Lecture 2 Flashcards by Delayne van Dijk

When doing a clinical/physical examination what is the purpose?

To look for clinical signs and symptoms reflecting nutritional status
-S&S usually in later stages of malnutrition

How well did you know this?

Not at all

Perfectly

What is the general procedure of the assessment?

Ask for informed consent 
-inform, answer Q's, ask consent
Be cautious
-wash hands before and after
Respect privacy and confidentiality
Make them feel comfortable
Proceed head to toe

How well did you know this?

Not at all

Perfectly

In the outline for the physical exam what do we look for in the general survey?

Overall appearance
Contractures
Body Positioning
Ability to communicate
Level of consciousness
Body habitus 
Amputations (BKA, ABA)
Surgical ostomies, wounds, drains
Vascular access devices

How well did you know this?

Not at all

Perfectly

What are ostomies and where are they found?

Having a bag on the outside of the body to catch matter as it passes through the large intestine

Found on either ascending transverse or defending colon

How well did you know this?

Not at all

Perfectly

Which side of an ostomie produces more liquid?

The right side because stuff going through the ascending colon has more liquid and hasn’t been absorbed back into the body

How well did you know this?

Not at all

Perfectly

What is a central line?

Parenteral nutrition which is delivered through the armpit into the superior vena cava

How well did you know this?

Not at all

Perfectly

What is a PICC line?

Peripheral
Inserted
Central 
Catheter
-inserted in the right arm and enters through superior vena cava

How well did you know this?

Not at all

Perfectly

What is a peripheral line?

Parenteral nutriton inserted via arm vein

-cant use all formulas with this method

How well did you know this?

Not at all

Perfectly

What is the overall appearance of PEM?

Square shoulders
Muscle wasting
Edema
Skin thinning

How well did you know this?

Not at all

Perfectly

What is the overall appearance of marasmus??

Generalized muscle wasting and lack of subcutaneous fat

How well did you know this?

Not at all

Perfectly

What is the overall appearance of someone with a Zn deficiency?

Stunted growth

How well did you know this?

Not at all

Perfectly

What is the overall appearance of someone with Vitamin D deficiency?

Compressed spine or rickets (knocked knee or bowed legs)

How well did you know this?

Not at all

Perfectly

When conducting the exam what vital signs do we look for?

BP
Temp
Respiration
Radial Pulse

How well did you know this?

Not at all

Perfectly

When conducting the exam what anthropometrics do we look for?

Hight
Weight
Skinfold Thickness
Muscle Tone and Mass

How well did you know this?

Not at all

Perfectly

When conducting the exam what do we look for on the skin?

Colour/pigmentation
Lesions
Edema
Texture/moisture
Trugor (elasticity)
Vascularity
Ecchymosis (under skin bleeding)
Petechiae (small coloured spots on skin)
Wounds/ulcers

How well did you know this?

Not at all

Perfectly

What is Pallagra dermatitis?

Skin lesions/ scaly skin

-Niacin and tryptophan deficiency

How well did you know this?

Not at all

Perfectly

When someone just has a niacin decificeny what is the result?

Pellagra

Diarrhea
Dermatitis
Dementia
Death

How well did you know this?

Not at all

Perfectly

What does Vitamin C deficiency look like?

Perifollicular petechiae (little spots), hemorrhage

impaired wound healing
Scurvy

How well did you know this?

Not at all

Perfectly

What are the symptoms of a Zn deficiency?

Scaly, Erythematous rash around mouth chin nose and palm of hands

How well did you know this?

Not at all

Perfectly

What are the symptoms of Vitamin B6 deficiency?

greasy dermatitis (around mouth, and skin looks greasy)

How well did you know this?

Not at all

Perfectly

What are symptoms of Vitamin A deficiency?

Hyperkeratosis (hardened skin, small tiny bumps)

Yellow Skin colouration

How well did you know this?

Not at all

Perfectly

What are symptoms of vitamin K deficiency?

Easy skin bruising (can’t clot blood efficiently)

How well did you know this?

Not at all

Perfectly

What are symptoms associated with PEM?

Dry flaky skin
Depigmentation
Rigid nail beds (with lines)
Discoloured hair, dull & easily pluckable

How well did you know this?

Not at all

Perfectly

What is Pallor a symptom of?

Resulting from anemia

-associated with Fe, Folate, and Vitamin B12 deficiency

How well did you know this?

Not at all

Perfectly

When conducting the exam what are we looking for when looking at nails?

``` Colour Shape Texturee Size Flexibility Clubbing Koilonychia ```

What is nail clubbing a sign of?

Fe or Chromium deficiency | -except for in CF patients

What is koilonychia?

Thin concave nails with raised edges - spoon nails - Fe deficiency anemia

When conducting the exam what are we looking for when looking at the head?

