Chapter 11: Nutritional Assessment

Nails

Should be smooth and pink.

Rationale for adolescents use of steroids and muscle size

most adolescent are using steroids and it causes side effects such as personality disorders,aggression, and liver and organ damage.

How many pounds does a woman who is of normal weight need to gain for pregnancy?

25 to 35lbs

How many pounds does a woman who is underweight need to gain for pregnancy?

28-40 lbs.

Normal values for lab test

Glucose -young children-60-100mg/dL adults -less than 100mg/dL hemoglobin-adult males-14 to 18g/dL females- 12-16g/dL Hematocrit- males- 37%-49% females-36%-46% Cholesterol-120-200mg/dL Triglycerides-less than 150 for ages 20-65 Serum Proteins-3.5 to 5.5 albumin

Protein Calorie Malnutrition

inadequate consumption of protein and energy, resulting in a gradual body wasting and increased susceptibility to infection.

What does the term Halal mean and to what culture?

Halal is term that refers to Islamic dietary laws, here too, prohibition of pig meats is one of the many dietary laws.

What are people who are over-nutrition at risk for?

heart disease, type 2 diabetes, hypertension, stroke, gallbladder disease, sleep apnea, certain cancers, and osteoarthritis.

Anthropometry

measurement of the body( height, weight, circumferences, skin-fold thickness)

Neurological

normal reflexes, appropriate affect.

Examining the Skin

should be smooth, no rashes or bruises, or flaking.

Rickets

sign of vitamin D defeicency and calicum defiencey in children (disorders of cartilage cell growth, enlargement of epiphyseal growth plates) and adults osteomalacia.

Lips

Smooth no chapped or swollen.

Objective data: lab Studies

-are objective and can detect preclinical nutritional defecinces and can be used to confirm subjective findings. -use caution when interpreting test results that may be outside normal ranges, because they do not always reflect nutritional problems and because standards for aging adults have not yet firmly been established.

What are the various methods for collecting current dietary intake information?

1. 24 hour diet recall 2. Food frequency questionnaire 3. food diary(3 days) 4. During hospitalization, documentation of nutritional intake can be best be achieved through calorie counts of nutrients consumed and or infused.

what tools are used for screening different populations?

1. Admissions Nutrition Screening Tool validated for use by nurse in hospitals settings. 2. Nutrition Screening Initiative form designed and validates in outpatient, geriatric population.

adolescent girls

1. Age first started menstruating? -what is your menstrual flow like? -Malnutrition delays menarche. Like wise, amenorrhea or scant menstrual flow occurs with nutritional deficiency.

Medications and nutritional Supplements

1. Any prescription medications. 2. Nonprescription. 3. Use over a 24 hour period? 4. Type of vitamin or mineral supplement. amount? and duration of use? 5. Any herbal or botanical products? Specific type/brand and where obtained? How often used? Who recommended? How does it help you? have had any problems?

Waist -to -hip Ratio

1. Assess body fat distribution as an indicator of health risk. 2. Android Obesity- apple shape. 3. Gynoid Obesity- pear shape. 4. waist circumference is measured in inches at the smallest circumference below the rib cage and above the umbilicus. 5. Hip circumference is measured in inches at the largest circumference in buttocks. 6. waist circumference can predict health risk.

Derived weight measure

1. Body weight as a percentage of ideal body weight. 2.Percent usual body weight. 3. Body Mass Index.

Infants and Children Nutritional Standards

1. Breastfeeding is recommended for full-term infants for the first year of life . 2.Advantages of breast feeding: fewer food allergies and in-tolerances, reduced likelhood of overfeeding, less cost of commercial infant formulas, and increases mother-infant interaction. 3. Cow's milk causes GI and kidney problems is poor source of iron vitamins C and E, it is not recommended for infants until the age of 1. 4.Brain size also increases very rapidly during infancy and childhood. 5.Infants and children younger than 2 years should not drink skim or low fat milk or to be placed on low-fat-diets-fat (calories) is required for proper growth and central nervous system development.

