2: Nutrition Focused Physical Examination Overview
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Questions and Answers

What is indicated by bilateral pitting edema and possibly ascites?

  • Increased hydrostatic pressure (correct)
  • Venous obstruction
  • Increased capillary permeability
  • Lymphatic dysfunction

    • Which condition is associated with unilateral pitting edema, erythema, and tenderness?

  • Venous obstruction (correct)
  • Lymph node dissection
  • Nephrotic syndrome
  • Renal failure

    • Which of the following conditions leads to decreased capillary osmotic pressure?

  • Acute respiratory distress syndrome
  • Trauma
  • Increased capillary permeability
  • Cirrhosis (correct)

    • What is a common symptom of increased capillary permeability?

    <p>Bilateral pitting edema</p> Signup and view all the answers

    Which factor is NOT listed as a cause of edema?

    <p>Increased respiratory function</p> Signup and view all the answers

    What is the primary purpose of a Nutrition Focused Physical Examination?

    <p>To identify the risk for malnutrition or the existence of malnutrition</p> Signup and view all the answers

    Which of the following correctly distinguishes between signs and symptoms?

    <p>Signs are what the clinician observes and can be verified with objective data.</p> Signup and view all the answers

    Which physical examination technique involves listening for sounds made by internal organs?

    <p>Auscultation</p> Signup and view all the answers

    What approach should be taken during a physical exam to ensure comprehensiveness?

    <p>Use a head to toe approach</p> Signup and view all the answers

    What do Universal Precautions aim to prevent?

    <p>Transmission of infectious agents via bodily fluids</p> Signup and view all the answers

    Which scenario requires the implementation of Transmission-Based Precautions?

    <p>Patients with known infections that can be transmitted</p> Signup and view all the answers

    Which of the following is NOT a basic technique used in physical examinations?

    <p>Radiography</p> Signup and view all the answers

    To which patients do Universal Precautions apply?

    <p>All patients and settings</p> Signup and view all the answers

    What is a significant risk factor for the development of pressure injuries?

    <p>Inadequate nutrition</p> Signup and view all the answers

    What daily protein intake is recommended for patients with stages III and IV pressure injuries?

    <p>1.5-2.0 g/kg</p> Signup and view all the answers

    What is the primary cause of pressure injuries?

    <p>Intense or prolonged pressure</p> Signup and view all the answers

    Which micronutrient is specifically recommended for patients with unstageable pressure injuries?

    <p>Vitamin C</p> Signup and view all the answers

    What is the recommended fluid intake for patients at risk of pressure injuries?

    <blockquote> <p>30 ml/kg</p> </blockquote> Signup and view all the answers

    What condition can affect the soft tissue's tolerance for pressure and shear?

    <p>Microclimate</p> Signup and view all the answers

    What is the NPUAP's redefined term for what was previously known as pressure ulcers?

    <p>Pressure injury</p> Signup and view all the answers

    What is edema characterized by?

    <p>Increased interstitial fluid volume</p> Signup and view all the answers

    Which of the following is an example of an infection that requires airborne precautions?

    <p>Chicken pox</p> Signup and view all the answers

    What is the initial step in conducting a visual inspection?

    <p>Use a head to toe approach</p> Signup and view all the answers

    Which nutrient deficiency is indicated by corkscrew hair?

    <p>Vitamin C</p> Signup and view all the answers

    Which oral sign is associated with riboflavin deficiency?

    <p>Cheilosis</p> Signup and view all the answers

    Pellagra is characterized by which of the following clinical manifestations?

    <p>Glossitis and diarrhea</p> Signup and view all the answers

    Which skin finding is associated with vitamin K deficiency?

    <p>Purpura</p> Signup and view all the answers

    The appearance of pale conjunctiva is most commonly associated with a deficiency in which nutrient?

    <p>Iron</p> Signup and view all the answers

    What is a common oral sign associated with vitamin B12 deficiency?

    <p>Erosive glossitis</p> Signup and view all the answers

    Thinning, flattening, or concave nails are indicative of which nutritional deficiency?

    <p>Iron</p> Signup and view all the answers

    Which nutrient is associated with perifollicular hemorrhage in skin assessment?

    <p>Vitamin C</p> Signup and view all the answers

    What is a key sign of niacin deficiency in the skin?

    <p>Dermatitis</p> Signup and view all the answers

    Which oral condition is characterized by inflammation at the corners of the mouth?

    <p>Angular Cheilitis</p> Signup and view all the answers

    A patient exhibits muscle wasting and poor skin turgor. Which deficiency might these signs indicate?

    <p>Protein</p> Signup and view all the answers

    Which condition is often highlighted by swollen, bleeding gums?

    <p>Vitamin C deficiency</p> Signup and view all the answers

    What is the correct term for fluid accumulation in the peritoneal cavity?

    <p>Ascites</p> Signup and view all the answers

    Which method is least likely to be used for assessing edema?

    <p>Progressive muscle relaxation</p> Signup and view all the answers

    In the context of malnutrition, what is the primary concern associated with an inadequate intake of protein and/or energy?

