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FN 3344 > Lecture 2 > Flashcards

Lecture 2 Flashcards

1
Q

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

A

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

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2
Q

What is the general procedure of the assessment?

A 
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
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3
Q

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

A 
Overall appearance
Contractures
Body Positioning
Ability to communicate
Level of consciousness
Body habitus 
Amputations (BKA, ABA)
Surgical ostomies, wounds, drains
Vascular access devices
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4
Q

What are ostomies and where are they found?

A

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

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5
Q

Which side of an ostomie produces more liquid?

A

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

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6
Q

What is a central line?

A

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

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7
Q

What is a PICC line?

A 
Peripheral
Inserted
Central 
Catheter
-inserted in the right arm and enters through superior vena cava
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8
Q

What is a peripheral line?

A

Parenteral nutriton inserted via arm vein

-cant use all formulas with this method

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9
Q

What is the overall appearance of PEM?

A

Square shoulders
Muscle wasting
Edema
Skin thinning

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10
Q

What is the overall appearance of marasmus??

A

Generalized muscle wasting and lack of subcutaneous fat

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11
Q

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

A

Stunted growth

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12
Q

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

A

Compressed spine or rickets (knocked knee or bowed legs)

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13
Q

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

A

BP
Temp
Respiration
Radial Pulse

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14
Q

When conducting the exam what anthropometrics do we look for?

A

Hight
Weight
Skinfold Thickness
Muscle Tone and Mass

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15
Q

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

A 
Colour/pigmentation
Lesions
Edema
Texture/moisture
Trugor (elasticity)
Vascularity
Ecchymosis (under skin bleeding)
Petechiae (small coloured spots on skin)
Wounds/ulcers
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16
Q

What is Pallagra dermatitis?

A

Skin lesions/ scaly skin

-Niacin and tryptophan deficiency

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17
Q

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

A

Pellagra

  • Diarrhea
  • Dermatitis
  • Dementia
  • Death
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18
Q

What does Vitamin C deficiency look like?

A

Perifollicular petechiae (little spots), hemorrhage

  • impaired wound healing
  • Scurvy
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19
Q

What are the symptoms of a Zn deficiency?

A

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

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20
Q

What are the symptoms of Vitamin B6 deficiency?

A

greasy dermatitis (around mouth, and skin looks greasy)

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21
Q

What are symptoms of Vitamin A deficiency?

A

Hyperkeratosis (hardened skin, small tiny bumps)

Yellow Skin colouration

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22
Q

What are symptoms of vitamin K deficiency?

A

Easy skin bruising (can’t clot blood efficiently)

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23
Q

What are symptoms associated with PEM?

A

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

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24
Q

What is Pallor a symptom of?

A

Resulting from anemia

-associated with Fe, Folate, and Vitamin B12 deficiency

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25
Q

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

A 
Colour
Shape
Texturee
Size
Flexibility
Clubbing
Koilonychia
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26
Q

What is nail clubbing a sign of?

A

Fe or Chromium deficiency

-except for in CF patients

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27
Q

What is koilonychia?

A

Thin concave nails with raised edges

  • spoon nails
  • Fe deficiency anemia
28
Q

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

A 
Shape and symmetry
Temporal Muscle Wasting (and around eyes)
Condition or Hair/scalp
Tenderness
Masses
29
Q

What is alopecia associated with?

A 
Biotin deficiency (usually this) 
Vitamin A toxicity
30
Q

What does discoloured hair signify?

A

“flag sign” of discoloured hair is associate with PEM

31
Q

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

A

Sclera
Cornea
Conjunctiva

32
Q

What is Zerophalmia?

A

Associated with Vitamin A deficiency (cant produce tears)

33
Q

What are other signs of vitamin A deficiency?

A 
Night blindness
Photphobia
Bitots spot
Corneal ulceration
Scarring
34
Q

What is Nystagmus?