Nutrition screening

1. First step may be completes in any setting-(clinic, home, hospital, LTC) 2. Based on easliy obtained data, nutrition screening is quick and easy way to identify individuals at nutrition risk, such as those with weight loss, inadequate food intake, or prevent illness. 3. parameters include weight and weight history, conditions associated with increased nutritional risk and diet information, and routine laboratory data.(thicken liquids)

Serving sizes and portions for food needed daily

1. Grains-6oz.-1 oz is like a slice of bread, 1 cup of cereal, 1/2 cup of rice. 2.Vegetables-2 1/2 cups- green veggies, orange vegetables, dry beans. 3. Fruits-2 cups-variety of rresh, frozen, and dried. 4.Milk-3 cups-Low-fat, fat free, lactose free, fortified sources. 5. Meat and Beans-5 1/2 cups-Low-fat or lean meat and poultry. Bake it grill it broil it.

How many pounds does a woman who is overweight need to stay a in range to gain during pregnancy?

15-25 lbs

Developmental Competences: Aging Adult

1. Height -with age, height declines in both men and women and very slowly from early 30s. -Height measures may not be accurate in individuals confined to a bed or wheelchair or those over 60 years of age because of osetoporotic changes. -Arm span which is directly correlated with height, may be better measure for elderly.

Objective Data: Lab studies

1. Hemoglobin 2. Hematacrit. 3. Cholestrol 4. Triglycerides 5. lymphocyte count 6.serum albumin 7. glucose, low-and high-density lipoprotein, prealbumin, transferrin,and total protien levels also provide meaningful information.

What can go wrong with a 24 hour diet recall?

1. Individual or family member may not be able to recall type or amount of food eaten. 2. Intake within last 24 hours may be atypical or unusual. 3. Individual or family members may alter truth for a variety of reasons. 4. Snack items and use of gravies, sauces, and condiments may be under reported.

Subject data: Alcoholism and illegal drug use

1. Last drink? how much? amount of alcohol each day? each week? duration of use? repeat for each drug used?

Self -care Behaviors

1. Meal preparation facilities? 2. Transportation to the market? 3.Adequate income for food purchase? 4. Who prepares meals and does shopping? 5. Environment during meal times?

What are the potential problems with the food diaries?

1. Noncompliance 2. Inaccurate recording 3. Atypical intake on recording days 4. Conscious alteration of diet during recording period.

Eating patterns

1. Number of meals/ snacks per day? 2. Kind and amount of food eaten? 3. Fad, special, or alternative diets? 4. Where is food eaten? 5. Food preferences and dislikes? 6. Religious or cultural restrictions 7. Able to feed self?

What other factor contribute to their nutritional status when immigrants arrive in the U.S.?

1. Unfamiliar foods, food storage, food preparation, and food-buying habits. 2. familiar foods are hard to find and obtain. 3.Low income may also contribute to their access to the familiar foods. 4.when traditional food habits are disrupted, borderline deficicences or adverse nutritional consequences may result. Ex. Japenese people have increases rick of colon and breast cancer due to diets high in saturated fats and cholesterol.

Developmental competence for adolescents

1. Weight - height and weight should be measured at regular intervals, becasue longitudinal growth is one of the best indices of nutritional status over time. 2. Skin fold thickness -determination of skinfold thickness can be used to measure childhood and teenage overnutrition.

Lactose intolerance

1. a condition found in 30 to 50 million Americans. 2. 80% of African Americans are Lactose intolerant. 3. 80%to 100% American Indians. 4. 90 to 100% of Asia Americans. 5. It is least come among people from northern European descent.

Skin Testing

1. adequate immunity can be demostrated by a positive reaction to multiple skin test antigens. 2.PPd and allergy test.

Family History for nutritition

1. any heart disease, osteoporosis, cancer, gout, GI disordes, obesity or diabetes. 2. effect of each on eating patterns. 3. effect on activity patterns.

Daily reference Intakes

1. are recommended amounts of nutrients to prevent deficiencies and reduce the risk for chronic diseases. 2. In addition to recommending adequate intakes, also specify upper limits of nutrients to avoid toxicity. 3. With increased use of dietary supplements, risk for nutrients toxicities is on the rise.

What can you see in direct observation?

1. can lead to detection of problems not readily identified through standard nutrition interviews. 2. Observing typical feeding techniques used by parent or caregiver and interaction between individual and caregiver can be a value in assessing failure to thrive in children or unintentional weight loss in older adults.

What cultural factors must be considered when assessing the nutritional needs?

1. cultural definition of food. 2.Frequency and number of meals eaten away from home. 3. Form and content of ceremonial meals. 4. Amount and types of food eaten, and regularity of food consumption.

What role does cultural heritage play in nutrient needs?

