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Nutrition Assessment:
A method of identifying and evaluating data needed to make decisions about a nutrition-
related problem/diagnosis.
While the type of data may vary among nutrition settings meeting client or community needs,
the process and intention are the same. When possible, the assessment data is compare to
reliable norms and standards for evaluation. Nutrition Assessment initiates the data collection
process providing the base for Nutrition Diagnosis; Nutritional Recommendations/Care
Plan/Nutrition Intervention, and form the foundation for reassessment in Monitoring and
Evaluation.
Beginner:
Dietetic Intern with supervised practice.
At the beginner’s level, “you will identify potential nutrition-related problems by reviewing data
from the patient/client medical charts, which are gathered by the medical team during the physical
examination and comprehensive medical history. You will also look at nursing notes and
assessments, vital signs documentation, rehabilitation therapy (physical, speech, occupational,
respiratory) assessments and progress notes, as well as medication orders, lab test results, measure
of hydration status, anthropometric measurements, food and water intake.” (Litchford, M. (2013)
Putting the Nutrition-Focused Physical Assessment into Practice in Long-Term Care.
x. Auscultation – Medical diagnosis is made by listening to the sounds of the heart, lungs, or
other organs through a stethoscope
y. Quadrants – know the acronym and identify which organs are within each quadrant
1) LUQ – left upper quadrant-stomach, pancreas, left lobe of liver, spleen, left kidney
and adrenal gland.
2) RUQ – right upper quadrant-right kidney, adrnal gland, top of pancreas, duodenum,
liver
3) LLQ – left lower quadrant-desending and sigmold colon, left ovary, fallopian tube
4) RLQ – right lower quadrant-ascending colon, right ovary, right ureter, right ovary
z. Vital Signs – Body temp, pulse, rate, respiration rate, blood pressure
aa. HEENT – examination of the head, eyes, ears, nose, and throat
3. List of implements:
INSTRUMENT USES
Scale measures wt
Tongue Depressor depresses tongue to allow for examination of the mouth and
throat
Vaporizer use to add hot mist to the air to increase moisture in the air
Positive Pressure Ventilator increases the pts airway pressure to allow air to flow into the
airway unit the ventilator breath is terminated
Dialyser removes waste and excess water from the body for those
who have little to no kidney function
Nutrition Focused Physical Assessment Clinical Assignment Due: September 25, 2017
Endoscope a flexible tube with a light and camera used to examine the
digestive tract
4. HEENT
5. Neck
6. Nodes
7. Breasts
8. Chest
9. Heart
10. Abdomen
11. Back/spine
12. Extremities, including exam of pulses
13. Genitalia
14. Rectal
15. Neurologic
a. Mental status
b. Cranial nerves
c. Motor
d. Sensory
e. Cerebellar; posterior column
f. Reflexes
1. Vital signs: Blood pressure: right and left arms; supine and standing; Pulse:
including comments about whether regular vs. irregular respirations; temperature,
anthropometrics (height measured or stated; weight measured standing/bed scale
or stated)
2. General appearance: Should describe whether the patient appears acutely ill or
not, whether the patient is oriented (to time, place, and person)
3. Skin: Texture (dry, supple, moist, etc.) turgor, rash, skin lesion (describe
including location and size if present, icterus, pallor, edema, cyanosis
4. HEENT:
Head: Skull (normocephalic, atraumatic, any deformities), scalp, hair,
distribution
Eyes: Lids (any ptosis?), sclera (any icterus, muddy appearance), conjunctivae
(pale, injected red), cornea (opacified), pupils (PERRLA – Pupils Equal, Round,
React to Light and Accomodation), light reflex (both direct and consensual),
visal acuity, fundoscopic exam (includes description of optic disc, retinal vessels
retinal lesions)
Nutrition Focused Physical Assessment Clinical Assignment Due: September 25, 2017
15. Neurological:
Mental status – level of consciousness, behavior, attention and concentration,
language, memory, abstract reasoning, alert, lethargic, non-responsive, oriented x 3
(a&o x 3 – alert and orientated to person, place, &time)
Cranial nerves – II-XII are listed and checked
Motor – gait (regular, toe, heel, tandem), balance, involuntary movements,
(fasciculation, tremor, chorea, posturing), limb tone (spasticity rigidity, flaccidity),
contracture, strength, muscle bulk (atrophy, hypertrophy), muscle tenderness
Sensory – pinprick, light touch, graphesthesia, sterognosis, double simulation
touch
Cerebellar – gait for ataxia, finger to nose, heel to shin, rapid alternating
movements; standing with feet together and eyes open
Posterior column – vibratory sensation, position sense
Reflexes – deep tendon reflexes: biceps, triceps, knee jerk
VIII. PROBLEM LIST
This is simply a list of all abnormal findings from the history and physical exam.
