Nursing 110 - Module 2

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Nursing 110 - Module 2
2014-10-24 11:46:57

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  1. Afebrile
    Without a fever
  2. Alveoli
    Terminal ends of the respiratory tree

    Sites of gas exchange with the blood

    Alveolar membrane is the gas-exchange surface

    Carbon dioxide rich blood is pumped from the rest of the body into the alveolar blood vessels where, through diffusion, it releases its carbon dioxide and absorbs oxygen
  3. Apical
    The adjective for apex

    • The tip of a pyramidal or rounded structure,
    • such as the lung or the heart
  4. Abnormal sounds that are heard over a patient's lungs and airways
    Adventitious Breath Sounds
  5. Stopping of external breathing
  6. Atelectasis
    Collapse or closure of the lung resulting in reduced orabsent gas exchange

    May affect part or all of one lung

    Alveoli are deflated

    NOT the same as pulmonary consolidation
  7. To listen
  8. Blood Pressure
    • The pressure exerted by circulating blood upon the walls of
    • blood vessels

    One of the principal vital signs
  9. Resting heart rate less than 60 beats per minute (adult)
  10. Abnormally slow breathing rate
  11. Tubular, hollow sounds which are heard when auscultating over the large airways

    They will be louder and higher-pitched in expiration

    Heard best over the trachea

    Also heard on the back between the scapulae and at the lung apices
    Bronchial Breath Sounds
  12. Breath sounds are heard across the lung surface

    Lower-pitched, rustling sounds with higher intensity during inspiration

    During expiration, sound intensity can quickly fade

    Normally 2-3 times the length of expiration
    Vesicular Breath Sounds
  13. Bronchovesicular Breath Sounds
    Sounds intermediate between bronchial and vesicular breath sounds

    • Normal when heard between the 1st and 2nd intercostals spaces anteriorly and posteriorly
    • between scapulae
  14. Cyanosis

    Appearance of a blue or purple coloration of the skin or mucous membranes

    Due to the tissues near the skin surface having low oxygen saturation

    Develops when arterial oxygen saturation drops to 75-85%
  15. The first (top) number in a blood pressure reading

    Amount of pressure heart generates when pumping blood
    through your arteries to the rest of your body
    Systolic Pressure
  16. Diastolic Pressure
    The second (bottom) number in a blood pressure reading

    Amount of pressure in your arteries when your heart is at rest between beats
  17. Medical term for shortness of breath
  18. Ecchymosis
    Subcutaneous purpura

    Escape of blood into the tissues from ruptured blood vessels

    Looks like a bruise (not the same,bruises are considered hand in hand with trauma)
  19. Eupnea
    Normal, good, unlabored ventilation

    AKA quiet breathing or resting heart rate

    Expiration employs only the elastic recoil of the lungs
  20. Movement of air out of the bronchial tubes, through the airways, to the external environment during breathing
    Exhalation / Expiration
  21. Medical term for having a fever
  22. Flushing
    A redness of the skin, typically over the cheeks or neck

    Usually temporary

    Brought on by excitement, exercise, fever, or embarrassment

    Involuntary response of the nervous system leading to widening of the capillaries of the involved skin
  23. Extremely high fever (106°F +)
  24. Hypertension
    High blood pressure (hypertension) of 140/90 mmHg or above most of the time

    Considered a chronic condition
  25. Hypotension

    Definition & Causes
    Low blood pressure (below 90/60)

    • Can be caused by
    • Reduced blood volume (hypovolemia)
    • Hormonal changes or endocrine problems
    • Widening of blood vessels
    • Medicine side effects
    • Anemia
  26. Hypothermia

    Definition & Causes
    • Dangerously low body temperature
    • Below 95 °F (35 °C)

    • Can be Caused By
    • Cold exposure for a prolonged period (Mountain Climbing)

    Elderly, infants, babies in 60 degree house after power outage

    Diabetes,thyroid conditions, medications, severe trauma

    Severe use of alcohol
  27. Hypoxia
    • Reduction of oxygen supply to a tissue below physiological
    • levels

    • May be classified as generalized
    • (affecting the whole body) or local
    • (region of the body)
  28. Movement of air from the external environment, through the airways, and into the alveoli
    Inhalation / Inspiration
  29. Jaundice
    Jaundice is a yellow color of the skin, mucus membranes, or eyes

