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    Journal Review

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    The document summarizes guidelines for conducting a Nutrition Focused Physical Exam (NFPE) to assess patient nutritional status. It describes the NFPE as a necessary part of a comprehensive nutritional assessment, noting that dietitians are uniquely qualified to perform the exam. It provides details on examining different body areas through inspection and palpation techniques to identify signs of malnutrition like muscle wasting, fat loss, and fluid accumulation. Special considerations for certain patient populations are also outlined.

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    Journal Review

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    146 views18 pages
    The document summarizes guidelines for conducting a Nutrition Focused Physical Exam (NFPE) to assess patient nutritional status. It describes the NFPE as a necessary part of a comprehensive nutritional assessment, noting that dietitians are uniquely qualified to perform the exam. It provides details on examining different body areas through inspection and palpation techniques to identify signs of malnutrition like muscle wasting, fat loss, and fluid accumulation. Special considerations for certain patient populations are also outlined.

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    The document summarizes guidelines for conducting a Nutrition Focused Physical Exam (NFPE) to assess patient nutritional status. It describes the NFPE as a necessary part of a comprehensive nutritional assessment, noting that dietitians are uniquely qualified to perform the exam. It provides details on examining different body areas through inspection and palpation techniques to identify signs of malnutrition like muscle wasting, fat loss, and fluid accumulation. Special considerations for certain patient populations are also outlined.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    146 views18 pages

    Journal Review

    Uploaded by

    api-347854786
    The document summarizes guidelines for conducting a Nutrition Focused Physical Exam (NFPE) to assess patient nutritional status. It describes the NFPE as a necessary part of a comprehensive nutritional assessment, noting that dietitians are uniquely qualified to perform the exam. It provides details on examining different body areas through inspection and palpation techniques to identify signs of malnutrition like muscle wasting, fat loss, and fluid accumulation. Special considerations for certain patient populations are also outlined.

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    of 18

    Journal Review:

    Nutrition-Focused Physical
    Exam
    Mabel Wu, Queens College Dietetic Intern 2017-2018
    Malnutrition
    —  Academy of Nutrition and Dietetics (AND) and American Society for
    Parenteral and Enteral Nutrition (ASPEN)
    —  Collaborated to standardize the diagnosis of malnutrition

    —  Six Characteristics
    —  Reduced Energy Intake
    —  Weight Loss
    —  Muscle Mass Loss
    —  Body Fat Loss
    —  Fluid Accumulation
    —  Functional Status
    Nutrition Focused Physical Exam
    (NFPE)
    —  A necessary component of a
    comprehensive assessment to determine
    a patient’s nutritional status.
    —  Helps verify physical changes to the body
    —  Dietitians are uniquely qualified to complete
    the exam

    —  Properly diagnosing a patient’s nutritional


    status may:
    —  Reduce hospital length of stay (Decreasing
    hospital’s time and cost)
    —  Improve quality of care
    Systemic Approach to a Nutrition
    Assessment
    —  Gather patient’s pertinent
    information
    —  hx, dx, anthropometrics,
    labs, dietary record

    —  Prior to conducting the


    physical exam, explain the
    purpose in a manner
    considerate to patient’s
    condition
    Nutrition Focused Physical Exam
    —  Begin with a general inspection of body and skin, from head
    to toe
    —  Note position/posture/physique
    —  Is there presence of edema/ascites?
    —  Notable micronutrient deficiencies found on skin, hair, nails, or
    oral cavity?
    NFPE – Head-to-Toe Exam
    —  Proper positioning is necessary for exam
    —  Move blankets, clothing, and gowns to assure patient dignity and privacy
    —  Take note of both RIGHT and LEFT sides of body
    —  Are changes unilateral or bilateral?

    —  Continue communication may reveal additional information while each


    specific area is being assessed
    —  Examples: “Does you face appear thinner to you?”
    —  “Do clothing and jewelry not fit well?”
    —  “Are there any rashes or differences in hair, skin, or nails?”
    Exam techniques Using Inspection/
    Palpation - Head
    —  Eyes: inspect with penlight for color and abnormalities
    to appearance and discharge

    —  Nose: inspect for color, texture, and discharge


    —  Lips: inspect for cracks, lesions, color and texture Bitot’s Spot
    —  Mouth: inspect with penlight for color, texture,
    swelling*, lesions, dental caries, and erosions