    <p>Loss of fat stores and/or muscle wasting</p> Signup and view all the answers

    Which symptom is NOT typically associated with hypercatabolic conditions in malnutrition?

    <p>Higher blood pressure</p> Signup and view all the answers

    What condition is associated with the protein deficiency during weaning from breastfeeding?

    <p>Kwashiorkor</p> Signup and view all the answers

    Which method is used to differentiate between abdominal swelling due to ascites versus gas, fat, or feces?

    <p>Percussion</p> Signup and view all the answers

    What does the term 'pitting edema' refer to?

    <p>Swelling that produces a dent when pressed</p> Signup and view all the answers

    What factor does NOT contribute to the risk of malnutrition?

    <p>Increased affordability of food</p> Signup and view all the answers

    Which area of the body is most commonly assessed for muscle and fat depletion?

    <p>Upper body</p> Signup and view all the answers

    Which symptom does NOT indicate malnutrition?

    <p>Increased energy levels</p> Signup and view all the answers

    The grading of pitting edema primarily assesses what characteristic?

    <p>Depth and duration of the indentation</p> Signup and view all the answers

    Which term refers to the accumulation of fluid in the lungs?

    <p>Pulmonary edema</p> Signup and view all the answers

    Which statement about malnutrition is accurate?

    <p>It can lead to both overnutrition and undernutrition.</p> Signup and view all the answers

    Study Notes

    Nutrition Focused Physical Examination

    • The purpose of a Nutrition Focused Physical Examination (NFPE) is to identify malnutrition risk, distinguish between signs and symptoms associated with malnutrition and inflammation, and observe signs and symptoms for objective data.

    Overview of Physical Exams

    • A head-to-toe approach is used for physical exams.
    • Exams should be tailored to individual needs.
    • The four basic physical exam techniques are inspection, palpation, percussion, and auscultation.

    Universal Precautions

    • Universal precautions apply to all patients and settings to prevent the transmission of infectious agents.
    • Standard precautions include hand washing and personal protective equipment (PPE) use.
    • Transmission-Based Precautions are used when patients have known or suspected infections that can be transmitted via airborne, droplet, or contact routes.

    Visual Inspection

    • Observe the whole person, including overall appearance, contractures, amputations, feeding and vascular access devices, wounds, and communication abilities.
    • Examine dentition (teeth, lips, gums), mental status, muscle wasting, fat stores, jaundice, edema, ascites, as well as the eyes, nails, and skin.

    Nutrient Deficiencies

    • Eyes:
      • Bitot's spots (white/gray spots on conjunctiva) indicate a vitamin A deficiency.
      • Keratomalacia (drying/softening of the cornea) also indicates a vitamin A deficiency.
      • Pale conjunctiva suggests iron deficiency.
    • Hair:
      • Observe hair distribution, color, and texture.
      • Corkscrew hair and unemerged coiled hairs point to vitamin C deficiency.
      • Thin, sparse, or patchy hair may be due to protein, biotin, zinc, or iron deficiency.

    Oral Signs of Nutrient Deficiency

    • Riboflavin: Soreness, intraoral burning, cheilosis, angular stomatitis, glossitis with a magenta tongue.
    • Niacin: Intraoral burning, glossitis, swollen tongue with red tip and sides, swollen and red fungiform papillae, inflamed filiform papillae.
    • Folic Acid: Gingivitis, glossitis with atrophic or hypertrophic filiform papillae, angular cheilosis.
    • Vitamin B12: Intraoral burning, mucosal ulcerations and erosions, painful glossitis with a beefy red or fiery appearance, and atrophic tongue.
    • Vitamin C: Sore and bleeding gums, deep blue-red gums, loose teeth.
    • Iron: Cheilosis, atrophic glossitis, gingivitis, candidiasis, intraoral burning or pain, mucosal ulcerations and erosions, pallor.
    • Zinc: Marked halitosis (bad breath), stomatitis, white coating on tongue mucosa.

    Nails

    • Thinning, flattening, concave, or spoon-shaped nails may indicate nutrient deficiencies.

    Skin Assessment

    • Pellagra: Niacin deficiency.
    • Purpura: Vitamin K and Vitamin C deficiency.
    • Petechiae: Vitamin K and Vitamin C deficiency.
    • Perifollicular Hemorrhage: Vitamin C deficiency.
    • Yellow-Orange Pigmentation: Beta-carotene excess.
    • Pallor: Iron, folate, and B12 deficiency.
    • Poor Skin Turgor: Dehydration.
    • Slow Wound Healing: Zinc, vitamin C, and protein deficiency.
    • Follicular Hyperkeratosis: Vitamin A and Vitamin C deficiency.

    Pressure Injuries

    • Pressure injuries are localized damage to the skin and underlying soft tissues.
    • They usually occur over bony prominences or due to medical devices.
    • The National Pressure Ulcer Advisory Panel (NPUAP) redefined pressure injuries in 2016, replacing “pressure ulcer” with “pressure injury.”
    • Inadequate nutrition is a major risk factor for pressure injury development.

