Physical examinations – This book covers the entire syllabus of “Nutrition and Dietetics” prescribed by BNMC-for all Diploma in Nursing Science and Midwifery students. We tried to accommodate latest information and topics. This book is examination friendly setup according to the teachers’ lectures and examination’s questions. At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourished. The unique way of presentation may make your reading of the book a pleasurable experience.
Physical examinations
Weight for Height
Weight-for-height For children can be used as an alternative to weight-for-age as an index of nutritional adequacy; for adults it is the only acceptable way of expressing weight relative to ideal or desirable weight.
Basal Metabolic Rate (BMR)
The amount of minimum energy required to carry on the basic involuntary (internal) work of the body is known as Basal Metabolic Rate (BMR).
OTHER DEFINITIONS-NICE TO KNOW
Basal metabolic rate (BMR), and the closely related resting metabolic rate (RMR), is the amount of energy expended daily by humans and other animals at rest. Rest is defined as existing in a neutrally temperate environment while in the post-absorptive state. In plants, different considerations apply.
BMR refers to the, energy spent by a person while in a state of absolute physical and mental rest.
(Ref: Essential of Human Nutrition/1/11)
BMR is the amount of energy required by a person who is awake but he is nearly as possible as at complete mental and physical rest and has had no food for 12-24 hours. This is BMR.
(Ref: T. K. Indrani/1/2)
The Basal Metabolic Rate (BMR) is the rate at which the body uses energy for the chemical process that keeps up alive and warm and that build tissues and secrete fluid.
(Ref: Nutrition for Developing Countries/24/16)
Factors Affecting Basal Metabolic Rate:
1. Sex: Women have 6 to 10% lower basal metabolic rate when compared to men. The influence of sex hormone accounts for the difference.
2. Age: The BMR is highest during the first 2 years of life. It declines gradually throughout childhood and accelerates slightly in adolescence. The rapid growth rate explains the high metabolic rate in early childhood.
3. Sleep: During the sleeping hours the BMR is about 10% lower than in waking state.
4. Body temperature: An elevation in body temperature increases the basal metabolic by 13a/o for each degree centigrade {7% each degree Fahrenheit].
5. Endocrine glands: The thyroid gland regulates the rate of energy metabolism and any change in thyroid activity is reflected in the metabolic rate. If the thyroid is overactive (Hyperthyroidism) the metabolism may be increased to as 75 to 100% and if the activity is reduced, then the metabolism may be reduced to 30 to 400/o. The growth hormones that stimulate new tissue formation are responsible for the higher metabolism generally observed infants, children and teenagers.
6. When the persons are severely under nourished, there is destruction of body tissue which lowers the basal metabolic rate.
7. Pregnancy: During pregnancy and lactation there is general increase in the basal metabolic rate. During the last trimester the basal metabolic rate increases from 15 to 25%0. This increase can be accounted for almost entirely by increase in the weight of women and high rate of metabolism.
8. Climate: Depending on the climatic conditions also the basal metabolism increases or decreases. The thyroid gland can adjust to the climatic changes. Their decreased basal metabolism rate in tropical climates and increased metabolic rate in colder climates.
Cholesterol:
Cholesterol is a soft, fatlike substance found in the bloodstream. It comes from the animal source foods we eat and the cholesterol our body makes. Too much cholesterol can clog the blood vessels and lead to strokes and heart attacks.
Why should be concerned about cholesterol?
Should be concerned about it because: In the body, cholesterol is used to-
- Manufacture bile salts. About 80 percent of cholesterol is used by the liver to help produce bile salts. Bile salts are stored in the gallbladder and used to help in the digestion and absorption of fat in the diet.
- Produce hormones. Provides the basis of several important steroid hormones produced in the adrenal glands, ovaries, and testes.
- Maintain the integrity of cell membranes. Every cell uses cholesterol to construct its protective membrane and maintain its shape. Cholesterol also helps form a special barrier against various substances, making cells resistant to the penetration of certain liquids and keeping water from leaving your body too quickly. Without cholesterol, it is estimated that you would lose four to five gallons of water per day through evaporation, instead of the usual 10 to 14 ounces.
- Produce vitamin D. Cholesterol is an essential ingredient for making vitamin D.
- By itself, cholesterol is only a problem in the body when it becomes oxidized. When cholesterol becomes oxidized, it can damage artery linings and set the stage for mineral and fat deposits that lead to blockages.
Q. How will we prevent or decrease high cholesterol in the blood?
Answer:
1. Increase fiber:
- Whole wheat bread.
- Hot cereals (oatmeal).
2. Increase exercise:
- Walking three times per week if doctor approves.
3. Follow these suggestions:
- Limit intake of, meats, poultry and seafood to no more than 5-7 oz per day.
- Use fish, chicken or turkey in most of our main meals, limiting “red” meats to 3-4 servings per week.
- Use “low-meat” dishes or vegetables protein dishes such as dried beans or peas for regular entrees.
- Use low-fat dairy products-2 cups skim milk daily.
- Limit egg yolks to 2 per week including those in cooking. (1 egg: 274 mg cholesterol)
- Limit added fat to 5-8 teaspoons daily. Use soft margarines, vegetable oils (olive oil, too) in cooking.
Measurement Techniques of Arm Circumference:
Equipment:
1. A measuring tape.
2. A Shakir strip.
3. An insertion tape
Arm circumference/Mid-upper-arm circumference measurement:
- The measurement of mid-upper-arm circumference (MAC) serves as an Index for skeletal muscle mass and protein reserve. Instruct
- The client to relax and flex the forearm; with a measuring Tape, measure the circumference at the midpoint of the upper Arm.
Abdominal-Girth Measurement:
Equipment:
- A measuring tape.
- A Shakir strip.
- An insertion tape,
Abdominal-girth measurement:
- When made repeatedly over a span of time, an abdominal girth measurement serves. As an index as to whether abdominal distention is increasing,
- Decreasing, or remaining the same. With an indelible pen, place An X on the client’s abdomen at the point of greatest distention. Using a measuring tape, measure the abdomen’s circumference.
Q: Why it is difficult to measure weight-for-height?
Answer:
Measuring a child’s height can take time and it can be difficult to do accurately. We also have to weigh the child which takes more time. Then we have to look the weight for height up a in a complex table. The whole procedure can take a long time and it can be difficult to interpret the measurements. The method is very useful for research and it is useful for in-patient care of severely malnourished children, but it is not very useful for growth monitoring. The extra time is better spent in taking to families.
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