    —  Neck: inspect and palpate for swelling and symmetry

    *may affect chewing/swallowing and should be referred to a


    Angular Stomatitis
    Speech Language Pathologist J
    Exam techniques Using Inspection/
    Palpation - Fluid
    —  Inspection: assesses the overt
    presence and general
    severity of edema

    —  Palpation: assesses the


    quality and severity of
    edema
    Exam techniques Using Inspection/
    Palpation - Skin
    —  Inspection: Inspect for color,
    pigmentation, rashes, textures,
    and wounds

    —  Palpation: Examine for texture


    and temperature
    Pressure Injury

    Dermatitis
    Exam techniques Using Inspection/
    Palpation -Nails

    Flaky Nails Beau’s/transverse line

    —  Inspect and palpate for color and hygiene


    Exam techniques Using Inspection/
    Palpation - Hair

    —  Inspect for pigmentation/shine (consider chemical alteration),


    distribution, and texture

    Alopecia
    Exam techniques Using Inspection/
    Palpation – Muscle/Fat
    —  Inspection: observe for texture,
    size, and note of symmetry and
    posture (Using just clinical
    observation is subjective)

    —  Palpation: examine for bulk and


    tone of muscle, adequacy of fat
    stores, and edema
    Physical Assessment: Fat and Muscle Stores
    The upper body is more often used to identify muscle and fat loss
    Examination Techniques Normal/Well Mild-Mod Loss Severe Loss
    Areas Nourished
    Temple Region Stand directly in front of patient Able to see/feel well-defined Slight depression Hollowing, scooping
    and observe. Turn face and muscle. Could appear as depression
    observe from side. slight buldge or be flat

    Clavicle Bone •  Upright with erect back Males: Bone not visible Males: Bone visible Protruding, prominent
    Region •  Avoid hunching forward or bone
    slouching Females: bone visible but Females: Bone with
    Pectoralis major •  Avoid back resting against not prominent some protrusion
    anything, as medically and
    physically appropriate

    Shoulder Acromion Sitting or standing, arms down Rounded, curves at Acromion process Shoulder appears square.
    Bone Region at side shoulder/neck slightly protrude, Sharp angles. Bones
    shoulders develop some prominent. Acromion
    angles protrusion very prominent
    Scapular Bone And While sitting or standing, hands Bones not prominent, no Mild depressions, bones Prominent bones with
    Upper Back Region extended straight out, push significant depressions may show slightly definitive angles,
    against solid object depressions easily visible
    between ribs, scapula,
    spine, shoulders
    Physical Assessment: Fat and Muscle Stores

    Lower Body (less sensitive to change)


    Examination Techniques Normal/Well Mild-Mod Loss Severe Loss
    Areas Nourished
    Anterior Thigh Region Sit with leg propped up Well-rounded, developed Mild depression of inner Obvious depression/line
    on bed/chair, bent at muscle thigh on thigh; thin
    knee
    Grasp quads bilaterally
    Patellar Region Sit with leg propped up Muscles protrude, Kneecap less prominent; Bones prominent and
    on bed/chair, bent at difficult to see bones less muscle definition extend beyond quad
    knee surrounding the patella muscles; little sign of
    muscle around patella
    Posterior Calf Region Sit with leg propped up, Well rounded, developed Less bulging of the Thin, minimal to no
    bent at knee or with leg muscle muscle yet has some muscle definition and
    hanging off side of bed. shape and slight firmness
    Grasp calf muscle firmness on palpation
    bilaterally
    NFPE: Special Considerations
    —  Patients who are obese
    —  May not readily exhibit signs of muscle and fat loss
    —  Difficulty moving in bed
    —  Losses may be identified in the orbital region

    —  ICU patients
    —  May not be hemodynamically stable
    —  May express they are in too much pain for an assessment
    —  Commonly present with multiple lines and tubes
    —  Outpatient setting (ex. Dialysis Center, Oncology)
    —  Public areas for nutrition counseling
    —  Many patients may be considered high risk
    …
    References
    —  Fischer M, Jevenn A, Hipskind P. Evaluation of Muscle and Fat Loss as
    Diagnostic Criteria for Malnutrition. Nutrition in Clinical Practice.
    2015;30(2):239-248. doi:10.1177/0884533615573053.

    —  Nutrition-Focused Physical Exam: an Illustrated Handbook. S.L.:


    American Society for Parenteral and Enteral Nutrition.; 2016.

    —  Nutrition Focused Physical Exam. YouTube. https://


    www.youtube.com/watch?v=6ny2FLW_Z3o. Published December 4,
    2017. Accessed April 29, 2018.

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