    Yellow coloring comes from bilirubin, a byproduct of old red blood cells

    Often seen in liver disease (hepatitis, liver cancer)

    • Seen in infants
    • Common condition, usually no treatment needed
    • Because liver not mature yet to get rid of bilirubin in the bloodstream
  30. Korotkoff Sounds
    Blood flow sounds that healthcare providers observe while taking blood pressure with a sphygmomanometer over the brachial artery

    Sounds appear and disappear as the blood pressure cuff is inflated and deflated
  31. Orthopnea
    Shortness of breath (dyspnea) which occurs when lying flat
  32. Orthostatic Pressure
    A form of hypotension in which a person's blood pressure suddenly falls when standing up or stretching

    Caused by blood pooling in the lower extremities upon a change in body position

    Common and can occur briefly in anyone

    Prevalent in elderly & those with low blood pressure
  33. Pale / Pallor
    Abnormal loss of color from normal skin

    • May be the result of
    • Decreased blood supply to the skin

    Decreased number of red blood cells (anemia)

    Can be general (whole body) or affect only a region (limb)

    Most easily seen on the face, lining of the eyes, inner mouth, and nails
  34. Using hands to examine the body
  35. Tapping body parts with fingers, hands, or small instruments
    as part of a physical examination

    Used in clinical examinations to assess the condition of the
    thorax or abdomen
  36. Petchiae (Petechia)
    (pronounced puh-TEE-kee-ee)
    Pinpoint, round spots that appear on the skin as a result of bleeding under the skin

    Red, brown or purple

    Commonly appear in clusters and may look like a rash

    Usually flat to the touch

    Don't lose color when you press on them

    • Can be caused by prolonged straining during activities such as
    • Crying
    • Coughing
    • Vomiting
    • Childbirth
    • Weightlifting
  37. Pulse
    The rhythmic dilation of an artery that results from beating of the heart

    Often measured by feeling the arteries of the wrist or neck
  38. Pulse Deficit
    Difference between heart beats and pulsations at the periphery

    Determined by simultaneous palpation at radial artery & auscultation of heart apex

    Subtract radial pulse from apical pulse
  39. Pulse Oximetry
    Non-invasive method for monitoring a patient's O2 saturation

    Placements of a clip on a thin part of the patient's body, usually

    Fingertip, earlobe, across a foot (infant)
  40. Pulse Pressure
    The difference between the systolic and diastolic pressure readings

    Represents the force that the heart generates each time it contracts

    If BP is 120/80 then pulse pressure is 40
  41. Medical term for fever
  42. The transport of oxygen from the outside air to the cells
    within tissues

    Transport of carbon dioxide in the opposite direction
  43. Spirometer
    Apparatus for measuring the volume of air inspired and expired by the lungs

    Identifies two different types of abnormal ventilation patterns (obstructive & restrictive)
  44. Stertorous
    Noisy & lazy breathing characterized by heavy snoring or gasping

    Caused by partial obstruction of airway above the level of the larynx

    Verses stridor which is caused by turbulent air flow below or in the larynx
  45. Stridor
    A high-pitched breath sound resulting from turbulent air flow in the larynx or lower in the bronchial tree

    Caused by a narrowed or obstructed airway

    Can be inspiratory, expiratory or biphasic

    Usually heard during inspiration

    Inspiratory stridor often occurs in children with "croup."

    • Possible Causes
    • Epiglottitis
    • Foreign body lodged in the airway
    • Laryngeal tumor
  46. Tachycardia
    Heart rate that exceeds the normal range

    More than 100 bpm in adults
  47. Tachypnea
    Rapid breathing

    More than 20 breaths per minute in adults (12-20 is normal)
  48. Thoracentesis

    What is it?
    When is it done?
    Common Causes for its need?
    Invasive procedure to remove fluid or air from the pleural space

    A cannula (hollow needle) is introduced into the thorax after administer of local

    Fluid can yield clinically useful info

    • Indicated When
    • Unexplained fluid accumulates in the chest cavity outside the lung          

    Therapeutically to improve patient comfort and lung function

    • Common Causes for Need
    • Cancer, CHF, pneumonia, recent surgery
    • TB (in some countries)
  49. (Skin) Turgor

    How to test for it?
    Skin’s ability to change shape and return to normal (elasticity)