1. cultural values may conflict with optimum nutrition, for example, many cultures worlwide consider obesity and indication of beauty,affeluence, and well-being. 2.The best way to learn about the eating patterns of people is to talk with them, eat with them, and ask about dietary customs. 3.Recent immigrants groups, such as Southeast Asians, are often shorter and weigh less than Western counterparts, so standard tables of weight for age, height for age, and weight for height may not be appropriate to evaluate growth and development of immigrant children.

What factors effect nutritional status in the older adults?

1. decrease in energy requirements due to the loss of lean body mass and increase in fat mass. 2. socioeconomic conditions frequently have a significant effect on nutrtitional status. 3.the decline of extended families and increased mobility of families reduce the support system. 4.Facilities in meal preparation, transportation to the grocery store, physical limitations, income, and social isolation interfere with acquisition of balanced diet. 5. Multiple medications that have a potential for interaction with nutrients and one another.

Subjective Data: What are you going to ask them?

1. eating patterns. 2. Usual weight 3.Changes in appetite, taste, smell, chewing, swallowing. 4. Recent surgery,trauma, burn, trauma, infection. 5. Chronic illnesses. 6. Vomiting, diarrhea, constipation. 7. Food allergies or intolerance 8. Medications and or nutritional supplements 9. Self-care behaviors 10. alcohol or illegal drug use. 11. Exercise and activity patterns.

Why is important to know a person's religious practices related to food?

1. enables you to suggest improvements or modifications that do not coflict with dietary law. 2. other issues as fasting and other religious observations that may limit a person's food or liquid intake during specified times. 3.Muslims fast from dawn to sunset during the month of Ramadan in Islamic calendar and eat only twice a day, defore dawn and after sunset. 3. Jews observe a 24 hour fast on Yom Kippur.

Cultural Competence in Nutritional Status

1. foods and eating customs are culturally diverse, and each person has unique cultural heritage that may affect nutritional status. 2.Immigrants commonly maintain traditional eating customs long after language and manner of dress of adopted country become routine. 3. Occupation, class ,religion, gender, and heath awareness also have a great bearing on eating customs. 4. not only do food habits change to accommodate their new cultures, but also their food habits have influence on their adoptive country.

Adulthood nutrition

1. growth and nutrient needs are stablize.

History for the aging adult

1. how does your diet differ from your diet in your 50's and 60's? -Why? -what factors affect the way you eat? 2. review the Mini-Nutrition assessment tool (MNA) -It has 6 questions that indicate risk factors for inadequate nutritional status.

What is the food frequency questionnaire?

1. may be used to counter some difficulties inherent in the 24 hour diet recall method. 2. Information collected with this tool, can tell you how many times per wek, or month individuals eat this particular foods.

Classification of malnutrition

1. obesity 2. Marasmus(protein-calorie malnutrition) 3. Kwashiorkor (protein malnutrition) 4. Marasmus-Kwashiorkor mix

Adolscence Nutrition

1. rapid physical growth and endocrine and hormonal changes. 2. increase in caloric and protein requirements to meet the demand of bone growth and increasing muscle mass. 3. Girls onset of menarche. Calcium and iron requirements also increase. 4.They need more than tree meals a day. they need nutritious snacks and play an important role in achieving adequate nutrient intake. 5. Teaching for the adolescence includes: skipped meals, excessive fast foods and sweetened beverages consumption, limited fruit and vegetable intake, peer pressure, alternative dietary patterns, eating disorders, hectic schedules, and possible experimentation with drugs and alcohol.

What are food diaries or records?

1. require asking the individual or family member to write down everything consumed for certain period of time. 2. Three days, including two weekdays and one weekend day, are customarily used. 3. Food diary is most complete and accurate if individual instructed to record information immediately after eating.

Pregnancy and Lactation Nutrient

1. sufficient calories and protein, vitamins, and minerals must be consumed to support synthesis of maternal and fetal tissues. 2.Iron, folate, and zinc are esstential for fetal growth and vitamin and mineral supplements are often required.

What is the 24 hour diet recall?

1. the easiest most popular method for obtaining information about dietary intake. 2. Individual or family member completes questionnaire or interviews and asked to recall everything eaten within last 24 hours.

What three guides are commonly used to determine adequacy or inadequacy of a diet?

1. the food guide pyramid 2. dietary guidelines 3. Daily reference Intakes

What is the purpose of nutritional Assessment?