A

Rhythmic oscillation of the eyes either pendular or jerky

  • Thiamine Deficiency
  • Deficit of lateral gaze
35
Q

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

A

Shape
discharge
NG suction
Tube feeding device

36
Q

What are 2 methods of feeding tubes?

A

Nose to stomach

Nose to Duodenum

37
Q

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

A 
Lips
Mucosa
Gums
Gag reflex
Dentition
Tongue
Palates
Ability to chew/swallow
Feeding device
O2 device 
Dentures
38
Q

What is Atrophic lingual papillae?

A

Fe deficiency

39
Q

What is Glossitis?

A

Niacin. Riboblavin, Folate, Cobalamin deficiency

-smooth, sore “beefy red” tongue

40
Q

What is angular stomatitis?

A

B vitamins deficiency or
Fe or
Protein

41
Q

What is Cheilitis?

A

B vitamins deficiency
Protein
Fe
Zn

42
Q

What is angular cheilitis?

A 
B vitamins deficiency
Protein
Fe
Zn
-just angled downward from the mouth
43
Q

What is scurvy?

A

Inflammed and Bleeding gums and teeth loss

-Vitamin C deficiency

44
Q

What causes aphthous ulcers?

A

PEM

45
Q

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

A 
Trachea & Thyroid
Parotid Gland
Tracheostomy
Range of motion
Feeding devices
46
Q

What is parotid hyperplasia?

A

When parotid glands are swollen

-Due to bullimia nervosa

47
Q

What is an enlarged thyroid due to?

A

Iodine deficiency

-can cause goiter

48
Q

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

A 
Musical and respiratory development
Muscle wasting 
Edema
IV access denies
Breath and Heart sounds
(Respiratory and cardio systems)
49
Q

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

A

thiamine deficiency

-wet bereberi

50
Q

What is cardiomyopathy/heart failure associated with?

A

Selenium deficiency

51
Q

What is another symptoms of Vitamin D deficiency?

A

Beaded ribs

52
Q

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

A 
Contour
Muscle develpment
Symmetry
colour
Ostomies
Feeding devices
Bowel sounds
Umbilicus
Distention and tenderness
Wounds/scars
53
Q

How can you get ascites?

A

usually during end stage liver disease

54
Q

What are the 4 abdominal quadrants?

A

Right and Left Upper

Right and Left Lower

55
Q

What organs are in the quadrants?

A

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

56
Q

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

A 
Size
Shape
Symmetr5y
Strength
Range of motion
Hair distribution
Skin discolouration
Muscle loss
Joint pain
Swelling
57
Q

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

A 
Mental acuity
Gross and fine motor skills
Coordination
Weakness
Paralysis
58
Q

What is Dementia and sensory neuropathy associated with?

A

Thiamine, niacin and vitamin B12 deficiency

59
Q

What is peripheral neuropathy associated with?

A

Vitamin B6 and 12
Niacin
Thiamine
Vitamin E

60
Q

What causes spina bifida

?

A

Folate deficiency

61
Q

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

A 
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
62
Q

What are the signs and symptoms of over hydration?

A 
increased BP, decrease HR
Edema
-peripheral (ankles/hands/face)
-sacral
Shortness of breath/ dyspnea 
Puffy swollen eyes
Abnormally fast weight gain
63
Q

what are the 3 limitations in the clinical assessment?

A
  1. Specificity
  2. Sensitivity
  3. Examiner Bias
64
Q

Why is specificity a limitation?

A

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

65
Q

Why is sensitivity a limiting factor?

A

Clinical signs of nutrient deficiencies occur in later stages

66
Q

Why is examiner bias a limitation?

A

Inconsistencies

  • minimized by standardized criteria used to define physical signs
  • training examiners
67
Q

Why are there variation in the pattern of physical signs?

A

Age, genetics, activity level, environment

No universal set of signs and symptoms suitable for all ages and all countries

FN 3344 (13 decks)

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