Transcript Weight gain

CHAPTER 6
GROWTH AND MEASUREMENT
. an imprint of Elsevier Inc.
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"Who in the world am I? Ah, that's the great
puzzle." --Lewis Carroll
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GROWTH AND MEASUREMENT
Weight and body composition offer much information about
an individual’s health status and often provide a clue to
the presence of disease when they are out of balance
Focus is on the evaluation of individual’s anthropometric
parameters and the examination for growth, gestational
age, and pubertal development
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PHYSICAL EXAMINATION PREVIEW
From the history, assess the patient’s size, including the
following:
 Recent growth, weight gain, or weight loss
 Chronic illnesses affecting weight gain or loss
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PHYSICAL EXAMINATION PREVIEW
(CONT.)
Obtain the following anthropometric measurements, and
compare them to those in standardized tables:
 Standing height
 Weight
 Frame size
 Calculate the body mass index.
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ANATOMY AND PHYSIOLOGY
Growth is the increase in size of an organ or person.
Growth depends on sequence of endocrine, genetic,
constitutional, environmental, and nutritional influences.
Through the biologic process of development and
maturation, individual organ systems acquire function.
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GROWTH DIFFERENCES BY
ORGAN SYSTEM
Brain: peak fetus, early infancy
Skeleton: peak fetus, infancy, adolescence
Muscle: peak fetus, adolescence
Adipose: peak infancy, adolescence
Lymphoid: peak age 10 to 12 years
Neural: peak age 4 to 14 years
Genital: peak adolescence
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INFANTS AND CHILDREN
Fetus
 Head growth predominates
Infant
 Trunk growth predominates
 Weight gain at rapid but decelerating rate
Child
 Legs are fastest growing
 Weight gained at steady rate
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Figure 6-03. Changes in body proportions from 8 weeks of gestation through adulthood.
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ADOLESCENCE
Trunk and legs elongate.
50% of ideal weight is gained.
 Of adults who become obese
 30% are obese during childhood
 70% are obese during adolescence
Skeletal mass and organ systems double
in size.
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PREGNANT WOMAN
Progressive weight gain is expected.
Fetus is 6 to 8 lb of weight gained.
Rest of gain is from increase in maternal tissue
and fluids.
 Weight gain is slow in first trimester and rapid in second
trimester and slows in third trimester.
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OLDER ADULT
Stature declines in older adult, beginning at 50 years of age.
 Thinning intervertebral discs
 Development of kyphosis with osteoporotic vertebral
compression
An increase in overweight and obese older adults has been
documented over the past 15 to 20 years.
A decrease in weight for height and body mass index has
been found in longitudinal studies among individuals
over age 60.
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OLDER ADULT (CONT.)
A loss of 5% body weight over several years often occurs.
 Accompanied by an increase in body fat as skeletal muscle
declines
 Most likely due to decreased exercise and reduced anabolic
steroid secretion
An age-associated reduction in the size and weight of
various organs has been identified.
 Liver
 Lungs
 Kidneys
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HISTORY OF PRESENT ILLNESS
Weight loss and weight gain
 Undesired weight loss, anorexia, vomiting or diarrhea, difficulty
swallowing, excessive thirst, frequent urination, change in
lifestyle, activity and stress levels
 Medications: chemotherapy, diuretics, insulin, fluoxetine, diet
pills, laxatives, steroids, oral contraceptives
Changes in body proportions
 Coarsening facial features, enlarging hands/feet, moon facies
 Change in fat distribution
 Medication: steroids
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PAST MEDICAL HISTORY
Chronic illness
 Gastrointestinal
 Renal
 Pulmonary
 Cardiac
 Cancer
 HIV or other infections
 Allergies
Previous weight loss or gain efforts
 Weight at 21
 Maximum body weight
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FAMILY HISTORY
Obesity
Constitutionally short or tall stature
 Precocious or delayed puberty
Genetic or metabolic disorder
 Cystic fibrosis
 Dwarfism
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PERSONAL AND SOCIAL HISTORY
Usual weight and height
Activity and exercise pattern
Use of alcohol
Use of recreational drugs
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INFANTS
Estimated gestational age, birth weight, length, head
circumference
Following an established percentile growth curve
Development: achieving milestones at appropriate ages
Congenital anomaly or chronic illness
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CHILDREN AND ADOLESCENTS
Sexual maturation of girls: early (before 7 years) or delayed
(beyond 13 years); signs of breast development and
pubic hair, age at menarche
Sexual maturation of boys: early (before 9 years) or delayed
(beyond 14 years); signs of genital development and
pubic hair
Short or tall stature
Medications: steroids, growth hormones
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PREGNANT WOMEN
Pregnancy weight, dietary intake
Age at menarche
Date of last menstrual period, weight gain pattern, following
established weight gain curve for gestational course
Eating disorders
History of pica (eating laundry starch, ice, clay, raw rice)
Nausea and vomiting
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OLDER ADULTS
Chronic debilitating illness
 Problems with meal preparation
 Difficulty feeding self, chewing, swallowing, poorly fitting
dentures
 Ability to follow prescribed diet
 Difficulty with digestion
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EQUIPMENT
Standing platform scale with height attachment