1. to identify idividuals who are malnourished or at risk for developing malnutrition. 2. Provide data for designing a nutrition plan of care that will prevent or minimize development of malnutrition. 3.Establishes a baseline data for evaluating efficacy of nutritional care.

Chronic Illness

1. type 2. When diagnosed 3. How was it treated? 4. Dietary modifications? 5. Recent cancer and chemotherapy or radiation therapy.

Additional History for the adolescent

1. use of metabolic steriods or other agents to increase muscle size and physical performance? -when? -how much? -any problems? use of caffeinated, energy boosting drinks? When? Type? Duration? - energy drinks like red bull contain large amounts of caffeine and stimulants and herbal products. Side effects include dehydration, HBP, and heart rate and sleep problems. 2. What snacks or fast foods do you like to eat? -When? -How much? -Binge eating is now more common eating disorder. SKipping meals and consuming fast foods and sweetened beverages are associated with increased weight from adolescence to adulthood.

What is your usual weight?

1. usual weight 2. the 20% below or above desirable weight 3. Recent weight change 4. how much lost or gained? 5. Over what time period? 6. reason for loss or gain?

why is it necessary to avoid cultral stereotyping?

1. we tend to view individuals of common cultural backgrounds similarly and according to a preconceived notion of how they ought to behave. 2. Certain dietary preferences among people from certain cultural groups, however, can be described, for example, characteristic ethnic dishes, methods of food preparation. 3.Cultural food preferences are often interrelated with religious dietary benefits and practices. 4. many religions use food as symbols in celebrations and rituals.

History for the adolescent

1. what is your present weight? -What would you like to weigh. -How do you feel about present weight? -on a special diet to lose weight? FAD diet -On other diets to lose weight? If so, were they successful? -Constantly think about "feeling fat"? -Intentionally vomit or use laxatives or diuretics after eating?

what are the drawbacks to the frequency questionnaire?

1.1. Does not quantify amount of intake. 2. Relies on individual's family members memory for how often food was eaten.

Why are most immigrants at a nutritional risk when coming to the Unites States?

1.Because most of them come from countries with limited food supplies caused by poverty, poor sanitation, war, or political strife. 2.General undernutrition, hypertension, diarrhea, lactose intolerance, osteomalacia (soft bones), scurvy, and dental caries, are among more common nutrition-related problems of new immigrants from developing countries. 3. They are in a new country with a completely new language, culture, and society.

How many pounds can an obese woman need to gain to stay in range during pregnancy?

11-20lbs

Biocultural variations in lab studies

African Americans are 1g lower level in hemoglobin. Is a factor that could be important for the treatment of anemia.

Nausea, Vomiting,diarrhea, constipation

Any problems, due to, how long?

Obstruction of by passed sections or pouch

Avoiding chunks of food that can cause blockage.

What lifestyle factors influence the healthy adulthood?

Cigarette smoking, stress, lack of exercises, excessive alcohol intake, and diets high in saturated fat, cholesterol and salt, and sugar and low in fiber can be factors.

Scorbutic Gums

Deficiency of vitamin C. Gums are swollen, ulcerated , and bleeding due to vitamin C induced deficits.

Follicular hyperkeratosis

Dry, bumpy skin associated with vitamin A and or/ lineloic acid (essential fatty acid)deficiency. Results in eczematous skin, especially in infants.

Musculoskeletal

Erect posture, no malformations, good muscle tone. can walk or run without pain.

Biot's Spots

Foamy plaques of the cornea that are a sign of vitamin A deficiency. severe depletion may result in conjunctival xerosis (drying) and progress to corneal ulceration and, finally, destruction of the eye.(keratomalacia)

Exercise and activity patterns

How much exercise? what type of excerise?

What diseases are influence by factors that affect the adulthood?

Hypertension, obesity, atherosclerosis, cancer, osteoporosis, and diabetes mellitus.

Who are the most at risk for impaired growth and development, lowered resistance to infection and disease, delayed wound healing, longer hospital stays, and higher health care costs?

Infants, children, pregnant women, recent immigrants, person with low incomes, hospitalized people and aging adults.

What does the term kosher mean and what is its importance to Jews?

Kosher is a term that referfs to dietary laws of observant Jews. 1. Not mixing milk and meat products, prohibition of eating pig meats and crustaceans are example s of many rules within the systems.