``` Shape and symmetry Temporal Muscle Wasting (and around eyes) Condition or Hair/scalp Tenderness Masses ```

What is alopecia associated with?

``` Biotin deficiency (usually this) Vitamin A toxicity ```

What does discoloured hair signify?

"flag sign" of discoloured hair is associate with PEM

When conducting the exam what do we look for when looking at the eyes?

Sclera Cornea Conjunctiva

What is Zerophalmia?

Associated with Vitamin A deficiency (cant produce tears)

What are other signs of vitamin A deficiency?

``` Night blindness Photphobia Bitots spot Corneal ulceration Scarring ```

What is Nystagmus?

Rhythmic oscillation of the eyes either pendular or jerky - Thiamine Deficiency - Deficit of lateral gaze

When conducting the exam what do we look for when looking at the nose?

Shape discharge NG suction Tube feeding device

What are 2 methods of feeding tubes?

Nose to stomach Nose to Duodenum

When conducting the exam what do we look at when looking at the mouth?

``` Lips Mucosa Gums Gag reflex Dentition Tongue Palates Ability to chew/swallow Feeding device O2 device Dentures ```

What is Atrophic lingual papillae?

Fe deficiency

What is Glossitis?

Niacin. Riboblavin, Folate, Cobalamin deficiency | -smooth, sore "beefy red" tongue

What is angular stomatitis?

B vitamins deficiency or Fe or Protein

What is Cheilitis?

B vitamins deficiency Protein Fe Zn

What is angular cheilitis?

``` B vitamins deficiency Protein Fe Zn -just angled downward from the mouth ```

What is scurvy?

Inflammed and Bleeding gums and teeth loss | -Vitamin C deficiency

What causes aphthous ulcers?

PEM

When conducting the exam what do we look at when looking at the Neck?

``` Trachea & Thyroid Parotid Gland Tracheostomy Range of motion Feeding devices ```

What is parotid hyperplasia?

When parotid glands are swollen | -Due to bullimia nervosa

What is an enlarged thyroid due to?

Iodine deficiency | -can cause goiter

When conducting the exam what do we look at when looking at the chest?

``` Musical and respiratory development Muscle wasting Edema IV access denies Breath and Heart sounds (Respiratory and cardio systems) ```

What is Congestive heart failure and rapid heart rate associated with?

thiamine deficiency | -wet bereberi

What is cardiomyopathy/heart failure associated with?

Selenium deficiency

What is another symptoms of Vitamin D deficiency?

Beaded ribs

When conducting the exam what do we look at when looking at the abdomen?

``` Contour Muscle develpment Symmetry colour Ostomies Feeding devices Bowel sounds Umbilicus Distention and tenderness Wounds/scars ```

How can you get ascites?

usually during end stage liver disease

What are the 4 abdominal quadrants?

Right and Left Upper | Right and Left Lower

What organs are in the quadrants?

Upper right: Liver, Gallbladder Duodenum, Common bile duct Upper left: Pancreas, Stomach Lower Right: Ascending and 1/2 transverse colon, Appendix, Cecum Lower left: Decsending colon, Ileum, Recutm anus

When conducting the exam what do we look at when looking at the arms&legs?

``` Size Shape Symmetr5y Strength Range of motion Hair distribution Skin discolouration Muscle loss Joint pain Swelling ```

When conducting the exam what do we look at when doing a neurological exam?

``` Mental acuity Gross and fine motor skills Coordination Weakness Paralysis ```

What is Dementia and sensory neuropathy associated with?

Thiamine, niacin and vitamin B12 deficiency

What is peripheral neuropathy associated with?

Vitamin B6 and 12 Niacin Thiamine Vitamin E

What causes spina bifida | ?

Folate deficiency

What are the sings and symptoms of dehydration or under hydration?

``` Thirst Oliguria (little pee) Decrease turgor/pale skin Dry mouth area, thick saliva Coated, wrinkled tongue Heachache, dizziness, confusion Weight Body temp Decrease BP, increase HR ```

What are the signs and symptoms of over hydration?

``` increased BP, decrease HR Edema -peripheral (ankles/hands/face) -sacral Shortness of breath/ dyspnea Puffy swollen eyes Abnormally fast weight gain ```

what are the 3 limitations in the clinical assessment?

1. Specificity 2. Sensitivity 3. Examiner Bias

Why is specificity a limitation?

Some physical signs produced by more than one nutrient or non nutritional factor

Why is sensitivity a limiting factor?

Clinical signs of nutrient deficiencies occur in later stages

Why is examiner bias a limitation?

Inconsistencies - minimized by standardized criteria used to define physical signs - training examiners

Why are there variation in the pattern of physical signs?

Age, genetics, activity level, environment No universal set of signs and symptoms suitable for all ages and all countries