Final Nutriton Assessment

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