Overweight - 25-29.9
Obese - 30
Skinfold thickness
Skinfold thickness is an indirect measure of subcutaneous adipose tissue using skinfold calipers at various body sites. Body density and
percentage body fat can then be estimated based on these measurements.
Tricep skinfold thickness measurement with plastic calipers. Subscapular skinfold thickness measurement with plastic calipers.

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Mid-arm muscle circumference and mid-upper-arm muscle area

Mid-arm muscle circumference (MAMC) has been used for reflection of muscle protein reserves. This is performed in addition to triceps
skinfold measurement to calculate mid-upper-arm muscle area, which correlates with lean body mass. These anthropometric measures
have proven easy to perform.
PHYSICAL
Upper arm length measurement and mid-arm mark.
EXAMINATION
The following equations are used for mid-upper arm muscle area:
Men (cm2): Area = ([arm circumference { x triceps skinfold}]2/4) - 10
Women (cm2): Area = ([arm circumference { x triceps skinfold}]2/4) - 6.5
Table 2: Standards for Upper Arm Muscle Area in Adults (From the Merck Manual of Diagnosis and Therapy, edited by Robert Porter. Copyright 2012 by Merck Sharp
& Dohme Corp., a subsidiary of Merck & Co, Inc, Whitehouse Station, NJ. Available at http://www.merckmanuals.com/professional/. Accessed 11/18/2013).
Percentage of Standard (%) Men (cm2) Women (cm2) Muscle Mass
100 20* 54 11 30 7 Adequate
75 40 22 Marginal
60 32 18 Depleted
50 27 15 Wasted
*Mean mid upper arm muscle mass 1 standard deviation. From the National Health and Nutrition Examination Surveys I and II.

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Hair
ABNORMAL FINDINGS INDICATION
Spare & thin Protein, zinc, biotin
Deficiency
Easy to pull out Protein deficiency
Corkscrew Vit C & Vit A
Coiled hair deficiency
Mouth
Glossitis Riboflavin, Niacin, Folic Acid, B12
Deficiency
PHYSICAL Bleeding & spongy gums Vit. C,A, K, Folic Acid & Niacin Deficiency
Angular stomatitis, cheilosis & fissured tongue B 2,6,& Niacin Deficiency
EXAMINATION
Leukoplakia Vit.A,B12, B-Complex, Folic Acid & Niacin
Sore mouth & tongue Vit B12,6,C, Niacin ,Folic Acid & Iron
Eyes
Night blindness, exophthalmia Vitamin A Deficiency
Photophobia-blurring, Vit B2 & Vit A
conjunctival inflammation Deficiencies
Nails
Spooning Iron deficiency
Transverse lines Protein deficiency

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Skin
Pallor Folic acid, iron, B12
Follicular hyperkeratosis Vitamin B & Vitamin C
Flaking dermatitis PEM, Vit B2, Vitamin A, Zinc & Niacin
Pigmentation, desquamation Niacin & PEM
Bruising, purpura Vit K ,Vit C & folic acid
Thyroid Gland
PHYSICAL ABNORMAL FINDINGS INDICATION
EXAMINATION Goiter Iodine Deficiency
Joints and Bones

Imperfect calcification, softening, and distortion of Vitamin D Deficiency (Rickets)
the bones typically resulting in bow legs
Ground-glass osteopenia Vitamin C Deficiency (Scurvy)

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Metabolism
Vital signs
Variations in temperature may associated with thyroid dysfunction. Cardiovascular changes such as bradicardia , tachycardia,
hypotension or hypertension maybe seen with endocrine problems.
Height and weight