    Sign used by health care workers to assess fluid loss or dehydration

    Grasp skin on the back of the hand, lower arm, or abdomen between two fingers

    Skin should tented up & is held for a few seconds then released

    Normal turgor snaps rapidly back to its normal position

    Decreased turgor remains elevated and returns slowly to its normal position
  50. Crackles (Rales)
    Caused by the "popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration

    • Found in patients with
    • Pulmonary
    • Edema due to Left sided CHF
    • Pneumonia
    • Asthma
    • COPD
  51. Wheezes

    Continuous, coarse, whistling sound

    Most commonly wheezing occurs during expiration

    • Narrowing of the airways can be caused by            
    • Inflammation from asthma
    • Infection                  
    • Allergic reaction           
    • Physical obstruction (tumor, inhaled foreign object)
  52. Gurgles (Rhonchi)
    Rattling respiratory sound somewhat like snoring

    Usually caused blockages to bronchial airways by mucous, lesions, or foreign bodies

    Pneumonia, chronic bronchitis, cystic fibrosis

    Coughing can sometimes clear this breath sound and make it change to a different sound
  53. Cheyne–Stokes Respiration
    Abnormal pattern of breathing

    Progressively deeper and sometimes faster breathing, followed by a gradual decrease that results in a temporary apnea

    Pattern repeats every few minutes
  54. Normal Labs for the following
    RBC 4.2 - 5.1 million (cells/mcL)

    WBC 5000-10,000 mcL

    • Hematocrit
    • 42-50% (male)
    • 40-48% (female)

    • Hemoglobin
    • 13-18 gm/dL (male)
    • 12-16 gm/dL (female)
  55. Most accurate measure of respiratory function
    Arterial Blood Gas

    Uses radial artery

    Needs 3 minutes of pressure once needle comes out
  56. Best time of the day to collect sputum?
    • First thing in the morning
    • First cough up is best
  57. The fetal circulation contains how many umbilical veins & arteries?
    • 1 umbilical vein
    • 2 umbilical arteries
  58. Foramen Ovale
    An opening between the right & left atria

    Allows oxygenated blood to enter the left atrium bypassing the pulmonary circulation
  59. The umbilical vein bifurcates at the base of the ______ with the branches going to...

    First branch unites with portal vein supplying the liver

    Second branch forms the ductus venosus
  60. Ductus Venosus
    One of the two branches from the umbilical vein

    Shunts oxygenated blood into the inferior vena cava
  61. In fetal circulation, the _________ receives both oxygenated & deoxygenated blood.

    Oxygenated blood enters the heart thru the ________

    Deoxygenated blood enters the heart thru the _________
    Right Atrium

    Inferior Vena Cava

    Superior Vena Cava
  62. Ductus Arteriosus
    Shunts blood from the pulmonary arteries to the descending aorta

    Allowing blood to bypass the lung
  63. Core Foods
    • Provide significant source calories
    • Regularly included in diet on daily basis                                   
    • Typically complex carbs '
    • (rice, wheat, millet, corn, potatoes, plantains)
  64. Secondary Foods
    • Foods that are wide spread in diet but not eaten consistently                                               
    • Typically a veggie, legume, nuts, fish, eggs, or meat                                               

    Chinese consume mung beans & soybeans                                                        

    Latin America consume black & pinto beans
  65. Peripheral / Occasional Foods
    Foods eaten sporadically based on individual preferences not cultural norms
  66. acronym DETERMINE

    What does the acronym stand for?
    What is it used for?
    Used to identify risk factors for warning signs of poor nutritional health

    D – Disease (any illness chronic or acute)

    E – Eating (poorly, too little or too much)

    T – Teeth & Mouth (missing teeth, sores in mouth, dentures not fitting)

    E – Economics (Hardships)

    R – Reduced social contacts

    • M – Medications (Multiple medications can interfere with taste, appetite. Many cause constipation, diarrhea, nausea)

    • I – Involuntary weight loss or gain

    N – Needs (Patient needs assistance in self-care, ADLs, transportation to get food)

    E – Elderly (80+ years of age)
  67. What groups that are at high risk for malnutrition?
    Severely over or under weight

    Loss of 15% of body weight

    Anyone NPO longer than 5 days

    Severe diarrhea, vomiting, burns

    • Increased metabolic needs (trauma,
    • burns, fever)

  68. Hematocrit definition

    If a patient has an elevated hematocrit it could mean ___________

    decreased hematocrit could mean ___________

    What are the normal lab values?
    Proportion of total blood volume that is composed of red blood cells

    • Dehydration
    • Anemia

    • 36-54% generally
    • Males are higher (40-54%)
    • Females are lower (36-46%)
  69. What is a serum albumin test?

