Nutrition Assessment and Physical Examination Report Example

Introduction

The nutrition assessment is a physical examination conducted to a patient beginning from head to toe to help check the nutrition status of the individual by uncovering the nutrients deficiencies, nutrient toxicities and any signs of malnutrition. In 2012, the Academy of Dietetics and Nutrition and the Parenteral Nutrition during a consensus statement they define lack of nutrients as a scenario where the human body has the presence of two or more characteristics such as; Weight loss, Decreased functional status, Loss of subcutaneous fat and muscle mass and Generalized or localized fluid accumulation (Brand et al., 2010). The essay outlines how the use of NFPA can determine the physical findings that relate to micronutrient deficiencies and impact it can bring in the nutrition status of the individual.

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Loss of muscle mass and subcutaneous fat, decreased functional status and the accumulation of fluids are what the physician assesses. Fat or muscle loss tell more about an individual's nutrition status than how the diet can reveal. An NFPE, therefore, remains the primary domain of nutrition assessment along with the medical history, clinical data, BMI and the history of food (Wickstrom, 2010). Thus if the physical examination is not conducted to a patient, then the complete nutrition assessment cannot be acquired. In other words, the Registered Dietitian will not manage to gain a comprehensive nutritional assessment and could be missing the comprehensive nutrition assessment. All patients need to have a full evaluation.

The NFPE starts with a visual examination where the Dietitian looks for any physical signs of loss of nutrition. The review also includes an overall state of the level of fitness or frailty, body symmetry, posture and physical health. The assessment may also involve the patient's emotional status, ability to communicate and breathing ability (Julien, 2016). For instance, when the patient shows any sign of shortness of breath, it could be an indication of congestive heart failure, and so the RD could increase the intake of Sodium

The RD's Written Report in the Evaluation and Assessment during an NFPA

The heightened utilisation and interest on NFPA are done with a defining guideline that elaborates more on malnutrition and the awareness of health care practitioner when it comes to dealing with the malnutrition patients. Moreover, the report on the increase on nutrition deficiency shows that the surgical weight loss individuals including those with various chronic and acute disease require a physical examination and assessment skills to identify the defects. The RD, therefore, uses the NFPA to check for weaknesses alongside the domains of the assessment to find out the necessary diagnosis.

The application and usage of NFPA use several settings to show the best patient practice to be used. The NFPA, in this case, constitutes to the NCPM (nutrition care process and model), and a framework of nutrition that is planned using four consecutive and separate steps; the assessment, diagnosing, intervening and evaluation and monitoring (Myers, 2014). The application and usage in this type of set up show how the RD uses NFPA doe nutrition assessment and how the physical findings relate to the micronutrients deficiencies. Moreover, several disciplines are also utilised to tailor the tangible results in the evaluation. The external appearance and the review of the hair, skin, abdomen, nails and extremities of the patient are therefore observed to give ideas incase nutritional deficiencies are detected. While the general inspection reveals the weight of an individual, the body tends to hide many clues concerning the person's nutritional status.

The RD, in this case, uses specific guidelines to conduct the physical, nutritional assessment. Generally, the RD selects particular areas to assess the nutritional status of the patient (Starker, 2010). Distinct essential regions, in this case, are selected by the RD while evaluating the nutrition status of the patient. All findings are then documented appropriately in the medical section and communicated health team members. The examination begins with a physical check-up by inspecting the skin and body from head to toe. During this inspection, any skinny appearance shows that the body does not take in enough energy. When the individual indicates that there is protein-energy malnutrition it shows the following signs; flaking dermatitis, loss of appetite, hepatomegaly, weakness of the extremities and distended abdomen (Costello & Plack, 2011). The deficiency of protein is also revealed by extremity in the transverse and oedema lines, particularly on the nails. The below is the how the RD assesses the patient.

The skin

The RD begins by examining the surface by using palpation and inspection, including the patient's eye and power of observation. The examination of the skin purposely shows the colour and uniform appearance, hygiene, symmetry and the presence of any rashes, bruising, oedema, flakiness, tears or lesions. As the inspection continues, the RD also palpates and inspects the skin for temperature, mobility, turgor, temperature and turgor (Costello & Plack, 2011). When there is the detection of oiliness, it means that the changes its temperature from cold to warm. To asses' mobility and turgor, the ear is gently pinched on the skin of the sternal or forearm area and then released. The ear part should also be resilient and returns into its position. However, turgor may be altered if oedema is present or if the client dehydrated. If lesions are discovered (a pathologic skin occurrence or change, they are defined according to their characteristics; configuration (shape, depression, elevation, texture or size); exudate (consistency, amount, colour) and distribution and location of the body.

