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. Copyright © 2015 by Mosby, an imprint of Elsevier Inc. Chapter 6 Growth and Measurement

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Chapter 7 Body Systems

Chapter 6Growth and Measurement

. Copyright 2015 by Mosby, an imprint of Elsevier Inc.

Copyright 2015 by Mosby, an imprint of Elsevier Inc.

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Growth and MeasurementWeight and body composition offer much information about an individuals health status and often provide a clue to the presence of disease when they are out of balanceFocus is on the evaluation of individuals anthropometric parameters and the examination for growth, gestational age, and pubertal development2

Copyright 2015 by Mosby, an imprint of Elsevier Inc.

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Physical Examination PreviewFrom the history, assess the patients size, including the following:Recent growth, weight gain, or weight lossChronic illnesses affecting weight gain or loss3

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Physical Examination Preview (Cont.)Obtain the following anthropometric measurements, and compare them to those in standardized tables:Standing heightWeightFrame sizeCalculate the body mass index.4

Copyright 2015 by Mosby, an imprint of Elsevier Inc.

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Anatomy and Physiology5

. Copyright 2015 by Mosby, an imprint of Elsevier Inc.

Copyright 2015 by Mosby, an imprint of Elsevier Inc.

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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.6

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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 adolescence7

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8Figure 6-02.Growth rates for the body as a whole and three types of tissues. Lymphoid type: thymus, lymph nodes, and intestinal lymph masses. Neural type: brain, dura, spinal cord, optic apparatus, and head dimensions. General type: body as a whole; external dimensions; and respiratory, digestive, renal, circulatory, and musculoskeletal systems. Genital type: includes the reproductive organ system. (From Wong, 1999; modified from Harris et al, 1930.)

Differences in Growth by Organ System (Cont.)

Copyright 2015 by Mosby, an imprint of Elsevier Inc.Infants and ChildrenFetusHead growth predominates Infant Trunk growth predominates Weight gain at rapid but decelerating rateChild Legs are fastest growing Weight gained at steady rate9

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10Figure 6-03.Changes in body proportions from 8 weeks of gestation through adulthood.

Copyright 2015 by Mosby, an imprint of Elsevier Inc.Children and AdolescentsSexual maturation of girls: early (before 7 years) or delayed (beyond 13 years); signs of breast development and pubic hair, age at menarcheSexual maturation of boys: early (before 9 years) or delayed (beyond 14 years); signs of genital development and pubic hair11

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AdolescenceTrunk and legs elongate.50% of ideal weight is gained.Of adults who become obese30% are obese during childhood70% are obese during adolescenceSkeletal mass and organ systems double in size.12

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Pregnant WomanProgressive weight gain is expected. Fetus is 6 to 8 lb of weight gained.Rest of gain is from increase in maternal tissue and fluids.Fluid volume: 2 to 3 lbBlood volume: 3 to 4 lbBreast enlargement: 1 to 2 lbUterine enlargement: 2 lbAmniotic fluid: 2 lbMaternal fat and protein stores: 4 to 6 lbWeight gain is slow in first trimester and rapid in second trimester and slows in third trimester.13

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Older AdultStature declines in older adult, beginning at 50 years of age.Thinning intervertebral discsDevelopment of kyphosis with osteoporotic vertebral compressionAn 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 60.14

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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 declinesMost likely due to decreased exercise and reduced anabolic steroid secretionAn age-associated reduction in the size and weight of various organs has been identified.LiverLungs Kidneys15

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Examination and Findings16

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Weight and Standing HeightWeightHeightFrame sizeDetermined to assess the appropriateness of a persons weight for age, height, and gender when using weight tables17

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Body Mass IndexThe most common method used to assess nutritional status and total body fatFor adult men and women, the following are classifications of weight for height by BMI values (kg/m2):Undernutritionunder 18.5Appropriate weight for height18.5 to 24.9 Overweight25 to 29.9 Obese30 to 39.9Extreme obesity40 and higher18

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InfantsRecumbent lengthWeightHead circumferenceChest circumferenceGestational ageSize for gestational age Classification Weight PercentilesAppropriate for gestational age (AGA) 10th to 90thSmall for gestational age (SGA) Less than 10thLarge for gestational age (LGA) Greater than 90th

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ChildrenStature and weightBMI is now standardized for use in children and adolescents, and it is calculated the same way as for adultsUnderweight BMI for age under the 5th percentileAt risk of overweight BMI for age greater than the 85th percentileOverweight BMI for age greater than the 95th percentile20

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Children (Cont.)Upper/lower segment ratioA higher upper-to-lower body segment ratio than expected may be associated with dwarfism or bone disordersArm spanArm span that exceeds height is associated with Marfan syndrome21

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22Figure 6-08.Measuring the stature of a child.

Copyright 2015 by Mosby, an imprint of Elsevier Inc.Pregnant WomenWeight gainWeight gain during pregnancy should be calculated from the womans prepregnancy weight. To provide guidance in weight gain during pregnancy, first determine the prepregnancy body mass index (BMI).23

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Older AdultsMeasurement procedures for the older adult are the same as those used for the general population.Compare the individuals 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. 24

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