    What are the normal ranges?

    What does it mean if a patient has a decreased value of serum albumin?
    Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood

    Normal Level is 3.5 - 5.5 g/dL

    Prolonged protein depletion
  70. What does BUN stand for?
    What does it mean?
    What are the normal ranges?

    If an increase or decrease is seen in patient, what does it mean in terms of nutrition?
    Blood Urea Nitrogen

    Liver produces ammonia — which contains nitrogen — after it breaks down proteins

    Nitrogen combines carbon, hydrogen and oxygen, to form urea

    Urea travels from liver to kidneys

    kidneys filter urea and remove other waste products from your blood.

    Filtered waste products leave body through urine

    Higher than normal may mean kidneys or liver not functioning properly

    Nutrition Terms

    • Increased
    • Starvation, high protein intake, severe dehydration

    • Decrease
    • Over hydration, malnutrition

    • Normal Ranges
    • Adults:    8 - 21 mg/dL
    • Children: 15-18 mg/dL

    Patients on dialysis:  40-60 mg/dL
  71. What is Creatinine test?

    What are the normal ranges?

    What does it mean if a patient has an increase / decreased value of Creatinine in terms of nutrition?
    • A chemical waste product produced due to muscle metabolism
    • kidneys filter creatinine blood & the waste products leave body in urine

    • Normal Level
    • 0.4-1.5 mg/dL

    • Increased
    • Dehydration

    • Decrease
    • Reduction in total muscle mass, could be severe malnutrition

    • Creatinine Test - Urine
    • Serum Creatinine Test - Blood
  72. What is a Hemoglobin Test?

    What does it mean if a patient has higher or lower levels of it?

    What is the normal lab range?
    Hemoglobin is a protein in RBCs that carry oxygen to organs and tissues and transports carbon dioxide back to lungs.

    • Low Hemoglobin
    • Patient has anemia related to vitamin deficiencies, bleeding or chronic disease(s)

    • High Hemoglobin
    • Polycythemia
    • Live in a high altitude
    • Smoking
    • Dehydration
    • Burns
    • Excessive vomiting

    • Normal Lab Range
    • Adults: 12-18 mg/dL
    • Females: 12-15 mg/dL  (11 is not worrisome)
    • Males:   13-17 mg/dL
  73. What are indicators of malnourishment that can be observed from just looking at a patient?
    Hair & its condition

    Tongue is red, purple, & smooth

    Fat deposits around joints

    Nails are pale, spoon shaped, brittle

    • Swollen abdomen (Think: Children
    • in commercials with thin limbs & swollen torso)
  74. Normal average house diet is ______ calories
  75. Liquid diets are ________________

    What are the various forms & its purposes
    Transitional diet when eating resumes after acute illness, surgery

    • Each of the following diets are a progression from the previous
    • (i.e. patient advances from clear to full liquid diet)

    • Clear Liquid Diet
    • Foods that are clear at room temperature

    Gelatin, fat free broth, ice pops, clear juice, soda, tea, coffee (with no creamer)

    • Inadequate in calories and most nutrients
    • Progression to more nutritious alternative is needed

    • Full Liquid Diet
    • Anything that can be poured at room temperature

    • Milk, pudding, custards, plain frozen dessert
    • Pasteurized eggs, cereal gruels, veggie juices

    High calorie & protein supplements are recommended if on this diet 3+ days

    • Soft Diet
    • Canned fruit, avocado, potatoes (no skin)
    • No raw fruits or vegetables
    • White rice (not brown)
    • No whole grains

  76. NPO means
    Nothing by Mouth

    Implemented before surgery to prevent aspiration due to anesthesia

    After surgery until bowel sounds return

    2+ days will require either nutritional support enteral or parenteral
  77. Enteral vs Parenteral Nutrition
    • Enteral Nutrition
    • Administering directly into stomach                       

    • Parenteral Nutrition
    • Administering via IV
  78. Vitamins are...

