Lecture 2 Flashcards
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
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
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
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
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
What is a central line?
Parenteral nutrition which is delivered through the armpit into the superior vena cava
What is a PICC line?
Peripheral Inserted Central Catheter -inserted in the right arm and enters through superior vena cava
What is a peripheral line?
Parenteral nutriton inserted via arm vein
-cant use all formulas with this method
What is the overall appearance of PEM?
Square shoulders
Muscle wasting
Edema
Skin thinning
What is the overall appearance of marasmus??
Generalized muscle wasting and lack of subcutaneous fat
What is the overall appearance of someone with a Zn deficiency?
Stunted growth
What is the overall appearance of someone with Vitamin D deficiency?
Compressed spine or rickets (knocked knee or bowed legs)
When conducting the exam what vital signs do we look for?
BP
Temp
Respiration
Radial Pulse
When conducting the exam what anthropometrics do we look for?
Hight
Weight
Skinfold Thickness
Muscle Tone and Mass
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
What is Pallagra dermatitis?
Skin lesions/ scaly skin
-Niacin and tryptophan deficiency
When someone just has a niacin decificeny what is the result?
Pellagra
- Diarrhea
- Dermatitis
- Dementia
- Death
What does Vitamin C deficiency look like?
Perifollicular petechiae (little spots), hemorrhage
- impaired wound healing
- Scurvy
What are the symptoms of a Zn deficiency?
Scaly, Erythematous rash around mouth chin nose and palm of hands
What are the symptoms of Vitamin B6 deficiency?
greasy dermatitis (around mouth, and skin looks greasy)
What are symptoms of Vitamin A deficiency?
Hyperkeratosis (hardened skin, small tiny bumps)
Yellow Skin colouration
What are symptoms of vitamin K deficiency?
Easy skin bruising (can’t clot blood efficiently)
What are symptoms associated with PEM?
Dry flaky skin
Depigmentation
Rigid nail beds (with lines)
Discoloured hair, dull & easily pluckable
What is Pallor a symptom of?
Resulting from anemia
-associated with Fe, Folate, and Vitamin B12 deficiency
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?
- Specificity
- Sensitivity
- 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
