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The Basics of Performing a Nutrition-focused Physical Examination Part 1: A Look at the Mouth & Eyes |
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Written by Adele Huls
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The Basics of Performing a Nutrition-focused Physical Examination Part 1: A Look at the Mouth & EyesWhen learning to do a nutrition-focused physical exam it is good to start from the top down. This is what I call the Head to Toe approach. For one thing, your equipment, including your gloves, are clean so it makes sense to start with the client’s mouth and eyes. My routine is to start with the mouth, eyes, the facial skin and the rest of the head.
Actually, the visual scan starts when I approach the client to ask them for permission to do a nutrition physical exam. (This is a good time to get out your Key Terms chart or other resources you may have to refer to what each of the terms you may not be familiar with are.) I'm looking at areas around the mouth for angular stomatitis (often B vitamin, folate or vitamin B12 deficiency) and/or undifferentiated mucocutaneous border (usually riboflavin deficiency). I'm also eyeing the skin on their face and the appearance of their eyes.
After obtaining the client’s verbal consent to perform a nutrition physical exam, I proceed by asking them if “it hurts” any place in their mouth. Then I ask them to open their mouth while I examine for oral hygiene, skin lesions, inflammed gums, etc. and then I ask them to stick out their tongue for me. I often demonstrate this to take any tenseness out of the situation and to give them direction. (several of my older clients have expressed that they have learned long ago that sticking out their tongue is disrespectful)
They then follow suit and I can easily then examine their tongue for glossitis (often niacin, riboflavin B12 or folate deficiency) or whatever is present or not present and observe the color of the tongue (as you can see on your Clinical Terms handout), the color of the tongue can be indicative of a deficiency, usually iron, folate, B12 or a B vitamin).
You may observe a lobulated tongue or a geographic tongue which are not typically of nutritional concern. Look at a lobulated tongue for some areas of balding or glossitis or filiform atrophy that IS likely to be of nutritional concern.
Then I go to the eyes, observing for brightness. I look for corneal arcus (usually dyslipidemia related), and other visual abnormalities like the “Thiamine Stare “ (seen in some cases of Thiamin deficiency, especially related to alchohol abuse, and pterygium which is nonnutritional. It is important to ask questions about abnormalities you see especially if the abnormality can be explained by the client --- history may point to the cause. I had a man who had lye splash up into his eye causing scarring and blinding in one eye. I could have investigated all day and not been able to figure out what caused his eye to appear white like it did.
Get proficient at looking up lesions in a medical dictionary with lesion pictures or other lesions resources. Looking at pictures of lesions is a great way to get these visions “pasted” into your memory. This web site is planning to help with this task by producing videos and eventually DVDs
Tags: Performing the Exam General Performing the Exam The Basics of Performing a Nutrition-focused Physical Examination Part 1: A Look at the Mouth & Eyes Head to Toe approach Objective information Subjective information Nutrition Diagnosis nutritional deficiency iron Vitamin B12 Folate microcytic anemia macrocytic anemia nutrient-based lesion exam procedure signs of nutritional deficiency symptoms of nutritional deficiency
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