Skinfold thickness calipers
Measuring tape
Infant scale
Recumbent measuring device (for infants)
Stature-measuring device (for children)
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WEIGHT AND STANDING HEIGHT
Weight
Height
Frame size
 Determined to assess the appropriateness of a person’s
weight for age, height, and gender when using weight tables
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BODY MASS INDEX
The most common method used to assess nutritional status
and total body fat
For adult men and women, the following are classifications
of weight for height by BMI values (kg/m2):
 Undernutrition―under 18.5
 Appropriate weight for height―18.5 to 24.9
 Overweight―25 to 29.9
 Obese―30 to 39.9
 Extreme obesity―40 and higher
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CALCULATING THE BMI
The formula to calculate the BMI using pounds (be sure to
convert ounces to a decimal) and inches:
 [weight in pounds ÷ (height in inches)2 ] × 703
The formula to calculate the BMI using kilograms and
centimeters:
 weight in kg ÷ [height in meters]2
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INFANTS
Recumbent length
Weight
Head circumference
Chest circumference
Gestational age
Size for gestational age
 Classification
Weight Percentiles
 Appropriate for gestational age (AG) 10th to 90th
 Small for gestational age (SGA)
Less than 10th
 Large for gestational age (LGA)
Greater than 90th
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CHILDREN
Stature and weight
 BMI is now standardized for use in children and adolescents,
and it is calculated the same way as for adults
 Underweight ‒ BMI for age under the 5th percentile
 At risk of overweight ‒ BMI for age greater than the 85th
percentile
 Overweight ‒ BMI for age greater than the 95th percentile
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CHILDREN (CONT.)
Upper/lower segment ratio
 A higher upper-to-lower body segment ratio than expected may
be associated with dwarfism or bone disorders
Arm span
 Arm span that exceeds height is associated with Marfan
syndrome
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SEXUAL MATURATION
Assessing growth and development of the older child and
adolescent includes evaluating the patient’s sexual
maturation.
The height growth spurt and timing of other physiologic
events are associated with the stage of secondary sexual
characteristic development.
Sexual maturation
 Girls: breast, pubic hair, menarche
 Boys: genital development, pubic hair, ejaculation
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Sexual Maturation – Male and Female
Sexual maturation
 Female: breast, pubic hair, menarche
 Male: genital development, pubic hair, ejaculation
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Sexual Maturation - Females
Figure 6-09. Five stages of breast development in females. (From Frisch, 1972. Reproduced with
permission from Pediatrics, volume 49, by the AAP.)
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Figure 6-10. Six stages of pubic hair development in females. (From Frisch, 1972. Reproduced with
permission from Pediatrics, volume 49, by the AAP.)
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SEXUAL MATURATION - MALES
Figure 6-11. Five stages of penis and testes/scrotum development in males. (From Frisch, 1972.
Reproduced with permission from Pediatrics, volume 49, by the AAP.)
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Figure 6-12. Six stages of pubic hair development in males. (From Frisch, 1972. Reproduced with permission from
Pediatrics, volume 49, by the AAP.)
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PREGNANT WOMEN
Weight gain
 Weight gain during pregnancy should be calculated from the
woman’s prepregnancy weight.
 To provide guidance in weight gain during pregnancy, first
determine the prepregnancy body mass index (BMI).
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PREGNANT WOMEN (CONT.)
Weight gain
 Monitor the woman’s weight throughout pregnancy using the
BMI weight gain curve guidelines on the prenatal weight gain
chart.
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OLDER ADULTS
Measurement procedures for the older adult are the same as
those used for the general population.
Compare the individual’s weight for height, and triceps
skinfold thickness by gender and age.
Approximately 60% of adults over age 65 years are
overweight with a BMI greater than 25, and 20% are obese
with a BMI greater than 29.
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ABNORMALITIES
Acromegaly
 A rare disease of excessive growth and distorted proportions
caused by hypersecretion of growth hormone and insulin-like
growth factor after closure of the epiphyses
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ABNORMALITIES (CONT.)
Cushing Syndrome
 A disorder associated with a prolonged and excessively high
exposure to glucocorticoids
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ABNORMALITIES (CONT.)
Turner syndrome
 A genetic disorder in which there is partial or complete absence
of a second X chromosome
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ABNORMALITIES (CONT.)
Hydrocephalus
 An excess volume of cerebrospinal fluid (CSF) in the brain
leading to an enlarged head circumference
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ABNORMALITIES (CONT.)
Failure to thrive
 Growth in an infant or child below the 3rd to 5th percentiles on
a growth chart, or
 Slower than normal rate of growth in a short period of time
(e.g., from the 50th percentile to below the 10th percentile on
the growth chart)
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ABNORMALITIES (CONT.)
Growth hormone deficiency
 Failure of the anterior pituitary to secrete adequate growth
hormone to support growth in stature
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ABNORMALITIES (CONT.)
Precocious puberty
 The onset of secondary sexual characteristics before 7 years of
age in girls and 9 years of age in boys with progressive sexual
maturity
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