Changes in weight may be associated with endocrine problems. Growth pattern abnormalities suggest problems associated with growth
hormone. Thyroid disorders and diabetes mellitus are example for disorders that can affect body weight.
Integumentary
The nurse should note the colour and text of the skin, hair, and nails. The hair distribution should be noted on the head, face,trunk, and
extremities. Dull brittle hair, excessive hair growth or hair loss indicates endocrine dysfunction.
PHYSICAL
EXAMINATION Head
The size of the head should be examined. Facial features should be symmetric. Eyes should be inspected for position shape and eye
movement.
Neck
When inspecting the thyroid gland first observation should be made in the normal position, then in slight extension, and then as the
patient swallows some water. The trachea should be in midline and neck should appear symmetric. If there is no noticeable enlargement
of the thyroid gland, palpation can be done. Water should be available for the patient t swallow as a part of the examination. There are
two types of thyroid palpation.
For anterior palpation the nurse stands in front of the patient, with patients neck flexed. The thumb is placed over the cricoid cartilage
and moved over the isthmus as the patient swallows. Then each lateral lobe is palpated before and while the patient swallows water.
For posterior palpation , examiner stands behind the patient. With thumb of both hands rest on nape of the neck of the patient, uses the
index and middle fingers for the thyroid isthmus and for the anterior surfaces of the lateral lobes. The thyroid is palpated for size shape,
symmetry, tenderness and for any nodules.
Extremities
The size, shape, symmetry, and general proportion of hand and feet should be noted. Muscle strength and deep tendon reflexes should
be noted. In the upper extremities, the presence of tremors is assessed by placing a piece of paper in the outstretched fingers, palm
down.

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DIAGNOSIS DIAGNOSTIC EXAMINATIONS PATIENT PREPARATIONS
COMPLETE BLOOD COUNT COMPLETE BLOOD COUNT

A complete blood count (CBC), to look at the
ANEMIA Advice patient to wear short sleeve-shirt/sleeve
shape, color, number, and size of your blood that could easily be rolled up.
A condition of having less than the normal cells. Clarify the procedure and the purpose of the test
number of red blood cells or less than the to the patient.
normal quantity of hemoglobin in the blood. Male: 4.32-5.72 trillion Inform patient that after the procedure,
The oxygen-carrying capacity of the blood is, cells/L* hematoma may occur at the puncture site and
therefore, decreased. Red blood cell count (4.32-5.72 million the remedy for this.
cells/mcL**)
Female: 3.90-5.03
trillion cells/L
Pertinent Signs And Symptoms :
(3.90-5.03 million
cells/mcL)
Extreme fatigue.
Pale skin. Male: 13.5-17.5
Hemoglobin grams/dL***
Weakness. (135-175 grams/L)
Shortness of breath. Female: 12.0-15.5
Chest pain. grams/dL
(120-155 grams/L)
Frequent infections.
Headache. Hematocrit Male: 38.8-50.0
Dizziness or lightheadedness. percent
Female: 34.9-44.5
percent
White blood cell 3.5-10.5 billion cells/L
count (3,500 to 10,500
cells/mcL)
150-450 billion/L
Platelet count (150,000 to

450,000/mcL**)
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IRON TEST IRON TEST

Iron tests, which measure the amount of iron (Same with CBC)
Instruct patient not to eat/drink anything for
in your blood, to help determine the type and
8hrs before a blood test for iron level and not
severity of anemia. take iron pills for 24 hrs. before the test.
Ask patient if he/she had any recent procedures,
Normal Results
medications, herbs or supplements taken
Iron: 60-170 mcg/dL (micrograms per deciliter)
ANEMIA regularly.
Higher-than-normal iron level may mean:
Too much iron in the body (hemochromatosis)
Breakdown of red blood cells (hemolysis)
Anemia due to red blood cells being destroyed

too quickly (hemolytic anemia)
Liver tissue death (hepatic necrosis)
Inflammation of the liver (hepatitis)
Vitamin B-12 deficiency, vitamin B-6 deficiency
Iron poisoning
Many blood transfusions
Lower-than-normal levels may mean:
Long-term digestive tract bleeding
Heavy menstrual bleeding

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Intestinal conditions that cause poor absorption

of iron
Not enough dietary iron
Pregnancy
RETICULOCYTE COUNT
To help determine the cause of anemia. (Same with CBC)
Reticulocytes are immature red blood cells

produced by bone marrow and released into
ANEMIA
the bloodstream.
A normal result for healthy adults who are not

anemic is around 0.5%-1.5%.
Levels of reticulocytes are lower in iron
deficiency anemia.
FERRITIN TEST
(same with CBC)
A ferritin level test, which reflects how much
iron may be stored in the body. Abnormally
low ferritin levels may point to iron deficiency
anemia. This is one of the first tests to be
abnormal when you have iron deficiency.
The results may vary slightly among laboratories,

but in general, normal ferritin levels are 12-300
nanograms per milliliter of blood (ng/mL) for males
and 12-150 ng/mL for females.