The head

The assessment begins from the palpate of the hair, and healthy skin should be smooth, has no cracked or split ends and should be symmetrically distributed. When the head has brittle and coarse hair, it is associated with hypothyroidism. A silky hair, on the other hand, means that there is the presence of hyperthyroidism. Hair that is thin, sparse and easy to pull indicates a sign of protein deficiency. The RD then moves to check the eyes to spot deficiencies like Vitamin A which is essential for the body's visual centre. When there is vitamin A deficiency, the patient usually has poor vision at night, a visible glare recovery, blurring inflammation, excessive dryness, sensitive to light followed by progressive softening and cloudiness of the corneas (Costello & Plack, 2011). When the eye has advancement of vitamin A deficiency it usually has silver-grey deposits that are seen on the delicate membrane which cover the white part of the eye. When the eye lacks riboflavin it means that the eye will be sensitive to light, have blurry vision and is inflamed with conjunctiva.

The Mouth

The oral health of the patient is vital because the mouth is the entry point for adequate hydration and nutrition. When there are abnormal conditions, there can be a pain when swallowing or chewing. Moreover, other signs of dehydration are also detected notably through longitudinal tongue furrows, dry tongue and dry mucous membranes. With this signs, the RD then conducts an oral exam by requesting the individual to close their mouth. The RD then palpates and inspect the skin for colour, any surface abnormalities, symmetry and oedema. Cracked, dry lips show that the patient is dehydrated thus having excessive lip licking, dentures, and wind chapping (Costello & Plack, 2011).

When a patient has painful cracks, and scaling lips shows that they have riboflavin deficiency. The colour of the lips, in this case, is facilitated by some varieties such as anaemia. When such signs are noticed, the RD remove the dental appliances such as a tongue blade and bright light to inspect the teeth, gums and buccal mucosa. The mucosa membrane in an average patient should have a pink appearance, slightly stippled and has tight margins at each tooth. The gums beneath the surface should not have any swelling bleeding or inflammation. Bleeding gums indicate that there are ill-fitting dentures, lack of riboflavin deficiency or absence of vitamin.

Joints and Bones

Finally, in regards to the extremities of the skin condition, bone's tenderness and softness may be a sign of vitamin D deficiency. Joint pain and bone ache show the inadequacy of Vitamin C (Costello & Plack, 2011). When the muscles become painful or are tender; it means there is a lack of thiamine. Spooning of the nails also shows lack of iron deficiency.

Conclusion

The Nutrition-focused physical assessment, therefore, is a method used by the RD to detect any signs of illness from the patient. The technique is also used to do a thorough check-up to ensure that no disease or deficiency is not diagnosed. With such the assessment begins by checking the head all the way to the toe. All areas are then tested for any defect, function abnormality and the causes of development. For accuracy, the registered Dietitian may combine the physical factors and nutrients to determine the health of the patient.

References

Brand, R., Touger-Decker, R., Rigassio, D. R., & Parrott, J. (2010). Usage Patterns of Nutrition-Focused Physical Assessment by the Registered Dietitian Following Completion of a Nutrition-Focused Physical Assessment Program. Journal of the American Dietetic Association, 110(9). doi:10.1016/j.jada.2010.06.091

Costello, E., & Plack, M. (2011). Validating a Standardized Patient Assessment Tool Using Published Professional Standards. Journal of Physical Therapy Education, 25(3), 30-46. doi:10.1097/00001416-201107000-00007

Julien, J. K. (2016). Dietary compliance-a partnership between patient and dietitian. Topics In Clinical Nutrition, 1(1), 51-57. doi:10.1097/00008486-198601000-00008

Myers, E. F. (2014). Nutrition Care Process and Model and the International Dietetics and Nutrition Terminology. Nutrition Today, 49(1), 26-31. doi:10.1097/nt.0000000000000015

Starker, P. M. (2010). Nutritional Assessment of the Hospitalized Patient. Advances in Nutritional Research, 109-118. doi:10.1007/978-1-4613-0611-5_5

Wickstrom, J. (2014). Physical Diagnosis, the History and Examination of the Patient, Second Edition. Physical Therapy, 44(1), 71-72. doi:10.1093/ptj/44.1.71b