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Assessment – Nutrition-Focused Physical Exam to Detect Micronutrient Deficiencies
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Skin turgor refers to the elasticity of the skin. To assess turgor, pinch the skin on the arm or hand to form a tent; it should spring back within one to two seconds. Poor skin turgor may be a sign of dehydration; however, skin loses elasticity with age, thus poor turgor in adults over 65 years of age may occur in the absence of dehydration. Therefore, a thorough diet history and in-depth assessment of hydration status should be conducted to correctly identify the underlying etiology.
Neonatal Care
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Sylvia Garry, Andrew Chapman, Elizabeth Ledger
All newborns should be referred to hospital if they are not feeding 6 hours after delivery or have stopped feeding since (this indicates possible sepsis). Later and concerning signs include jaundice, sleepiness, poor feeding, sunken fontanelle, weight loss and increased skin turgor. If there are any signs of concern (also see Box 13.3.4) or an inability to feed (e.g. due to prematurity or newborn illness), the family should be referred immediately to a hospital or paediatrician for further review. If dehydrated, the newborn may require hospital admission for NG feeding or IV fluids. Sepsis should always be considered.
Body fluids and electrolytes
Published in Peate Ian, Dutton Helen, Acute Nursing Care, 2020
Skin turgor can be assessed by gently pinching the skin over the forearm, sternum or dorsum of the hand (see Figure 4.6). If the patient is adequately hydrated, the skin will return to its original position when released. Skin turgor can also be tested over the clavicle; in patients with hypovolaemia, the pinched skin may remain elevated for several seconds. However, an older patient’s skin may have lost elasticity, so this can be an unreliable measure of dehydration.
Remodelling of the superficial vascular network of skin flaps in rats, following a vasodilatory cream application, before elevation
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Glykeria Pantazi, Iraklis Evangelopoulos, Christos Evangelopoulos, Sofia Tilaveridou, Ioannis Iakovou, Athanassios Kyrgidis, Ioannis Tilaveridis
The beneficial effects of prostacyclins have been well documented, with both local and systemic application of prostaglandin Ε1 (PGE1) and PGI2 showing positive effects on flap survival [9,19]. Additionally, experiments using both PGE1 and PGI2 consistently report improvements in skin flap survival and/or increased blood flow in the proximal region [9,20,21], with PGI2 reportedly outperforming PGE1 in these areas [22]. Previous studies described improvements in thigh-vein circulation following PGI2 administration and that PGI2 treatment decreased turgor pressure in the arterial wall, resulting in decreased interference of blood flow and clot formation [23,24]. Moreover, systemic administration of PGI2 has also been associated increased flap survival rates [15]; however, these application have little therapeutic value due to the chemical instability and small half-life of PGI2 (2–3 min at pH 7.5 and 37 °C). Furthermore, Emerson and Sykes [19] reported negative results associated with flap survival following local and intraperitoneal administration of PGI2 prior to surgery, attributing this to the short half-life of the drug; however, a later experiment injecting PGI2 at both the beginning of surgery and post-operation revealed an increase in flap survival.
‘Drink clean, safe water and/or other fluids through-out the day even if you do not feel thirsty’: a food-based dietary guideline for the elderly in South Africa
Published in South African Journal of Clinical Nutrition, 2021
Upasana Mukherjee, Carin Napier, Wilna Oldewage-Theron
Small reductions in fluid intake or increased output can lead to severe dehydration.2 A reduction of total body water (TBW) is defined as dehydration and it can be brought about mainly by two mechanisms: water loss or electrolyte or salt loss.23 Water is also stored in the muscle mass of the body so a loss in muscle mass and increase in fat mass (which is associated with ageing) also leads to a decline in TBW.10 Chronic use of certain drugs like diuretics, corticoids and metformin as well as their route of administration have been shown to affect hydration status of the elderly in clinical studies.25,26 The elderly are particularly at risk of unrecognised dehydration because, in many cases, in the early stages of dehydration, no signs are present and dehydration is only detected when it is in the severe stage.26 Clinical signs of dehydration include oral dryness (tongue furrows, dry mucous membranes), weight loss, skin turgor, constipation, orthostatic hypotension and urine concentration.
Bacteremia with Staphylococcus pseudintermedius in a 4 month old pediatric oncology patient
Published in Journal of Chemotherapy, 2020
Leah D. Blondeau, Joseph E. Rubin, Harry Deneer, Rani Kanthan, Stephen Sanche, Nicole Beshard, Chris Mpofu, Joseph M. Blondeau
Patient JH, born in December, 2017, was diagnosed with an adrenal neuroblastoma (Stage L1) and underwent resection for such in February, 2018. He did not receive any chemotherapy. On April 29th, 2018 he was admitted through the emergency department with a 2 day history of fever (38.9 °C) and hematuria. He had been administered acetaminophen at home by his parents. On examination he was quiet and lethargic, continuously licking his lips which were dry along with his tongue and oral mucosa. His skin was uniformly dry and scaly, consistent with eczema, which had been noted since birth. His fontanelle was slightly sunken and skin turgor was significantly reduced. Cardiovascular and abdominal examinations were unremarkable. Two days earlier he developed loose frequent stools and vomiting and his oral intake over the past 24 hours was poor. None of his family members were sick. He was not on any medications. The patient was noted to have eczema on his face, arms and legs in a follow-up visit in October, 2018 with many areas broken from scratching. Eczema was noted from birth and appears important with this case.