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What is a nutrition focused physical exam?
hands-on assessment specific to nutrition-related components of health
what are the components we look in a NFPE?
body system, muscle, fat, oral health and respiratory system
does the nutrition focused physical exam replace a physical exam?
no
what are the specific concerns and symptoms that a Nutrition Focused Physical Exam look at?
overall appearance, vital signs, skin, digestive, nerve, cognitive, cardiopulmonary system, extremities, head, ear, eyes, nose, throat
what are the clinical characteristics for a diagnosis of malnutrition?
compromise intake, loss of body mass and inflamation
explain the AND/ASPEN critera
diagnosis of malnutrition requires two of the following criteria met
inadequate energy intake, weight loss, muscle wasting, loss of subcutaneous fat, edema and decrease hand grip
explain the GLIM criteria for diagnosing malnutrition
Meet one phenotypic and one etiological sign
Phenotypic- weight loss, low BMI, decrease in muscle mass
etiologic- decrease food intake, inflammation/disease burden
what are the three types of inflammation?
non-starvation, mild-moderate, marked inflammatory response
No inflammation indicates what?
pure chronic starvation, anorexia nervosa
mild to moderate inflammation indicates ________
organ failure, pancreatic cancer, rheumatoid carutrona
marked inflammatory response indicates _____
acute disease/ injury related, infection, burn, trama
what tools are used to perform a nutrition focused physical exam
glove, pen lights
what are the steps to conduct a nutrition focused physical exam
conduct general survey of appearance & compare with findings with notes
available patient data from medical records & sources
evaluate resident body habitus & compare BMI and weight changes to finding
perform hands on physical assessment, focusing on evaluations on body system, skin, hair, nail, oral cavity, nutrition deficency and toxicity
what are the techniques used for NFPE
inspection and palpatation
what is inspection
close observation of detail appearance, behavior and movement
what is palpatation
tactile examination to feel pulsation and vibration
use fingertip pad to assess areas of skin elevation, texture, size, depression, temperature, tenderness and motility
what is normal blood pressure?
120/80
when should lifestyle changes occur (blood pressure)
130/80
what is the range of normal heart rate?
35-90
what is normal respiratory rate?
18-20
what assessments assess for fat loss
orbital assessment, clavicular assessment, upper body
what assessments assess for muscle loss
temporal, clavicular, lowe body
For an orbital assessment, what indicates fat loss?
hallow depression or lose skin in eye area
what is an indication of muscle loss in the temporal region
depression and pitting
what is a sign of muscle and fat loss in the upper body
fat loss at tricep, depression in interosseous muscle, visible bone in torso, depression between rib and shoulder blade
what is a sign of fat and muscle loss in the clavicular region
prominent bone, sharply squared shoulders
what is a sign of muscle and fat loss in the lower body?
bony and minimal muscle
what is the edema scale?
no pitting, mild pitting, moderate pitting, moderate sever pitting, sever pitting
what are the characteristics of no pitting edema?
0 mm depression
what are the characteristics of mild pitting edema?
2 mm depression that disappears rapidly
what are the characteristics of moderate pitting edema?
4 mm depression that disappears after 10 to 15 seconds
what are the characteristics of moderately severe pitting edema?
6 mm depression that last for more than 1 minute
what are the characteristics of severe pitting edema?
8 mm depression that last for 2-5 minutes
what is ascites
adomen edema
what population is at risk for fluid loss?
elderly, farmers, construction workers, athletts, inflants, children, pregnant, dysphagia, congestive heart failure
what are the assessment questions we ask to assess for fluid loss?
difficulty swallowing, access to water, difficulty of drinking water in comparison to thick liquids, sunken eye appearance, mucous membrane dry
what are the physical signs of fluid loss?
dry scaling skin with crack lips
cheilosis
dry mucosa membrane
tongue sunken and deep furrow
corner of mouth splitting
what are ways we can assess for fluid loss?
skin tenting, capillary refill time
casal necklace is an indication of
low niacin
how does the casal necklace form?
decrease in niacin → pellagra → diarrhea, dementia → thick scaly dark pigmented rash
what is acanthosis nigricans an indication of?
hyper insulin
what is acanthosis nigricans?
increase brownness of skin → area of dark, thick, velvety skin in body fold & creases
patches occur when skin cells rapidly produce → abnormal skin growth
what are the risk factors for acanthosis nigricans
obesity, insulin resistance, metabolic syndrome, hypertension, dyslipidemia, pituitary gland, hypothyroidism, growth hormone therapy
what is jaundice an indication of
excess serum of bilirubin
why does jaundice symptom yellowish skin?
