What is a Nutrition Focused Exam? A nutrition assessment is encompassing of all the data from the client or patient or setting that is available. The areas of data collection include the client history, their food history, anthropometric measurements, and available biochemical data as well as medical test and procedure data. After review of this information nutritional insult or risk may be flagged that would lead a health care professional to further examination of the patient for nutrition-focused physical findings and possibly more in depth subjective information. The practitioner may decide to do a full or a focused nutrition physical exam depending on the data collected, the symptoms and diseases of the client and the referrals of other health care providers. If a person has blood work that suggests an iron deficiency (low hemoglobin and hematacrit with a high red blood cell distribution width and a low mean cell volume) the practitioner could be focused in looking for signs and symptoms of iron deficiency anemia such as pale nails, pale everted lower eyelids or a pale tongue or koilynchcia. On the other hand if a person is a known, longstanding alcoholic who eats poorly, the practitioner may suspect general undernutrition or malnutrition and look for signs of malnutrition in general as well as those specific to alcoholism. The nutrition-focused physical exam time is a great time to spend visiting with the client and asking about possible symptoms, about an unusual finding, about their appetite or foods that most appeal to them. A great way to start a conversation is to lead in with, “Tell me about . . . . . “ or “How long have you had . . . . “. Most people appreciate your spending time with them regarding their concerns. On the other hand the whole process may be new to most clients so it is best to ask them if it would be okay to check them for signs of nutritional concern. Most people don’t object to a “check up” and will agree. I think I have only had one person in my years of dietetics who refused and his wishes were granted. That said, most people are more than happy to cooperate with a nutrition physical examination. During this time you are looking for lesions that aren’t normally there, for things that are missing that should be there and for any negative situations that would influence nutrition. Let me give you some examples. We’ll start with lesions that are there that aren’t “normal”, things that shouldn’t be there. Examples might be a goiter, ecchymosis, or pitting edema. They can all be caused by nutrient deficiency or be nutrition related. What you are doing is gathering pieces of the puzzle. Lets’ go on to nutrition-related or nutrient deficiency-caused things that are missing next. Missing affect, missing color (pale nails or tongue), or patches of hair that are missing would all be examples of things that should be there but aren’t. Once discovered missing, finding the etiology of the problem is the next challenge. It may take asking questions, further tests, a referral or nutrient treatment with follow up and monitoring. Going on to negative situations, some examples might be dental debris that clearly shouts “lack of oral cares” or missing teeth that prevent proper chewing and therefore limit the variety of foods a client can or will eat. Whatever the case, the challenge is “fixing what can be fixed” or, in other words, looking for the solution to the problem with the most important person on the health care team, the client. The nutrition physical exam is like a mystery, you as the health care practitioner are the investigator. Are you up to the challenge?
Tags: Nutrition focused physical exam nutrition assessment Nutrition Focused Exam nutrition-based lesions nutritional deficiency malnutrition
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