Related problems may be grouped together (i.e. shortness of breath (SOB),
tachypnea, and abnormal lung exam could be all listed as part of the same
problem). The list should be organized such that the most serious problems are
listed first.
IX. DIFFERENTIAL DIAGNOSIS
A list of disease that the physician can explain the major problems identified on
the problem list. They should be organized such that the most likely diagnoses are
listed first. It is typical to account for as many problems as possible with a single
diagnosis.
X. LABORATORY DATA
A list of abnormal laboratory data will be provided related to the problem list.
Normally it will include BMP (basic metabolic panels) WBC, RBC, sodium,
potassium, chloride, CO2, BUN, creatinine, glucose, calcium, liver enzymes
(ALT/AST), alkaline phosphate
XI. DIAGNOSTIC STUDIES
Depending on the chief complaint and history of present illness, diagnostic studies
will be performed and notes of the physician conducting the studies will be
provided. Diagnostic studies includes but not limited to: CT, U/S (ultrasound), X-
ray, MRI, PET scan, etc.
Nutrition Focused Physical Assessment Clinical Assignment Due: September 25, 2017
BUN
Na+ Cl-
Glucose
K+ HCO3- Creatinine
Hgb
WBC Plts
Hct
Nutrition Focused Physical Assessment Clinical Assignment Due: September 25, 2017
Mean Cell Average volume Alcoholism & B12 iron deficiency &
Volume (MCV) of red blood cells deficiency anemia
Cheilosis –
A. Definition: inflammation and cracks in the corner of the mouth
B. Physical Findings: doesn’t usually require any labs or images to diagnose it.
C. Nutrition Intervention/Deficiency: pt is most likely deficient in B2
Thrush –
A. Definition: Candida albicans accumulates on the lining of the tongue
B. Physical Findings: creamy white lesions on the tongue or cheeks.
C. Nutrition Intervention/Deficiency: Pt may be deficient in iron, folic acid, or B12
EYES
Orbital Fat Pads –
A. Definition: fat pads in the eye that provide support to the eyeball
B. Physical Findings: the eyes look very sunken in.
C. Nutrition Intervention/Deficiency: Abnormal hormones can cause the eyese to look like
they’re bulging out of the sockets
Bitot’s spots –
A. Definition: white or gray triangular deposits on the bulbar conjunctiva next to the lateral
portion of the cornea
B. Physical Findings: It can be confirmed by a specialist or an ophthalmologist. Can be
determined by measuring retinol and blood serum retinol.
C. Nutrition Intervention/ Deficiency: sign of vitamin A deficiency
NAILS
Koilonychias –
A. Definition: abnormally thin nails
B. Physical Findings: nails grow in a way that looks like a ski jump
C. Nutrition Intervention/ Deficiency: Sign of iron deficiency and anemia
Beau’s Lines –
A. Definition: deeply grooved nails from side to side on fingernails and toe nails
B. Physical Findings: grooved lines that cause deep depressions on the nails
C. Nutrition Intervention/ Deficiency: may be the result of injury to the nails or treatment
to a disease like radiation (chemotherapy)
SKIN
Pallor –
A. Definition: pale skin due to decreased oxyhemoglobin levels
B. Physical Findings: the skin on the palms of the hands and the face are pale
C. Nutrition Intervention/ Deficiency: can be caused by high amounts of stress or low
amounts of oxyhaemoglobin.
Nutrition Focused Physical Assessment Clinical Assignment Due: September 25, 2017
Purpura –
A. Definition: blood vessels burst and blood pools under the skin causing spots
B. Physical Findings: purple and red spots on the body
C. Nutrition Intervention/ Deficiency: The underlying cause related to the hemorrhage
should be treated.