Developmental competence: Aging Adult

MAC and TST are not accurate and difficult to obtain in older adults because of sagging skin changes in fat distribution and declining muscle mass. -BMI and waist to hip ratio are better indicators of obesity in this age group.

Skinfold Thickness

Measurements provide an estimate of body fat stores or extent of obesity or undernutrition..

Creatinine-height Index

Method of estimating skeletal muscle mass. .It is excreted in the urine unchanged at a constant rate in proportion to the amount of body muscle.

Serial Assessment

Monitors the nutritional status in malnourished individuals or in indivdiuals at risk for malnutrition. -are made at routine intervals. -Weight and dietary intake should be evaluated weekly. -Data on these parameters should be collected bimonthly or weekly.

Observation of general appearance

Obese, cachectic (fat and muscle wasting), or edematous, can provide clues to overall nutritional status, 1. more specific clincial signs and symptoms of nutritional deficiences can be detected through physical examination. 2. Places where nutritional defeciences are readily observable are:skin, hair, nails, mouth, lips, and eyes. 3. signs may be nonnutritional in origin. 4. Lab test are required to make an accurate diagnosis.

What can affect nutritional status?

Physiologic, psychosocial, developmental, cultural, and economic factors.

What are the major risk factors for malnutrition in older adults?

Poor physical or mental health, social isolation, alcoholism, dentures, limited functional ability, poverty, and polypharmacy.

Tongue

Should be red in appearnance, not swollen or smooth, no lesions.

Hair

Should be shiny, firm, does not fall out easily, healthy scalp.

Gums

should be reddish pink firm, no bleeding

Why is alcohol consumption important?

These agents are subsitiuted for nutritious foods and increase requirements for some nutritents. Pregnant women who smoke, drink alcohol, and use illegal drugs give birth to infants with low birth weight, failure to thrive, and other serious complications.

Changes in appetite, taste, smell, chewing, swallowing

Type of change? When did it occur?

Abnormal findings for metabolic syndrome

Waist circumference- greater than 40 inches in men greater than 35 inches in women. Glucose- greater than 100mg/dL or drug treatment foe elevated dose. HDL- less than 40 mg/dL in men and less than 50 mg/dL in women Triglcerides- greater than 150 mg/dL BP- greater than 130mmHg in systolic and greater than 85mmHg in diastolic BP

When should a comprehensive nutritional assessment be done? and what does it include?

When individuals are identified at nutritional risk during screening . 1. Dietary history 2. Physical examination 3. Anthropometric measures 4. Laboratory test

Recent surgery, trauma, burn, infection

When? Type? How treated? Condition that increase nutrient loss, for example, draining wounds, effusion, blood loss, dialysis.

Diet History

a detailed record of dietary intake obtainable from 24-hour recalls, foods frequency questionnaires, food diaries, and similar methods.

Mid-arm muscle area(MAMA)

a more sensitive indicator of lean body mass than MAC or MAMC.

Rationale for adolescents present weight

adolescent increased body awareness and self-consciousness may cause disorders such as anorexia or bulimia.

Lab test for the aging adult

all serum and urine data must be interpreted with understanding of declining renal efficacy and tendency for aging adults to be overhydrated or underhydrated.

Mid-upper arm circumference (MAC)

an indicator of lean body mass and fat stores.

Food allergies and Intolerances

any problematic foods? type of reaction? how long? Ex. Ulcerative colitits, IBS, Divertivulititis

Nutritional monitoring

assessment of dietary or nutritional status at intermittent times with the aim of detecting changes in the dietary or nutritional status of a populations.

Metabolic Syndrome

asssociated with increased risk for cardiovascular disease, type 2 diabetes, mortaltily.

Weight re-gain

avoid excessive intake of calorically dense liquids/ foods.

Rationale for exercise

caloric and nutrient needs increase with competitive sports and manual labor. Inactive or sedentary lifestyles often lead to excess weight gain.

Eyes

corneas are clear, shiny, membranes are pink and moist, no sores at corner of eyelids.

Potential Nutritional Consequences of Bariatric Surgery-Malabsorption of protein and calories due to decreased absorptive surface and availability of digestive enzymes

dietary related chanegs- eating small, nutrient dense meals.

Skinfold thickness

double fold of skin and underlying subcutaneous tissue that is measured with skinfold calipers at various body sites.

Gynoid Obesity

excess body fat that is placed predominantly within the hips and thighs.