    • Organic compounds needed by the body in small amounts           
    • Active in form of coenzymes (with enzymes to facilitate chemical reactions in body)           
    • Do not provide energy like calories            Needed for metabolism of carbs, protein, & fats           
    • Not synthesized or insufficient amounts in body
  79. Water Soluble Vitamin
    • Absorbed thru intestinal wall directly into bloodstream
    • Not stored in body
    • Excess of need excreted in urine
    • Megadoses can occur causing toxicity

    Daily intake recommended as deficiency symptoms develop quickly            

    Niacin,Folic Acid, Vitamin C, & B complex vitamins
  80. Vitamin C
    Water Soluble Vitamin

    • Production of collagen
    • Improves iron absorption
    • Helps bone marrow form red blood cells        
    • Broccoli, Brussel sprouts, citrus, strawberries
  81. Vitamin B1

    Water Soluble Vitamin

    • Metabolize energy from proteins
    • Maintain normal nervous system
    • functioning                       

    Organ meat, green leafy veggies, whole enriched grains
  82. Vitamin B2
    Water Soluble Vitamin

    Metabolize carbs, proteins, fats (especially dairy products)

    Organ meats, eggs, enriched grains
  83. Vitamin B6
    Water Soluble Vitamin

    Blood formation, maintenance of nervous tissues

    Yeast, whole wheat, whole grains, pork

    Amino Acid
  84. Vitamin B12
    Water Soluble Vitamin

    Synthesis of RNA & DNA

    Blood formation

    Meat, fish, seafood, milk, eggs

    Vegans need B12 injections
  85. Vitamin B3 (Niacin)
    • Water Soluble Vitamin
    • Promote nervous system
    • Supplements are popular but cause flushing
    • Enriched whole grains, yeast, poultry, liver, kidney
  86. Vitamin B9 (Folic Acid)
    Water Soluble Vitamin

    DNA & RNA synthesis

    Formation of mature RBCs

    Very important for child bearing women

    Organ meats, OJ, green leafy veggies, dried beans
  87. Fat Soluble Vitamins
    Absorbed with fat into lymphatic circulation

    Must attach to a protein to be transported thru blood

    Excess stored in liver & adipose tissue

    Daily intake not imperative

    Excessive intake of Vitamin A & D can be toxic

    Vitamins A, D, E, & K
  88. Vitamin A
    Fat Soluble Vitamin

    Vision, bone health, teeth development, skin & hair

    • 2 Types of Vitamin A
    • Retinol
    • Milk, liver, fish

    • Beta Carotene
    • Green leafy veggies, deep yellow veggies

    • Toxic in excess
    • Slow growth, dry skin, & decreased appetite in newborns
    • Enlarged spleens, livers
  89. Form of Vitamin A found in

    Milk, liver, fish
  90. Type of Vitamin A found in

    Green leafy veggies, pumpkin, carrots, sweet potatoes
    Beta Carotene
  91. Vitamin D
    Fat Soluble Vitamin

    • Skin & skeletal development
    • Calcium & phosphorous metabolism

    • Fortified milk
    • 15 minute sunlight (no sunscreen)

    • Deficiencies
    • Rickets, knocked knees

    • Toxic in Excess
    • Weightless, calcification in soft tissue
    • Excessive urination
  92. Vitamin E

    Fat Soluble Vitamins

    • Maintain membranes
    • Calcium reabsorption from kidney
    • Anti-oxidant

    Veggie oil, whole wheat products
  93. Vitamin K
    Fat Soluble Vitamins

    • Blood clotting
    • Regulate blood calcium
    • Production prothrombin
    • Production coagulation

    • Eggs, liver, dark green leafy veggies
    • Anything from cabbage family
  94. Macrominerals
    Minerals needed by the body in amounts greater than 100 mg/day

    Aka Bulk Minerals

    • Examples
    • Calcium, phosphorus, sulfur, sodium, chloride, potassium, & magnesium
  95. Calcium
    A Macromineral

    Healthy bone, teeth, blood clotting, normal heart beat, muscle contraction

    Absorption of B12

    Dairy products, canned fish with bones, green leafy veggies

    Normal serum value in body is 8.4-10.2 mg/dL

    Recommended Daily Amount 1,000 mg / day
  96. Phosphorus
    A Macromineral

    • Bone & teeth formation
    • Energy metabolism
    • Acid base balance

    Eggs, poultry, dairy, fish

    • Normal serum value in body is 2.5-4.5 mg/dL
    • Recommended Daily Amount 700 mg /day
  97. Magnesium
    A Macromineral