excess amount of serum bilirubin dissolve in subcutaneous fat causing the color
what is cyanosis an indication of?
lack of oxygen
why in cyanosis is there blue skin?
increase concentration in cutaneous blood vessels
what are the different types of anemia?
iron deficiency anemia, pernicious anemia, megaloblastic and microcytic anemia
what is anemia
a blood disorder that occurs when the body doesn't have enough healthy red blood cells, or when red blood cells don't function properly
what is koilonychia?
spoon shaped concave nail as a result of need of oxygen
what is koilonychia an indication of?
iron deficiency, malnutrition, protein deficiency,lupus, raynaud, need oxygen
what is a beau line?
horizontal line depression in the nails
what is a beau line an indication of?
severe infection, heart attack, uncontrolled diabetes, malnutrition, chemotherapy
what is cheilosis?
a fungi bacteria
Cheilosis indicates ___
b vitamin deficiency
iron deficiency
what is stomatitis?
inflamed and sore mouth
what is stomatitis an indication of?
b vitamin deficiency, malnutrition, iron deficiency
what is cachexia?
physical wasting, malnutrition associated with chronic disease
what is glossitis?
tongue swollen and inflammed
what is goiter
swelling to thyroid gland, enlarge neck
what is stunting?
low height for age as a result of long term, inadequate food intake or poor quality diet
what is wasting?
low weight for height, develop rapidly & reversed quickly with appropriate nutrional support
what is normal classification numbers for wasting?
90-110%
what is mild deficit classification numbers for wasting?
80-89%
what is moderate deficit classification numbers for wasting?
75-79%
what is severe deficit classification numbers for wasting?
< 75% or with edema
what is normal classification numbers for stunting?
95-105%
what is mild deficit classification numbers for stunting?
90-94%
what is moderate deficit classification numbers for stunting?
85-89%
what is severe deficit classification numbers for stunting?
< 85%
what is a pressure uncler?
localized injury to skin and underlying tissue in a bony prominence due to pressure and friction which obstructs circulation
what nutrients promotes wound healing?
energy, protein and zinc?
what are the stages of pressure ulcers?
suspected deep tissue injury, 1, 2, 3 , 4 and unstageable/unclassified
what is suspected deep tissue injury?
purple/ maroon area, discolored intact skin/ blood fill blister, tissue may be painful, mushy, boggy, and different temperature than surrounding tissue
what is stage 1 of pressure ulcers?
nonblanchable erythema, intact skin and localized redness
what is stage 2 of pressure ulcers?
partial thickness, open redness skin (epididymis)
what is stage 3 of pressure ulcers?
full thickness skin loss, subcutaneous fat and slosh visible
what is stage 4 of pressure ulcers?
full thickness tissue, expose to bone, tendon or slough, tunneling
what is unstageable/ unclassified pressure ulcer?
full thickness tissue lost, dept hidden by eschar
usually stage 3 or 4
what are stages of wound healing?
hemostasis, inflammation, proliferative and modeling
what is hemostasis?
blood clotting
platelet activation, adhesion and aggregation growth factor
what is inflammation?
partial granulation
vessels leask water, salt and protein - swelling
increase in neutrophils, cytokines, macrophages
warm
what is proliferative?
partial granulation progress to full
cell synthesis of granulation tissue
scab forms
what is remodelling?
fully granulated
What is static test?
measurement based on the measurement of nutrients on metabolites in urine, blood, or body tissue. Readily available. Indicates nutrient levels in tissue or fluid but fails to reflect overall nutrient status reflect overall nutrition status
what is functional test?
based on outcome of nutrient deficiency which is the failure of the physiological process. says general nutrient status but no identification of specifics.
what are somatic proteins?
found within skeletal muscle (75%)
what are visceral proteins?
proteins found within organs or viscer of the body (liver, kidney, pancreas, heart, RBC, serum) (25%)
what does nitrogen balance indicate?
proteins in the body
what does a positive nitrogen balance indicates?
protein intake exceeds output
when is a positive nitrogen balance needed?
during stages of growth (pregnancy, puberty)
what is a negative nitrogen balance?
when output is greater than input (muscle depletion)
we can typical find a negative nitrogen balance in
cancer cachexia patients
what is balance nitrogen balance?
input = output
in healthy adults
what are the different types of protein that shows up in a blood test?
ferritin, hematocrit, hemoglobin, prealbumin, transferrin, albumin
what does albumin do?
maintain fluid balance of the body
what is the half life of albumin?
14 to 20 days
what is albumin an indication of?
depleted protein status over several weeks
___ % of albumin is found outside the blood stream?
60
what is the normal range of albumin
3.5-5 g/dL
Note 
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