When would a practitioner do a nutrition-focused physical exam?

Physical Examination Findings are one part of Nutrition Assessment, Step 1 of the Nutrition Care Process used by Registered Dietitians across the nation. Nutrition Physical Examination Findings are helpful along with information from the Food and Nutrition History, Biochemical and other Tests and Procedure results, Anthropometric Measures and Client History in determining a Nutritional Diagnosis(ses).

In order to gather these findings, a Nutrition-focused Physical Exam is performed. This website is designed to help advance the health care professional’s knowledge in examining for and recognition of nutrient-based lesions and situations that affect nutritional intake. I will, throughout the website, address properly identifying and documenting physical examination findings.

The Physical Examination Findings gathered during the Nutrition Physical Exam may be both subjective and objective in nature. This website is meant to help you to expand your knowledge in identifying specific, observable, nutrition-related lesions and situations and help you relate them to Nutrition Diagnoses. Learning these techniques can be somewhat like a CSI movie whereby supporting evidence is gathered to get to the bottom of the case. Once this is accomplished you, the defense, can present the case.

When a new skill is being learned one may have many questions. I’d like to suggest you use the TRIAGE system. There are answers to 3 questions that can guide you in decision making throughout the process. WHEN do I do a Nutrition Physical Exam? When there is a negative nutritional outcome or strong potential for it. HOW do I DECIDE? Let nutrition-related facts like lab results and past history guide your decision. & WHEN is a full vs a focused Nutriton Physical Examination best? If the evidence is global, go FULL, if it is pointed to one system start with a FOCUSED exam.

Rather than getting bogged down, examine and investigate, record your findings, they are ALL pieces of evidence.

One good rule of thumb is to investigate Food and Nutrition History and Client History information. Do they suggest potential for negative nutritional outcome? Are intakes significantly different than need? Has the client reported changes in appetite or a significant weight change? Does a condition or diagnoses point toward altered utilization of nutrients? Is there a history of something that may overlap with nutritional concerns like an eating disorder?Does the client report food allergies or are food medication interactions likely? In other words, look at the "evidence" you already have as a result of the Food & Nutrition and Client Histories.

Nutrition Physical Exam Findings are sometimes very evident just conversing with a person. The trained “eye” will easily be able to identify nutritional lesions like xanthomas, angular stomatitis, pallor, emaciation just upon meeting a person, perhaps to collect other nutrition information like a food history.

The WHEN of when a practitioner would do a nutrition-focused physical examination becomes pretty clear with experience. The question becomes, more often, is a nutrition-focused physical exam really not necessary in this case? Almost always the Nutrition-focused Physical Exam can add data to that already collected that will be helpful in correctly identifying a Nutrition Diagnosis(ses). Rather than spending a lot of time wrestling with the question, my advice is Just Do It!

Those skilled in performing a nutrition physical exam will help you acquire those skills with information, aids, resources offered on this website. Spend your time becoming skilled in identification of nutritional risk and the identification of nutrient-based lesions and the WHEN question of doing a nutrition-focused physical exam will answer itself.