Android Obesity

excess body fat that is placed prodominantly within the abdomen and upper body, as opposed to the hips and thighs.

Obesity

excessive accumulation of body fat; usually defined as 20% above the desirable weight or body mass index. BMI is 30.0-39.9. The causes of complex and multifaceted; genetic, social, cultural, pathologic, psychological, and physiologic factors are implicated. The imbalance of caloric intake and caloric expenditure. In most cases, a small caloric surplus over a long period results in the extra pounds. Although visceral protein levels are normal in the obese individual, anthropometric measures are normal.

Sickle -Cell Anemia

is a hemoglobin-related , genetic health problem/ It is genetically inherited trait that may have been an adaption to fight Malaria in Africa. Sickle-cell anemia occurs in African Americans and causes normal red blood cells to assume sickle shape.

Kwashiorkor (protein malnutrition)

is due to diets high in calories but contain little or no protein. e.g. low protein liquid diets, fad diets, and long-term use of dextrose containing IV fluids. Individuals with Kwashiorkor, in contrast to Marasmus, have decreased visceral protein levels but adequate anthropometric measures. They may therefore appear well nourished or even obese.

Marasmus (protein-calorie malnutrition)

is due to inadequate intake of protein and calories or prolonged starvation. Anorexia, bowel obstruction, cancer cachexia, and chronic illness are among the clinical conditions leading to marasmus. Marasmus is characterized by decreased anthropometric measures- weight loss and subcutaneous fat and muscle wasting. Visceral protein levels may remain in normal ranges.

Marasmic Kwashiorkor

is due to prolonged inadequate intake of protein and calories. such as severe starvation and severe catabolic states. The mix combines elements of both marasmus and kwashiorkor. Nutritional assessment findings include muscle, fat, and visceral protein wasting. Individuals have undergone acute catabolic stress, such as major surgery, trauma, burns in combination with prolonged starvation or have AIDS wasting. Without nutritional support, this type of malnutrition is associated with the highest risk for morbidity and mortality.

What is optimal nutritional status?

is when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness.

Recommended Dietary Allowance

levels of intake of essential nutrients considered to be adequate to meet the nutritional needs of practically all healthy persons.

Importance of family history

long term nutritional defeciences or excesses may first show as disease. Early detection permits dietary and activity modification at the time when the body can recover fully.

Malnutrition

may mean any nutrition disorder but usually refers to long-term nutritional inadequacies or excesses.

Anthropomorphic Measures

measurement and evaluation of growth and development, and body composition. - Height -weight -triceps skinfold thickness -Elbow breadth -arm and head circumference.

Kwashiokor

occurs in children and adults whose diets contain mostly carbohydrate and little or no protein and are under stress( growth, parasitic or viral infections, major surgery, trauma, or burns). Accompanying signs include generalized edema. scaling areas of decreased pigmentation, and decreased hair pigmentation.

Undernutrition

occurs when nutritional reserves are depleted and/or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands.

Pellagra

pigmented keratotic scaling lesions resulting from deficency in niacin. They are prodominantly in areas exposed to the sun, such as hands, forearms , neck, and legs. Mostly seen AA.

What are the normal physiological changes in aging adults that affect nutritional status?

poor dentition, decreased visual acuity, decreased saliva production, slowed GI motility, decreased GI absorption, and diminished olfactory, and taste sensitivity.

Serum Protein

proteins presented in serum that are indicators of the body's requirements visceral protein status. (albumin, prealbumin, transferin)

What is nutritional status?

refers to the degree of balance between nutrient intake and nutrient requirements.

HIV-infection person

skinny and malnourished looking.

Malabsorption of vitamins and minerals due to alchorhydria or loss of site of absoprtion

taking vitamin and mineral supplements

Lab test in the adolescent

unless a disease is suspected, lab evaluation of hemoglobin and hematocrit levles, and urinalysis for glucose and protein levels, are adequate.

Nitrogen Balance

used in protein nutritional status. Nitrogen is released with catabolism of amino acid and excreted in the urine. Indicates whether a person is anabolic-positive nitrogen balance, or catabolic.

Magneta Tongue

vitamin B complex defiencey, sign of riboflavin deficiency. red tongue

Body Mass Index

weight in kilograms divided by height in meters squared: values of 30 or more is indicative of obesity; value of less than 18.5 is indicative of under-nutrition.