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Higher level of ferritin - hemochromatosis.

Low levels of ferritin - iron deficiency.
FECAL BLOOD OCCULT TEST FECAL BLOOD OCCULT TEST

Explain procedure of the test to the patient.
A fecal occult blood test (FOBT), which looks
Instruct to avoid foods/medicines that can give
for blood in stool samples. false-negative or false-positive results; atleast 3
days before the test avoid: certain fruits and
Negative result. A fecal occult blood test is
vegetables, including broccoli and turnips, red
considered negative if no blood is detected in meat, horse radish, vitamin C supplements,
ANEMIA your stool samples. chocolate foods/drinks, pain relievers such as
Positive result. A fecal occult blood test is aspirin and ibuprofen.
considered positive if blood is detected in your

stool samples.
COLONOSCOPY COLONOSCOPY
A colonoscopy. This test inspects the entire Bowel preparation
large intestine (colon) using a long, flexible, - 2days prior: Eat as you would normally
or eat less than normal. Overindulging
lighted viewing scope to look for polyps or
make it harder to clean the colon.
other sources of bleeding. - The day prior to procedure: Consume
only clear liquids (except orange and
Normal: The lining of the colon looks smooth and
tomato juices). NO solid foods and
pink, with a lot of normal folds. No growths, alcohol.
pouches, bleeding, or inflammation are present. - At noon drink the prescribed laxative.
- Start drinking the bowel preparation
solution. Drink the bowel prep every 15-
Abnormal: Some abnormal findings of 20 minutes. Patient needs to drink at
colonoscopy include hemorrhoids (the most least half of this until you are passing
common cause of blood in the stool), polyps , yellow to clear liquid without formed
stool. If you tend to be constipated, try to
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cancer , one or more sores (ulcers), pouches in drink the entire container. If you are full
or nauseated, stop and rest for a while.
the wall of the colon (diverticulosis), or
Dont push yourself to the point of illness.
inflammation. A red, swollen lining of the colon - If bottom is sore, may apply ointment as
(colitis) may be caused by infection needed.
or inflammatory bowel disease (IBD). - The day of the procedure:
- If your procedure is scheduled for a time
before 2:30 pm, do not consume
anything after midnight, the day prior to
your procedure.
ANEMIA - If your procedure is scheduled at or after
2:30pm, you may consume clear liquids
only until 7 am the morning of your
procedure.
ENDOSCOPY ENDOSCOPY
An upper gastrointestinal (GI) endoscopy. Instruct patient to fast 4 to 8 hrs. Before
endoscopy to ensure stomach is empty.
This test, which uses a thin, flexible, lighted
Instruct patient to stop taking certain blood-
viewing instrument, can help identify thinning medications days before the procedure
stomach ulcers or other causes of irritation this can increase risk for bleeding.
or bleeding.
Normal: The esophagus, stomach, and upper

small intestine (duodenum) look normal.
Abnormal: Inflammation or irritation is found in
the esophagus, stomach, or small intestine.
Bleeding, an ulcer, a tumor, a tear, or dilated
veins are found. A hiatal hernia is found. A too-
narrow section (stricture) is found in the
esophagus. A foreign object is found in the
esophagus, stomach, or small intestine.

