Nutritional Status Exam

Question 1

General Inspection

Answer 1

Pt: well / unwell, BMI, alert, breathless, fever, lines

Bedside:
In - NG feed / parenteral nutrition, IV fluids, supplements, food / drink, NBM note
Out - catheter, stoma, NG tube, vomit bowl
Charts - obs, fluid balance, drug chart

Question 2

Hands and arms

Answer 2

Nails: clubbing, leukonychia, koilonychia
Palms: temperature, xanthomata
Pulse rate: tachycardia in dehydration
Arms: bruising (coagulopathy in vit K deficiency), extensor rash (dermatitis herpetiformis)
BP and postural drop (dehydration)

Question 3

Head and neck

Answer 3

Eyes: sunken, xanthelasma, corneal arcus, xerophthalmia (vitamin A deficiency), conjunctival pallor
Mouth / tongue: glossitis / stomatitis, ulcers, breath odour, dry mucous membranes, gingivitis
JVP (HF in wet beriberi) and carotid pulse
Goitre (iodine deficiency)

Question 4

Chest

Answer 4

Sternum - cap refill and skin turgor

Question 5

Abdomen

Answer 5

Ascites (hypoalbuminaemia, liver disease)
Adiposity
Loose skin / striae

Question 6

Legs

Answer 6

Peripheral oedema (hypoalbuminaemia)
Bowed legs (rickets / osteomalacia)
Peripheral neuropathy (B12, dry beriberi)

Question 7

To complete

Answer 7

Thank pt

Take full hx, calculate BMI, check obs, food and fluid balance charts, refeeding bloods… etc