special nutrition assessment done in kapkatet county hospital located in kericho county. this is the...
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NUTRITION ASSESSMENT IN KAPKATET COUNTY HOSPITAL , KERICHO COUNTY
SPECIAL NUTRITION ASSESSMENT DONE
BYCHERUIYOT SAMBU
CLINICAL NUTRITIONISTMSCN/BSCN/DCM
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DEFINITION: NUTRITION ASSESSMENT: Is
A comprehensive analysis of a person’s nutrition status that uses health, socioeconomic,
drug, and diet histories; anthropometric measurements;
physical examinations; and laboratory tests.
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Type of History What It Identifies
Health history Current and previous health problems and family health history that affect nutrient needs, nutrition status, or the need for intervention to prevent or alleviate health problems
Socioeconomic history Personal, cultural, financial, and environmental influences on food intake, nutrient needs, and diet therapy options
Drug history Medications (prescription and over-the-counter), illegal drugs, dietary supplements, and alternative therapies that affect nutrition status
Diet history Nutrient intake excesses or deficiencies and reasons for imbalances
Historical Data Used in Nutrition Assessments
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outline1. WAIST
CIRCUMFRENCE
2. TRICEPS SKIN FOLD (TSF)
3. WAIST/HIB
4. PHYSICAL EXAMINATION
5. CLINICAL ASSESSMENT
6. HEAD CIRCUMFRENCE
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Anthropometric MeasurementsUsed in Nutrition Assessments
Type of Measurement What It Reflects
Abdominal girth measurement
Abdominal fluid retention and abdominal organ size
Height-weight Over-nutrition and under-nutrition; growth in children
Head circumference Brain growth and development in infants and children under age 2
Skin-fold Subcutaneous and total body fat
Waist circumference Body fat distribution
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The purpose of determining waist girth is to gain a measure of the amount of abdominal fat (visceral fat), which has been linked to increased risk of coronary heart disease and diabetes.
The waist measurement is taken by a tape at the narrowest waist level, or if this is not apparent, at the mid point between the lowest rib and the top of the hip bone (illiac crest).
Waist or Abdominal Girth (circumference)
≥102cm (adult male) & ≥88 cm (adult female) considered having abdominal obesity
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A measure of subcutaneous fat stores taken at the midpoint of the posterior aspect of the humerus.Correlates closely with percentage of body fat and with total body fat.Triceps skin-fold thickness varies between 6 -12mm in lean individuals and between 40 - 50mm in obese individuals.
Triceps skin-fold (TSF)
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Men Women
Risk cm inches cm inches
Very High > 120 > 47 > 110 43.5
High 100 - 120 39.5 - 47 90 - 109 35.5 – 43
Low 80 - 99 31.5 - 39 70 - 89 28.5 – 35
Very Low < 80 < 31.5 < 70 < 28.5
Adapted from Ellie Whitney and Sharon Rady Rolfes; Under standing Nutrition, Twelfth
Edition. 2011
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Waist–hip ratio or waist-to-hip ratio (WHR) is the ratio of the circumference of the
waist to that of the hips.Waist/hips
WHR is used as a measurement of obesity,
Waist–hip ratio
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Male FemaleHealth Risk Based Solely on WHR
0.95 or below 0.80 or below Low Risk
0.96 to 1.0 0.81 to 0.85 Moderate Risk
1.0+ 0.85+ High Risk
The Waist to Hip Ratio Calculator indicates your probable health risks. People with more weight around the waist, face more health risks than people who carry more weight around their hips
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OBESITYWaist/hip ratio - divide the waist circumference by the hip circumference. Above 0.95 for men (or 0.8 in women) indicative of a health risk
WHO states that abdominal obesity is defined as a waist–hip ratio above 0.90 for males and above 0.85 for females, or a body mass index
(BMI) above 30.0
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Physical examinationsBody System Healthy Findings Malnutrition Findings What the
Findings Refl ect
Hair Shiny, firm in the scalp Dull, brittle, dry, loose; falls out
PEM
Eyes Bright, clear pink membranes adjust easily to light
Pale membranes; spots; redness adjust slowly to darkness
Vitamin A, B vitamin, zinc, and iron
Teeth and gums
No pain or caries, gums firm teeth bright
Missing, discolored, decayed teeth; gums bleed easily and are swollen and spongy
Mineral and vitamin C status
Glands No lumps Swollen at front of neck PEM and iodine status
Tongue Red, bumpy, rough Sore, smooth, purplish, swollen
B vitamin status
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Physical examinations
ADVANTAGES
Fast & Easy to performInexpensiveNon-invasive
LIMITATIONSDid not detect early cases
Trained staff needed
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Skin Smooth, firm, good color
Off-color, scaly, fl aky, cracked, dry rough, spotty; “sandpaper” feel orsores; lack of fat under skin
PEM, essential fatty acid, vitamin A, B vitamin, and vitamin C status
Nails Firm, pink Spoon-shaped, brittle, ridged, pale Iron status
Internal systems
Regular heart rhythm, heart rate, and blood pressure; no impairment of digestive function, reflexes, or mental status
Abnormal heart rate, heart rhythm, o rblood pressure; enlarged liver, splee nabnormal digestion; burning, tingling of hands, feet; loss of balance, coordination, mental confusion, irritability, fatigue
PEM and mineral status
Muscles and bones
Muscle tone; posture, long bone development appropriate for age
“Wasted” appearance of muscles swollen bumps on skull or ends of bones; small bumps on ribs; bowed legs or knock-knees
PEM, mineral, and vitamin D status
Physical examinations CONT…
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Vitamin B complex deficiency
• Glossitis • Cheilosis• Stomatitis• Neurological problems• Anaemia• Ariboflavinosis (Riboflavin)• Beri beri (Thiamine)• Pellagra (Niacin)• Birth defects (Folate)• Infertility (Folate + B12)
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Clinical assessment …
Iodine deficiency disorder
• Deficiency of micronutrient iodine
• Thyroid hormone deficiency• Features:• Goitre• Swelling over legs
(myxoedema)• Voice change• Skin changes• Abortions
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Clinical assessment …
• Lesions on the back of the hands and ‘Casal’s necklace’
Pellagra
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Clinical assessment …
ANGULAR CHEILITIS
Ariboflavinosis
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Clinical assessment …Vitamin D (Rickets)
• bony deformities• rickety rosary• tetany• osteomalacia
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HEAD CIRCUMFERENCE• Brain growth takes place 70% during fetallife, 15% during infancy and remaining 10% during pre-school years.
• Head circumference are routinely recorded until 5 years of age.
• If scalp edema or cranial moulding is present , measurement of scalp edema may be inaccurate until fourth or fifth day of life .
•The head circumference is measured by placing the tape over the occipital protuberance at the back and just over the supraorbital ridge and the glabella in front.
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Age Head circumference (cm)
At birth 34 – 35
2 months 38
3 months 40
4 months 41
6 months 42 - 43
1 year 45 - 46
2 years 47 - 48
5 years 50 - 51
• During first year there is 12 cm increase in head circumference , while 1 – 5 year age , only 5 cm gain occur in head size.
• Adult head size is achieved between 5 to 6 years .
Expected head circumference in children
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Thank you