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DIABETES MELLITUS
GLYCATED HEMOGLOBIN (A1C) TEST GLYCATED HEMOGLOBIN (A1C) TEST
This is a simple blood test. Patient can eat or
a chronic disease associated with abnormally This blood test indicates your average blood drink normally before the test is done.
high levels of the sugar glucose in the blood. sugar level for the past two to three months. It
Diabetes is due to one of two mechanisms: measures the percentage of blood sugar
attached to hemoglobin, the oxygen-carrying
Inadequate production of insulin (which is protein in red blood cells. The higher your blood
made by the pancreas and lowers blood
sugar levels, the more hemoglobin you'll have
glucose), or
with sugar attached. An A1C level of 6.5 percent
Inadequate sensitivity of cells to the action of or higher on two separate tests indicates that
insulin. you have diabetes. An A1C between 5.7 and 6.4
percent indicates prediabetes. Below 5.7 is
The two main types of diabetes correspond
considered normal.
to these two mechanisms and are called
If the A1C test results aren't consistent, the test
insulin dependent (type 1) and non-insulin
isn't available, or if you have certain conditions
dependent (type 2) diabetes. In type 1
diabetes there is no insulin or not enough of that can make the A1C test inaccurate such as
it. In type 2 diabetes, there is generally if you're pregnant or have an uncommon form of
enough insulin but the cells upon it should hemoglobin (known as a hemoglobin variant)
act are not normally sensitive to its action. your doctor may use the following tests to
diagnose diabetes:
Pertinent Signs and Symptoms:
RANDOM BLOOD SUGAR TEST
RANDOM BLOOD SUGAR TEST
Frequent urination A blood sample will be taken at a random time.
Patient may eat or drink before a random
Excessive thirst Regardless of when you last ate, a random blood glucose test.
Unexplained weight loss sugar level of 200 milligrams per deciliter
Extreme hunger (mg/dL) 11.1 millimoles per liter (mmol/L)
Sudden vision changes or higher suggests diabetes.

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Tingling or numbness in the hands or feet FASTING BLOOD SUGAR TEST FASTING BLOOD SUGAR TEST
Feeling very tired much of the time
If you are having a fasting glucose test, you should not
Very dry skin A blood sample will be taken after an overnight eat or drink for eight hours before your test. You can
Sores that are slow to heal fast. A fasting blood sugar level less than 100 only drink plain water. You may want to schedule a
More infections than usual mg/dL (5.6 mmol/L) is normal. A fasting blood fasting glucose test first thing in the morning, so you
do not have to fast during the day
sugar level from 100 to 125 mg/dL (5.6 to 6.9
HYPERGLYCEMIA mmol/L) is considered prediabetes. If it's 126
High blood glucose. mg/dL (7 mmol/L) or higher on two separate
High levels of sugar in the urinethe liquid waste tests, you have diabetes.
product filtered from the blood by the kidneys,
stored in the bladder, and expelled from the body ORAL GLUCOSE TOLERANCE TEST
by the act of urinating.X.
ORAL GLUCOSE TOLERANCE TEST .Explain procedure to patient.
Patient may eat and drink normally in the days
Frequent urination.
For this test, you fast overnight, and the fasting before the test.
Increased thirst.
blood sugar level is measured. Then you drink a Patient must abstain from food atleast 8hrs
HYPOGLYCEMIA before the test. You may drink water but avoid
sugary liquid, and blood sugar levels are tested
Confusion periodically for the next two hours. A blood sugar other beverages.
Dizziness level less than 140 mg/dL (7.8 mmol/L) is normal.
Feeling shaky A reading of more than 200 mg/dL (11.1 mmol/L)
Hunger after two hours indicates diabetes. A reading
Headaches between 140 and 199 mg/dL (7.8 mmol/L and
11.0 mmol/L) indicates prediabetes.
Irritability
Pounding heart; racing pulse
Pale skin
Sweating
Trembling
Weakness
Anxiety

