Clinical Assessment Flashcards
What is Clinical Assessment?
- estimation of nutritional status on the basis of
- recording a medical history and conducting a physical examination
- to detect signs symptoms
What are the uses of Clinical Assessment?
• Community nutrition survey
• Clinical medicine (prior to nutrition counseling)
At what stage in the development of nutrition deficiency is the clinical method used?
7th - Clinical Symptoms
8th - Anatomical Sign
What are the components of Clinical Assessment?
- Detailed History (Medical and Dietary)
- Thorough physical examination
- Interpretation of signs and symptoms associated with malnutrition
What are the components of Medical History?
- Past and current diagnosus of nutritional consequence
- Diagnostic procedures
- Surgeries
- Chemotherapy and Radiation therapy
- History of nutrition-related problems
- Existing nutrient deficiencies
- Medications and their interactions
- Psychosocial history
- Signs or symptoms suggestive of vitamin and/or mineral deficiency
What are the types of Medical Record?
- Source-oriented (SOMR)
- Problem-oriented (POMR)
What is an ongoing collection of information that documents a patient’s medical care, considered a legal document, and a complete assessment - history, physical exams, discharge notes, diagnostic & laboratory tests
Medical record
What is an SOMR?
• Based on source of information - doctor, nurse, RND etc.
• Obtained during the course of health care
• Consists of patient identification data, admission notes, physician’s orders, laboratory reports, medication records, consents, consultations, operating room records, progress notes, and flow sheets
What is a POMR?
• Organized according to series of problems identified during the data collection process
• Consists of defined data base, complete problem list, initial care plan, progress notes, flow sheets, and discharge summary
What are the components of a Dietary History?
- Weight changes
- Usual meal pattern
- Appetite
- Satiety
- Discomfort after eating
- Chewing/swallowing ability
- Likes/ Dislikes
- Taste changes/ Aversions
- Allergies
- Nausea/ Vomiting
- Bowel habits
- Living conditions
- Snack consumption
- Vitamin/Mineral supplement use
- Alcohol/Drug use
- Previous diet restrictions
- Surgery/Chronic diseases
- Ability to purchase and prepare food
- Access to and ability to pay for health care
What is a nutrition-focused physical examination?
• a physical exam that RDNs perform to assess nutritional status or evaluate malnutrition.
What are the 4 things RNDs assess during a NFPE?
- physical health
2.level of frailty or fitness, - posture, and
- body symmetry
What are the limitations of physical examination?
- Non-specificity of the physical sign
- Multiple physical signs
- Signs may be two-directional
- Examiner inconsistencies
- Variation in the pattern of physical signs
What is a SGA?
Clinical technique for assessing the nutritional status of a patient based on features of the patient’s history and physical examination
Elements of the Patient’s History as basis for SGA
Weight loss
Changes in usual diet
Significant gastrointestinal symptoms
Patient’s functional status
Elements of a Patients PHYSICAL EXAM as basis for SGA
• Loss of subcutaneous fat
• Muscle wasting
• Presence of edema or ascites
SGA Ranking Class A
Recent increased in weight, improvement in appetite
SGA Ranking Class B
At least 5% weight loss, reduced dietary intake, mild ot moderate loss of subcutaneous fat and muscle wasting
SGA Ranking Class C
Weight loss >10%, poor dietary intake, severe loss of subcutaneous fat and muscle wasting
What is a Mini Nutritional Assessment?
Designed to provide primary care professionals with a single tool to efficiently identify elderly patients and nutritionally at-risk individuals who may subsequently need a more extensive nutritional assessment
Effective for screening hospitalized elderly and those requiring surgery
What are signs suggestive of Dietary Obesity?
• Excessive weight in relation to height or other indices
• Excessive skinfolds
• Excessive abdominal girth in relation to chest girth
What are signs suggestive of Undernutrition?
• Lethargy, mental and physical (starvation)
• Low weight in relation to height or other skeletal indices
• Diminished skinfolds
• Exaggerated skeletal prominences
• Loss of elasticity of the skin
What are signs suggestive of protein-calorie deficiency disorder?
● Edema
● Muscle wasting
● Low body weight
● Psychomotor change
● Dyspigmentation of the hair
● Easy pluckability of hair
● Thin, sparse hair
● Moon-face
● Flaky paint dermatosis
● Diffuse depigmentation of the skin
What are signs siggestive of VAD?
● Xerosis of the skin
● Follicular hyperkeratosis (Type 1)
● Xerosis conjunctivae
● Keratomalacia
● Bitot’s spot
What are signs suggestive if Iron Deficiency?
● Pallor of mucous membranes
● Koilonychia
● Atropic lingual papillae
What are signs suggestive of Iodine Deficiency?
• thyroid enlargement
What are signs suggestiv of Riboflavin Deficiency?
● Angular stomatitis (or angular scars)
● Cheilosis
● Magenta tongue
● Central atrophy of lingual papillae
● Naso-labial dyssebacea
● Angular palpebritis
● Scrotal and vulval dermatosis
● Corneal vascularization
What are signs suggestive of Thiamin Deficiency?
● Loss of ankle jerks
● Loss of knee jerks
● Sensory loss and motor weakness
● Calf-muscle tenderness
● Cardiovascular dysfunction
● Edema
What are signs suggestive of Niacin Deficiency?
● Pellagrous dermatosis
● Scarlet and raw tongue
● Tongue fissuring
● Atrophic lingual papillae
● Malar and supraorbital pigmentation
What are signs suggestive of Vit C Deficiency?
● Spongy and bleeding gums
● Follicular hyperkeratosis (Type 2)
● Petechiae
● Ecchymoses
● Intramuscular or subperiosteal hematoma
● Epiphyseal enlargement (painful)
What are signs suggeative of Vit D Deficiency?
Active rickets (in young children)
● Epiphyseal enlargement (>6 months, painless)
● Beading of ribs
● Craniotabes (<1 year)
● Muscular hypotonia
Healed rickets (in children or adults)
● Frontal and parietal bossing
● knock-knees or bow-legs
● Deformities of the thorax
Osteomalacia (in adults)
● Local or generalized skeletal deformities
What are the differences between acute PEM and Chronic PEM?
Acute PEM
• Caused by recent severe food restriction
• Characterized in children by thinness for height
Chronic PEM
• Caused by long-term food deprivation
• Characterized in children by short height for age
What is Kwashiorkor?
• Results from protein deficiency and is commonly precipitated by an illness or infection
What is Maramus?
• Results from severe deprivation, or impaired absorption of energy, protein, vitamins, and minerals
Differentiate Marasmus and Kwashiorkor
see notes
Explain Clinical and Subclinical VAD
Clinical
• Detected physical signs and symptoms by examiner and patient, respectively
Subclinical
• Absence of clinical evidence of disease
• Subject has no complaints of being ill
• Examiner unable to elicit any physical signs of disease
Explain the stages of VAD
Subclinical
• Reducing stores
• Lowering serum level
• Metaplasia
Clinical
• Xerophthalmia
- non-binding
- binding
