The Basics of Performing a Nutrition-focused Physical Exam Part 2: Skin, Hair & ExtremitiesContinuing with the Head to Toe approach of performing a Nutrition-focused Physical Exam, after the mouth and eyes have been examined I usually take a close look at the rest of the head. First I focus on the skin and any other visual abnormalities like enlarged glands. Hair is checked after checking the skin. Facial skin is examined for abnormalities like xanthomas (often related to a lipid disorder). Xanthomas are good lesions to start with in performing a nutrition-focused physical examination because once you know what you are looking for they are very apparent to the naked eye. You can spot them just visiting with a person. Also look for differences in coloring or texture of the skin, etc. There are also several types of dermatitis that may be visable to the trained, naked eye. Nasolabial seborrhea, for instance, may be apparent as an oily secretion, sebum, in the folds near the bottom of the nose, the part of the nose closest to the lips. Nasolabial seborrhea is usually a sign of riboflavin, niacin, Vitamin B6 or essential fatty acid (EFA) deficiency. Next the hair is tested for easy pluckability (most often a protein deficiency). When carefully, lightly but firmly, pulling up on the client’s hair (I usually do this on the top or top back of the head) note how many hairs were plucked, if you end up with any of the client’s hairs in your hand. If you end up with several hairs in your hand, repeat the procedure to see if this happens the second time, confirming easy pluckability. This rules out the possibility that you just happened to pull on hair that was loosened earlier by brushing or some other unlikely cause. Next comes the rest of the skin which is not always accessible or easily seen. Often I will ask, "Do you have any sores or open areas on your skin that you are aware of?" They will usually identify every scratch they have if they are mentally alert. If they do identify an open area or sore, I usually ask if I can see it. This, along with nurses’ charting and visiting with a good nurse’s aide will give you a good overview of the client’s skin. Check for skin coloring changes like pellagrous dermatitis, most likely a niacin or tryptophane deficiency or caused by diseases like Addison’s or psoriasis, or like ecchymoses, areas that look like bruising caused by Vitamin K or Vitamin C deficiency. Ecchymoses root cause can be Vitamin K deficiency in clients on drugs like Coumadin or Warfarin. The extremities are then also checked for nail abnormalities, edema, etc. Nail abnormalities like koilonychia (likely to be iron deficiency), pale unblanchable nails (usually iron, Vitamin B12 or folate deficiency), or other unusual looking nails are really quite easy to spot. Lab tests can be used to confirm or rule out suspected deficiencies related to lesions of suspected nutritional cause. A good Food and Nutrition History will help you with zeroing in on the “most probable nutrient(s) cause” and Client History may add additional information to your “evidence”. By the time I get to the toes, I have a pretty good picture of the client's appearance and any lesions they present with. To get started, you need to do just that.....Get Started. Remember there are lesion resources like pictures in medical dictionaries and this web site’s videos and upcoming DVDs to help you with skills acquisition. For hands-on workshops to help you in your quest, check out our Resources section Calendar of Events or consider sponsoring a workshop in your area or state.
Tags: Performing the Exam General Performing the Exam The Basics of Performing a Nutrition-focused Physical Exam Part 2: Skin Hair & Extremities nutrient-based lesions nutritional deficiencies nutritional physical exam resources workshops for skills acquisition hands-on workshops
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