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FOLIC ACID DEFICIENCY FOLIC ACID BLOOD TEST (same with CBC)
( Vitamin B9 Deficiency) Since other blood conditions cause symptoms

similar to folic acid deficiency anemia, youll need
Folic acid, or folate, is a type of B vitamin. It helps to:
repair DNA to see your doctor for a diagnosis. To determine
make DNA if you have folic acid deficiency anemia, your
produce red blood cells (RBCs)
doctor will do a complete blood count (CBC) test.
Folic acid is a water-soluble vitamin. It
dissolves in water and is not stored in your This test will reveal if your red blood cell count is
fat cells. This means that you need to keep low.
taking folate as your body cannot develop a
Normal RBC count:
reserve.People release excess amounts of
water-soluble vitamins in their urine. Male: 4.32-5.72 trillion cells/L*
(4.32-5.72 million cells/mcL**)
A diet low in fresh fruits, vegetables, and
Female: 3.90-5.03 trillion cells/L
fortified cereals is the main cause of folic acid
deficiency. In addition, overcooking your food (3.90-5.03 million cells/mcL)
can sometimes destroy the vitamins. Folic Your doctor may also order a blood test to check
acid levels in your body can become low in
just a few weeks, if you dont eat enough your folic acid levels. This is called a red blood
folate-rich foods. cell folate level test.
Pertinent Signs and Symptoms: Normal Results
Fatigue The normal range is 2.7 to 17.0 nanograms per
Grey Hair milliliter (ng/mL).
If you are of childbearing age, your doctor may
Mouth Sores
order a pregnancy test to determine if this is the
Tongue Swelling cause of your deficiency.
Growth Problems

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IODINE DEFICIENCY 24 HOUR URINE COLLECTION 24 HOUR URINE COLLECTION

Iodine is an element that is needed for the
production of thyroid hormone. The body The Iodine 24hr Urine test requires patients void
The diagnostic workup of a suspected iodine
does not make iodine, so it is an essential urine at 8am and discard the specimen. Then
deficiency includes signs and symptoms as well collect all urine in 24-hour period, ending with
part of your diet.
as possible risk factors mentioned above. A 24- final collection at 8am the next morning.
hour urine iodine collection is a useful medical
Pertinent Signs and Symptoms: test, as approximately 90% of ingested iodine is
Goiter
Mental Retardation And excreted in the urine. For the standardized 24-
Problems With Growth, Hearing, And Speech hour test, a 50 mg iodine load is given first, and
Hypothyroidism 90% of this load is expected to be recovered in
Symptoms Of Choking, Especially When Lying
the urine of the following 24 hours. Recovery of
Down Difficulty Swallowing And Breathing.
less than 90% is taken to mean high retention,
that is, iodine deficiency. The recovery may
HYPOTHYROIDISM
Fatigue. however be well less than 90% during pregnancy,
Weakness. and an intake of goitrogens can alter the test
Weight gain or increased difficulty losing weight. results.
Coarse, dry hair. If a 24-hour urine collection is not practical, a
Dry, rough pale skin. random urine iodine-to-creatinine ratio can
Hair loss. alternatively be used.However, the 24-hour test
Cold intolerance (you can't tolerate cold
is found to be more reliable.
temperatures like those around you)
Muscle cramps and frequent muscle aches.
IODINE SKIN TEST

IODINE SKIN TEST
A general idea of whether a deficiency exists can Give patient teaching about procedure of the
be determined through a functional iodine test in patch test

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HYPERTHYROIDISM form of an iodine skin test. In this test, the skin is

Fatigue or muscle weakness.
painted with an iodine solution: if the iodine
Hand tremors.
patch disappears quickly, this is taken as a sign of
Mood swings.
iodine deficiency. However, no accepted norms
Nervousness or anxiety.
exist on the expected time interval for the patch
Rapid heartbeat.
to disappear, and in persons with dark skin color
Heart palpitations or irregular heartbeat.
the disappeance of the patch may be difficult to
Skin dryness.
assess. If a urine test is taken shortly after, the
Trouble sleeping.
results may be altered due to the iodine absorbed
previously in a skin test.
NIACIN DEFICIENCY URINE SAMPLING URINE SAMPLING

