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Two Techniques used:
1. Inspection: involves searching for physical sign by observing the patient
2. Palpation: involves using the sense of touch to evaluate the patient
-looking for scooping or hollowing of temporal region
-Example: if patient turned face to side and you poured water some of the water would catch in the hollowing area - severe
-looking for prominence of the clavicle and squaring of shoulders (indicates malnourishment)
-Normal: clavicle bone should be visible, with no area of depression behind the bone - nice curvature and roundness from neck to shoulders and down arm
-Mild-Moderate: depression behind the clavicle bone - acromion process may protrude slightly and slightly squared off but some curvature
-Severe: clavicle bone significantly protruded and area behind bone more depressed - bones clearly prominent and visible beneath the skin, very square
-look for prominent bone or areas of depression between bones
-Normal: scapula and other bones in area are not prominent and no areas of depression between bones
-Mild-Moderate: area around the should blade is mildly depressed and the bones may protrude slightly
-Severe: bones are clearly prominent and visible beneath the skin, depression can be seen along the scapula and spine
-combine thumb and for finger together and apply pressure
-Normal: bulge; in females it may appear almost flat
-Mild-Moderate: may appear flat or slightly depressed
-Severe: area between thumb and for finger will appear very depressed
-to observe and feel for areas where adipose or fatty tissue is normally present
-only observation; examine ribs for loss of fullness or loose skin, the ribs should not be apparent
-Normal: normal ribs with fullness and taught skin
-Mild-Moderate: loss of fullness with lose skin and outline of rib cage is apparent
-Severe: well defined rib cage and can see depression between the ribs
-observing the area under the eye, remember that is this something you can view when you first come in contact with the patient
-Normal: OFP should appear slightly bulged
-Mild-Moderate: OFP appear with slightly dark circles underneath the eyes, and have hollow appearance
-Severe: appear to have dark circles underneath eyes; skin around the eyes will appear loos, and the eyes will appear depressed with a more prominent hallow look
-to assess have patient make a 90 degree angle and take your thumb and for finger and make a slight pinch of skin above bicep (be careful not to grab the muscle)
-Normal: exhibit ample fat tissue between folds of skin
-Mild-Moderate: fingers will almost touch when palpating the skin, there will be some depth to pinch
-Severe: little space between skin folds; your fingers will touch
-assess when they are in the sitting position; looking for areas of depression along the inner thigh region and for thick appearance of the upper leg, which indicates wasting of thigh muscle
-Normal: quadriceps muscles well-rounded
-Mild-Moderate: area of depression along inner thigh, upper leg appears thin
-Severe: significant depression inner thigh and upper leg appears obviously thin
-client lie down, and bend knee allow access to muscles of the calve - pay special attention to muscle definition and tone
-Normal: calve appears round with well developed bulb
-Mild-Moderate: muscle neither well developed nor well defined, easily compressible upon papation
-Severe: lower leg is thin and minimal muscle definition
-Look and assess muscle or fat stores on patient (due to weight loss)
-Some tips to remember:
-always ask for a patients permission
-upper body is more susceptible to muscle loss
-muscle loss related to inactivity or bed rest is more prominent in the pelvis and upper legs
-bilateral muscle wasting is more clinically significant than subcutaneous fat loss
-Think of your grandparents or someone older that you know or have seen in your rotations; think of their physical features as we go through what to look for in a physical exam
-inspect and palpate the muscles around the knee (vatus lateralis and vastus medialis); observe and feel for areas of depression on both sides of the patella and prominence of patella
-Normal: patella not prominent, and muscles around knee are visible
-Mild-Moderate: patella slightly prominent; muscles are less obviouss and feel slightly depressed when palpated
-Severe: patella is very prominent, area around knee cap is depressed; muscles are absent
-if you don't see muscle wasting in the upper body, than you should not expect to see it on the lower body
-Must meet two criteria to meet the definition of malnutrition
-Can either be non-severe (moderate) or severe