Pellagra –
A. Definition: inflamed skin that can appear as lesions on the body
B. Physical Findings: inflamed skin, diarrhea, and sores in the mouth
C. Nutrition Intervention/ Deficiency: Deficient in B3
Jaundice –
A. Definition: A yellow tint to the skin and eyes
B. Physical Findings: yellow/orange bile tint to the skin and eyes of pts
C. Nutrition Intervention/Deficiency: Can be caused by liver disease or excess lysis of red
blood cells
Acanthosis Nigricans –
A. Definition :a skin condition
B. Physical Findings: dark and velvety discoloration in body folds and creases
C. Nutrition Intervention/ Deficiency: Most common in pts with diabetes, overweight, or
obese.
Cyanosis –
A. Definition: blush discoloration on the skin and mucous membranes as a result of excess
concentration of deoxyhemoglobin in the blood as a result of deoxygenation
B. Physical Findings: most prevalent in the mucous of dark skin toned people and on the
skin of lighter skin toned people.
C. Nutrition Intervention/ Deficiency: Can cause lung and heart condition if the oxygen
levels continue to dramatically decrease.
NECK/THYROID
Goiter –
A. Definition: abnormal enlargement of the thyroid gland
B. Physical Findings: pt may develop large thyroid nots that don’t function properly.
C. Nutrition Intervention/ Deficiency: The underlying cause of the condition should be
treated
SKELETAL
Osteoporosis –
A. Definition: brittle bones
Nutrition Focused Physical Assessment Clinical Assignment Due: September 25, 2017
B. Physical Findings: Any magnitude of stress can cause fractures or other complications
within the bones
C. Nutrition Intervention/Deficiency: Pt may be deficient in Vitamin D
Rickets –
A. Definition: softening and weakening of bones
B. Physical Findings: bowed legs
C. Nutrition Intervention/Deficiency: Pt may be deficient in vitamin D and calcium
Scurvy –
A. Definition: swollen and bloody gums
B. Physical Findings: Pt may be weak, tired, and have a loss of appetite
C. Nutrition Intervention/Deficiency: Pt is most likely deficient in Vitamin C
F.) MALNUTRITION
Read the following article to help you answer the following questions:
http://www.andjrnl.org/article/s2212-2672(12)00328-0/pdf
1. List four reasons why malnutrition is a problem.
a. It provides less resources to allow the body to perform its functions
b. It decreases the quality of life
c. It impairs the pts ability to function through day to day activities
d. It can be very timely and costly to make lifestyle changes to accommodate the
malnutrition
3. Discuss the relationship between serum albumin and pre-albumin, weight loss, and
malnutrition.
a. Previously serum albumin and prealbumin have been used as indicators of malnutrition
Serum albumin and prealbumin are not included as defining characteristics of
malnutrition because recent research has shown that proteins don’t change in resposnse
to nutrient intake.
5. List six characteristics that are required for the diagnosis of malnutrition. How many of these
must be present to confirm the diagnosis of malnutrition?
a. Insufficient energy intake
b. Weight loss
c. Loss of muscle mass
d. Loss of subcutaneous fat
e. Localized or generalized fluid accumulation
f. Diminished functional status assessed by handgrip strength
7. Patients with severe acute illness or injury (i.e. Extreme metabolic stress) can develop
malnutrition. List 3 contributing factors.
a. High levels of stress
b. Socioeconomic status (access to healthcare & quality food)
c. Preexisting illnesses or a combination of medical complications
● Most visible
ND Goes through the stomach and Decreased aspiration. Feedings are one very
end in the first portion of the Generally used for kids or slowly and the tubes
small intestine short term tube feeding can move/become
for adults displaced.
Decreased aspiration. This form of tube
NJ Goes through the stomach and
feeding can become
end in the second portion of clogged with food and it
the small intestine can move/become
displaced.
Placed through the abdominal Pt doesn’t have to There is an increased
PEG/G- wall and into the stomach undergo surgery for the risk of aspiration.
TUBE tube to be placed.
Placed into the child’s stomach Decreased aspiration. Pt is most likely placed
GJ and small intestine on continuous feeding.
Placed through the skin and into Decreased aspiration. Pt must undergo surgery
J the small intestine to have the tube placed.
Placed into a vein through a PICC It doesn’t take long for the The tube will most
TPN line or a central line procedure to place the tube likely get clogged
because it is so small.
1.) What determines where feeding tubes are placed?
a. It is dependent on a mixture of things, but primarily on the pts age, the
state of their condition, and the functionality of their organs.