(Pellagra) After niacin has been processed it can be
Pertinent Signs and Symptoms: For urine sample, advice patient to drink enough
excreted in the urine. The products detected in
"the three Ds": Diarrhea, Dermatitis, Dementia water to provide sample.
the urine include nicotinic acid, niacin oxide and
High sensitivity to sunlight
metabolites including 2-pyridone and 2-methyl
Aggression
nicotinamide.
Dermatitis, alopecia (hair loss), edema (swelling)
Smooth, beefy red glossitis (tongue The latter two metabolites can be measured to
inflammation) assess niacin deficiency (low levels will be
Red skin lesions present).
Insomnia
Weakness
Mental confusion
Ataxia (lack of coordination), paralysis of
extremities, peripheral neuritis (nerve damage)
Diarrhea
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PROTEIN ENERGY
Laboratory tests have a limited usefulness for the
MALNUTRITION The health care provider will tell you if you need
diagnosis or evaluation of PEM. Some
Refers to a form of malnutrition where there is biochemical estimations are used, and give to stop taking any drugs that may affect the test.
inadequate calorie or protein intake. different results for children with kwashiorkor Drugs that can increase albumin levels include
and nutritional marasmus than for normal anabolic steroids, androgens, growth hormone,
Types include and insulin.
children or those with moderate PEM.
In kwashiorkor there is a reduction in total serum
Kwashiorkor (protein malnutrition predominant) proteins, and especially in the albumin fraction.
Marasmus (deficiency in calorie intake) In nutritional marasmus the reduction is usually
much less marked. Often, because of infections,
Marasmic Kwashiorkor (marked protein
the globulin fraction in the serum is normal or
deficiency and marked calorie insufficiency even raised. Serum albumin drops to low or very
signs present, sometimes referred to as the low levels usually only in clinically evident
most severe form of malnutrition) kwashiorkor. Serum albumin levels are not useful
Pertinent Signs and Symptoms: in predicting imminent kwashiorkor development
in moderate PEM cases. It is often true that the
KWASHIORKOR more severe the kwashiorkor, the lower the
serum albumin, but serum albumin levels are not
Change In Skin And Hair Color (Reddish-Orange useful in evaluating less severe PEM.
Color)
There is general agreement that serum albumin
Fatigue.
concentrations below 3 g/dl are low and that
Diarrhea. those below 2.5 g/dl are seriously deficient (see
Loss Of Muscle Mass. Table 22). It has also been suggested that serum
Failure To Grow Or Gain Weight. albumin levels below 2.8 g/dl should be
Edema (Swelling) considered deficient and indicate a high risk.
Damaged Immune System, Which Can Lead To
More Frequent And Severe Infections. Concentration Interpretation
Irritability. (g/dl)
_ 3.5 Normal

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MARASMUS 3-3.4 Subnormal

2.5-2.9 Low
Chronic diarrhea
_ 2.5 Pathological
Dizziness
Fatigue Other biochemical tests that have been used or
Severe weight loss recommended for diagnosing or evaluating PEM have
limited usefulness. These include tests for:
Change in level of consciousness
Paralysis of legs fasting serum insulin levels, which are elevated
in kwashiorkor and low in marasmus;
Loss of bowel and bladder control
Prolonged vomiting ratio of serum essential amino acids to non-
essential amino acids, which is low in
Lethargy
kwashiorkor but not much influenced by
Delay in healing of wounds nutritional marasmus;
hydroxyproline and creatinine levels in urine,
Distended abdomen
which if low may indicate current growth deficits
Muscle atrophy and nutritional marasmus.
Growth retardation
VITAMIN D TEST
RICKETS (same with CBC)
Nutritional disorder that can develop if you do A vitamin D test measures the amount of vitamin
not get enough vitamin D, calcium, or phosphate. D in the blood.
Rickets leads to poor functioning of a bones
growth plate (growing edge), softened and Vitamin D
weakened bones, stunted growth, and, in severe Normal:
cases, skeletal deformities.
3080 nanograms per milliliter (ng/mL)

