EXAM AREAS MUSCLE LOSS (continued)
Shoulder and Acromion Process Region (Deltoid Muscle)
Scapular Bone Region (Trapezius, Supraspinatus, Infraspinatus Muscles)
Dorsal Hand (Interosseous Muscle)
Patient arms at side. Look for “rounded” vs. “squared” shape.
Prominent protrusion of acromion process and bones. Squared off appearance of shoulders. Minimal to no muscle tone/resistance.
Ask patient to extend hands straight out, push against solid object or your hand.
Look at the area between the metacarpal bones of the thumb and index finger while the thumb is pressed against the index and middle finger.
Anterior Thigh and Patellar Region (Quadriceps Muscles)
Ask patient to sit with leg propped up with knee bent. Look for rounded musculature. Assess the four muscles of the quadriceps on top, inner, outer thigh to the patella.
Posterior Calf Region (Gastrocnemius Muscle)
EDEMA
Lower and Upper Body, Scrotum, Vulva
(Rule out other causes of edema)
Assess feet, ankles, lower and upper extremities. View scro- tum/vulva in activity-restricted patient. Obtain dry weight.
PHYSICAL EXAM: DESCRIPTIONS OF NFPE FINDINGS PEDIATRIC MALNUTRITION INDICATORS
Deep to very deep pitting, indentation lasts 31 to >60 seconds, significant swelling (3-4+).
Mild to moderate pitting, indentation lasts 0-30 seconds, mild to moderate swelling (1-2+).
No sign of fluid accumulation.
Grasp the calf muscle/bulb while having patient point and flex their foot.
Prominent, visible bones. Depressions around scapula bone with minimal to no resistance in muscles.
Deep depression. Minimal to no muscle tone/resistance.
Slight protrusion of acromion process. Decrease in muscle tone/resistance.
Slight protrusion of the scapula bone, mild depressions. Decrease in muscle tone/resistance around scapula bone.
Slight depression. Decrease in muscle tone/resistance.
Rounded, curves at shoulder/arm juncture. Feel muscle tone/resistance.
Bones not prominent, no significant depressions. Feel muscle tone/resistance.
Muscle may bulge or be flat, no depression. Feel muscle tone/resistance.
Noticeable depressions along thigh; patella prominent, square appearance. Minimal to no muscle tone/resistance in quadriceps to patella.
Absence of bulb shape. Minimal to no muscle tone/ resistance.
Slight depression along inner/outer thigh; patella slightly prominent. Feel decrease in muscle tone/ resistance in quadriceps to the patella.
Some shape to the bulb, but not well-developed. Decrease in muscle tone/resistance.
Well-rounded, well- developed; patella not prominent. Feel muscle tone/resistance in quadriceps to patella.
Well-developed bulb with feel of tone/resistance of muscle in grasp.
TIPS
SEVERE LOSS
MILD–MODERATE LOSS
WELL-NOURISHED
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