    Bone & teeth formation

    Smooth muscle relaxation

    Normal serum value in body is 1.8-2.4 mg/dL

    Recommended Daily Amount 310-420 mg /day
  98. Sodium
    A Macromineral

    • Has + charge
    • Majorly comprised in extra cellar fluid
    • Water, Acid / Base Balance

    Normal serum value in body is 135-145 mEq/L

    Recommended Daily Amount 1,500 mg/day
  99. Potassium
    A Macromineral

    • Major intracellular fluid
    • Has + charge

    • Normal serum value in body is 3.5-5 mEq/L
    • Cardiac function, acid base balance

    Whole grains, leafy green veggies, potatoes, fruits (bananas)
  100. Chlorine
    A Macromineral

    • Gastric acidity
    • Needed for stomach to produce acid to digest food

    Has negative (-) charge

    Recommended Daily Amount 2,300 mg / day
  101. Microminerals
    Needed by body in amounts lesser than 100 mg/day

    Aka Trace Minerals

    • Examples
    • Iron, zinc, manganese, chromium, copper, selenium, fluoride, iodine
  102. Iron
    A Micromineral

    Hemoglobin formation

    Liver, lean meats, enriched cereals
  103. Iodine
    A Micromineral

    Thyroid hormone (to function correctly)

    • Seafood, iodized salt (not always available in other
    • countries)

    Deficiency causes goiters
  104. Zinc
    A Micromineral

    Tissue healing, growth, development

    Beats, liver, oysters, dried peas, beans, liver, some meats
  105. Minerals
    • Elements found in all body fluids & tissues
    • in the form of salts

    Can be combined with organic compounds

    Provide structure within body or regulate body processes

    Minerals = elements

    Not broken down or rearranged in body
  106. Hypovolemia
    Fluid volume deficit caused by loss of water & solutes in the same proportion from the ECF space

    aka Isotonic Fluid Loss
  107. Anorexia
    Medical term for "loss of appetite"
  108. Hypervolemia
    Excessive retention of water & sodium in ECF in near equal proportions

    • Caused by
    • Malfunction of kidneys (inability to excrete)

    Failure of heart to function as a pump (fluid accumulates in lungs)

    aka Excess of Isotonic Fl
  109. Anthropometric
    The science dealing with measurement of the size, weight, and proportion of the human body
  110. Basal Metabolic Rate (BMR)
    • Rate of energy expenditure at rest
    • Measured in kJ per hour per kg body mass
  111. Dysphagia vs. Dysphasia
    • Dysphagia
    • Difficulty in swallowing

    • Dysphasia
    • Partial or complete impairment of the ability
    • to communicate
    • Resulting from brain injury
  112. Edema
    Swelling is the enlargement of organs, skin, or other body parts.

    Caused by a buildup of fluid in the tissues.

    The extra fluid can lead to a rapid increase in weight over a short period of time (days to weeks).
  113. Enternal Nutrition
    Feeding into the GI tract

    Peg Tube
  114. Prolactin
    Protein best known for its role in enabling female mammals to produce milk
  115. Vegetarian Food Guide Pyramid
    Nutrition guide that represents a traditional healthy vegetarian diet

  116. What is MyPlate?
    The current nutrition guide published by the United States Department of Agriculture

    It replaced the USDA's MyPyramid guide on June 2, 2011, ending 19 years of USDA food pyramid diagrams

  117. Nutrient
    A substance that provides nourishment essential for growth and the maintenance of life
  118. Malnutrition is...
    Condition that occurs when body does not get enough nutrients

    • Face
    • Moon face

    • Eyes
    • Dry eyes, pale conjunctiva
    • Mouth
    • spongy bleeding gums (vitamin C)

    • Teeth
    • Enamel mottling

    • Hair
    • Dull, sparse, brittle hair, alopecia

    • Skin
    • Loose and wrinkled
    • shiny and edematous
    • dry, poor wound healing

    • Nail
    • Thin and soft nail plates, fissures or ridges

    • Musculature
    • Muscles wasting, particularly in the buttocks and thighs

    • Skeletal
    • Deformities usually a result of calcium, vitamin D, or vitamin C deficiencies

    • Abdomen
    • Distended - hepatomegaly with fatty liver, ascites may be present

    • Neurologic
    • Global development delay, loss of knee and ankle reflexes, poor memory
    • Behavior
    • Lethargic, apathetic