Pertinent Signs and Symptoms: High levels of vitamin D can be caused by:
Pain Or Tenderness In The Bones Of Your
Arms, Legs, Pelvis, Or Spine. William's syndrome. This is a genetic problem
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Deformities In Your Teeth Or Delayed Tooth that causes growth delays before and after birth.
Formation, An Increased Number Of Cavities,
Holes In Your Enamel, Abscesses, Or Defects Taking too many vitamin D supplements.
In The Structure Of Your Teeth.
Low levels of vitamin D can be caused by:
Impaired Growth And Short Stature.
Bone Fractures. Kidney disease.
Liver disease.
Not getting enough sunlight.
Not getting enough vitamin D in your diet.
BONE BIOPSY BONE BIOPSY
Rarely, a bone biopsy is performed. This involves Ask patient for supplements/medications that
using a needle to remove a small section of bone increase the risk for bleeding.
for laboratory analysis
The patient should notify about all allergies,
previous reactions to medications, if he or she
has had any bleeding problems in the past, or if
she is pregnant.
Before the procedure, the patient will be asked
to change into a patient gown.
Take patients vital signs.
The patient may be given some medicine to help

him or her relax.
The patient may be asked to position him or
herself on the stomach or on the side depending
on the site the doctor chooses to use.
Inform patient that wound site may bleed and pressure

will be applied.
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SCURVY BLODD SAMPLING BLODD SAMPLING
Body doesn't have enough vitamin C, it A blood test is the most reliable way of Advice patient to wear short sleeve shirts.
can't produce new collagen (a protein Inform patient about the process of the
diagnosing scurvy. A blood sample will be taken
found in many different types of body procedure (venepuncture).
tissue, including the skin and bones). from a vein, usually in your arm, and tested to
Without a new supply of collagen, the check the levels of vitamin C (ascorbic acid) in Inform patient that after the procedure, hematoma may
body's tissue will begin to break down your white blood cells. occur. Give patient instructions for the remedy.
and deteriorate.
Vitamin C levels are normally between 0.4 and
Pertinent Signs and Symptoms: 1.7 mg/dL in the human bloodstream. The
Feeling Very Tired And Weak All The Time concentration in tissues is normally higher but
(Fatigue) varies from tissue to tissue. For example, vitamin
C in white blood cells can be up to 80 times
A General Sense Of Feeling "Out Of
higher than in blood. Vitamin C deficiency occurs
Sorts" Such As Feeling Irritable And
when blood vitamin C concentration drops below
Miserable All The Time
0.2 mg/dL.
Pain In Your Limbs Particularly Your
Legs
The Appearance Of Small Red-Blue Spots
On Your Skin
Swollen Gums Which Become Soft And
Vulnerable To Bleeding (Your Teeth May
Feel Loose Or Fall Out)
Severe Joint Pain, Caused By Bleeding
Inside The Joints
Shortness Of Breath Particularly After
Periods Of Physical Activity
Redness And Swelling In Recently Healed
23
Wounds (New Wounds May Also Fail To

Heal)
Easily Bruised Skin
VITAMIN A DEFICIENCY BLOOD SAMPLING BLOOD SAMPLING

Major cause is roughage which include few
animal sources of pre-formed vitamin A. In A blood test can measure the amount of vitamin An 8 to 12 hour fast is required for this blood
addition to dietary problems, there are other A in the blood.
causes of VAD. Iron deficiency can affect vitamin test.
This test is done to check if you have too much or
A uptake. Excess alcohol consumption can No foods or supplements containing vitamin A
too little vitamin A in your blood
deplete vitamin A, and a stressed liver may be should be ingested in the previous 48 hours
more susceptible to vitamin A toxicity. People Normal Results leading up to the test.
who consume large amounts of alcohol should Normal values range from 50 to 200 micrograms
Take all medications as prescribed
seek medical advice before taking vitamin A per deciliter
supplements.

