Clinical Method Flashcards
What is the clinical method?
- Medical history
- Physical exam
- Interpretation of signs and symptoms
“Take a look at them!”
What type of ‘medical history’ information is collected?
- Medical factors relevant to nutrition assessment obtained by interview, review of records, and surveys
- Chief complaint
- Present/past illness
- Current health
- Past surgeries
- Psychosocial factors
- Family history of disease
- Use of medications
List as many medical history factors important to nutrition assessment that you can.
- Allergies/intolerances
- Appetite
- Bowel habits
- Chronic diseasees
- Dysphagia
- Edema/ascites
- Food purchase/prep
- Food likes/dislikes
- Living conditions
- Medications
- Nausea/vomiting
- Snack consumption
- Supplements
- Taste alterations
- Weight loss
Describe the nutrition-focused physical exam component of the clinical method.
- Best way to start a physical assessment - “Take a look”
- Practical and simple; integral component of assessment
- Skin
- Eyes
- Oral cavity
- Throat
- Hair, nails
- Bones, joints
- Neurologic (e.g., headaches, peripheral neuropathy, lethargy)
- Edema
Describe the systematic ‘head-to-toe’ approach of an NFPE. [4]
- Inspection: observations
- Palpation: gentle tactile examination
- Percussion: assessment of sounds (e.g., tapping on body)
- Auscultation: listening to abdominal sounds using stethoscope
What are two benefits of using the clinical method?
What is a ‘sign’?
- Observations made by a qualified examiner
- Can be felt, heard, or seen by examiner
- May or may not be noticed by patient
- Often measurable
- E.g., Blood pressure; heart rate; weight loss; grip strength
What are ‘symptoms’?
- Feelings reported by patient
- Assist the examiner in diagnosing the problem
- E.g., Fatigue; pain in knee; altered appetite; fever; pain
What are two limitations of using the clinical method?
What are the causes of nutritional deficiencies? [5]
Clinical method
- Inadequate intake (food insecurity, lack of food literacy, ED, absorption disorders)
- Poor absorption (e.g., celiac disease, IBS, excess alcohol consumption)
- Increased requirement (i.e., during phases of growth like childhood or pregnancy, during certain diseases)
- Increased losses (e.g., severe burn injury, chronic illness like poorly managed type II diabetes)
- Altered metabolism (e.g., due to environmental pollution, medications, genetics)
What is a primary deficiency?
Caused by inadequate dietary intake
What is a secondary deficiency?
Caused by underlying disease process in the body that alters nutrient intake, absorption, utilization, requirement, storag and/or excretion
What is a subclinical nutrient deficiency?
Declining nutrient stores (not meeting requirements, but not severe enough to see signs and symptoms - can’t really tell via clinical method)
What is covert deficiency?
Stable state where body has adapted to low reserves; no clinical signs appear until body is exposed to stress, trauma, growth… etc.
Deficiency is hidden. e.g., vitamin C deficiency
What is overt deficiency?
Classic clinical deficiency where it is severe enough that clinical signs and symptoms present.
What is the MNA for older adults and what are the questions?
Mini Nutritional Assessment (validated malnutrition screening and assessment tool for people > 65); asseses:
* Dietary intake over past 3 months
* Weight loss over past 3 months
* Functional capacity
* Illness, psychological stress
* Food intake
* BMI