Impaired dark adaptation of the eyes, which can
lead to night blindness.
Xerophthalmia (which is nearly pathognomonic)
results from keratinization of the eyes.
drying (xerosis) and thickening of the
conjunctivae and corneas
Superficial foamy patches composed of epithelial
debris and secretions on the exposed bulbar
conjunctiva (Bitot spots) develop.
Keratinization of the skin and of the mucous
membranes

24
VITAMIN K DEFICIENCY Explain to the patient how the procedure will be

Bleeding time, prothrombin time and activated performed.
Results from extremely inadequate intake, fat
malabsorption, or use of coumarin partial thromboplastin time are all elevated. Instruct patient to avoid certain medicines before
anticoagulants. Deficiency is particularly the test. Drugs that can affect the results of PTT
common among breastfed infants. It impairs Normal Results include: anti-histamines, heparin, Vitamin C
clotting. Prothrombin time is measured in seconds. Most (ascorbic acid), and aspirin.
of the time, results are given as what is called Inform patient of the risks of bleeding and hematoma.
INR (or international normalized ratio).11 - 13.5
Issues related to problematic blood clotting or
seconds, or INR of 0.8 - 1.1
bleeding: bleeding within the digestive tract, gum
bleeding, heavy menstrual bleeding, or
Partial thromboplastin time1Partial thromboplastin time
hemorrhaging.
(PTT):
Easily bruise or bleed.
Cartilage calcification. 6070 seconds
Uncontrollable bleeding at surgical or puncture sites. Activated partial thromboplastin time (APTT):
Brain bleeding in newborns.
3040 seconds
The most sensitive marker is the antibody test for

high level of des-gamma-carboxy prothrombin
(DCP) protein in vitamin K absence (PIVKA)
Normal:<7.5 ng/m
The reference range of vitamin K is 0.2-

3.2 ng/mL, but impaired blood clotting
has been associated with levels below
0.5 ng/mL by one source.Another source
cites a reference range of 0.10-2.2
ng/mL.
25


Health Assessment FHP - Nutrition and Metabolism

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1

Cebu Normal University

College Of Nursing - Graduate Studies [S.Y 2015-2016, 1ST SEMESTER]

MSN 4005 HEALTH ASSSESSMENT

CABRILLOS , JAKE CYDE S.

RUBI, RESSA LEA

MRS. NORMA A. HINOGUIN RN, MN, PhD.

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

NUTRITION AND METABOLIC PATTERN

Assess for Height and weight Rationale

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

Past Health History Rationale

Lifestyle and Health Practices

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

Height, weight, and body mass index

BMI = weight (kg)/height2 (m2) BMI = (weight [lb] X 703)/height2 (in2)

PHYSICAL BODY MASS INDEX

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

Mid-arm muscle circumference and mid-upper-arm muscle area

Men (cm2): Area = ([arm circumference { x triceps skinfold}]2/4) - 10

Women (cm2): Area = ([arm circumference { x triceps skinfold}]2/4) - 6.5

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

Joints and Bones

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

Height and weight

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

DIAGNOSIS DIAGNOSTIC EXAMINATIONS PATIENT PREPARATIONS

COMPLETE BLOOD COUNT COMPLETE BLOOD COUNT

Platelet count (150,000 to

IRON TEST IRON TEST

Too much iron in the body (hemochromatosis)

Breakdown of red blood cells (hemolysis)

Anemia due to red blood cells being destroyed

Liver tissue death (hepatic necrosis)

Inflammation of the liver (hepatitis)

Vitamin B-12 deficiency, vitamin B-6 deficiency

Many blood transfusions

Lower-than-normal levels may mean:

Long-term digestive tract bleeding

Heavy menstrual bleeding

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

Intestinal conditions that cause poor absorption

Not enough dietary iron

Reticulocytes are immature red blood cells

A normal result for healthy adults who are not

The results may vary slightly among laboratories,

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

Higher level of ferritin - hemochromatosis.

FECAL BLOOD OCCULT TEST FECAL BLOOD OCCULT TEST

considered positive if blood is detected in your

Normal: The esophagus, stomach, and upper

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

( Vitamin B9 Deficiency) Since other blood conditions cause symptoms

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

IODINE DEFICIENCY 24 HOUR URINE COLLECTION 24 HOUR URINE COLLECTION

IODINE SKIN TEST

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

HYPERTHYROIDISM form of an iodine skin test. In this test, the skin is

NIACIN DEFICIENCY URINE SAMPLING URINE SAMPLING

CEBU NORMAL UNIVERSITY COLLEGE OF NURSING

MARASMUS 3-3.4 Subnormal