    Pressure Injuries: MNT

    • Increased energy, protein, and fluid requirements are necessary for pressure injury management.
      • Energy: 30-35kcal/kg (25-30kcal/kg for stage I).
      • Protein: 1.25-1.5g/kg (1.5-2g/kg for stages III, IV, unstageable, DTI).
      • Fluid: >30ml/kg (unless on fluid restriction).
    • Micronutrient supplementation may be needed:
      • Multivitamin if oral intake or enteral nutrition is inadequate.
      • Vitamin C (1000-2000mg/day) for stages III, IV, unstageable, DTI.
      • Zinc Sulfate (220mg daily for 10-14 days) if deficiency is suspected.

    Fluid Accumulation (Edema)

    • Edema is an increase in interstitial fluid volume.
    • It occurs when fluid balance between the interstitium and capillaries is disrupted.
    • Common causes include increased hydrostatic pressure, decreased capillary osmotic pressure, lymphatic dysfunction, and increased capillary permeability.

    Etiology and Disease States Commonly Associated with Edema

    Etiology Common Disease States Signs/Symptoms
    Increased hydrostatic pressure Renal failure, heart failure, cirrhosis, sodium or fluid overload, medications Bilateral pitting edema, possibly ascites
    Increased hydrostatic pressure Venous obstruction Unilateral pitting edema, erythema, tenderness
    Decreased capillary osmotic pressure Nephrotic syndrome, protein-losing enteropathy, liver disease, severe malnutrition Bilateral pitting edema, ascites
    Increased capillary permeability Acute respiratory distress syndrome, trauma, burns, inflammation/sepsis, malignancy Bilateral pitting edema
    Lymphatic dysfunction Malignancy, lymph node dissection Unilateral or bilateral non-pitting edema
    • Edema can be generalized or localized in specific body parts.
    • Inspection and palpation are the primary methods to assess edema.
    • Percussion is used for ascites, and auscultation for pulmonary edema.
    • Edema can occur in several areas of the body, including the brain, eyes, lungs, arms and legs, abdomen, genitals, and feet.

    Assessing Ascites

    • Ascites is the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
    • Common in patients with cirrhosis.
    • Assess for bulging flanks and percuss the abdomen to differentiate between ascites and other causes of abdominal swelling.

    Skin Turgor

    • Assess skin turgor by gently lifting a fold of skin on the back of the hand or chest and observing how quickly it returns to its original position.

    Muscle and Fat Assessment

    • Muscle wasting and fat depletion are assessed through inspection and palpation.
    • Upper body is preferred due to ease of access.
    • Assessing muscle loss can be challenging in overweight and obese individuals, as well as critically ill patients.

    Oral/Facial Exam

    • Examine the temporal wasting, orbital and bichats (buccal) fat pads, zygomatic process, zygomaticus muscles, and the nasolabial skin fold.
    • Assess the oral cavity for missing teeth, poorly fitting dentures, ulcers, oral thrush, and lack of saliva.

    Clavicles/Shoulders

    • Inspect the clavicles, trapezoid, and deltoid muscles for muscle wasting.
    • Assess the supraspinatus and infraspinatus muscles.
    • Assess the clavicle for bone prominence and soft tissue wasting.

    Upper Arm and Forearm

    • Assess the biceps and triceps for muscle wasting by inspection and palpation.

    Scapular and Thoracic/Lumbar Regions

    • Assess the infraspinatus, supraspinatus, and trapezius muscles for muscle wasting.
    • Examine the thoracic and lumbar regions for prominent ribs and muscle wasting in the paraspinal muscles.

    Dorsal Hand: Interosseous

    • Assess the muscles between the metacarpals for muscle wasting.

    Lower Extremities

    • Assess the tibialis anterior, gastrocnemius, soleus, and quadriceps muscles for muscle wasting.

    Full Body Muscle and Fat Wasting

    • Assess the overall muscle and fat wasting.

    Malnutrition

    • Malnutrition is defined as any nutrition imbalance, including undernutrition and overnutrition.
    • It is a state of inadequate intake, increased requirements, impaired absorption, altered transport, or altered nutrient utilization.
    • Contributing factors: inflammatory, hypermetabolic, and/or hypercatabolic conditions.
    • Inflammation increases malnutrition risk, may contribute to poor response to interventions, and increases mortality risk.

    Consequences of Malnutrition

    • Increased morbidity and mortality
    • Decreased function
    • Decreased quality of life
    • Increased frequency and length of hospital stay
    • Higher healthcare costs

    Historical Perspective of Malnutrition

    • Protein energy malnutrition (PEM)
    • Marasmus
    • Kwashiorkor
    • Etiology-based definitions of malnutrition

    Kwashiorkor

    • Discovered by Cecily Williams in 1930.
    • Associated with a maize diet and a protein-deficient diet during the weaning process.
    • The name refers to the “disease of the first son when the second son is born.”

    Protein Energy Malnutrition (PEM)

    • Emerged in the 1970s.
    • Divided into marasmus (weight loss) and kwashiorkor (edema and growth retardation).

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    Nutrition Focused Physical Exam Malnutrition & Inflammation PDF Fall 2024

    Description

    This quiz covers the essentials of Nutrition Focused Physical Examination (NFPE), emphasizing its role in identifying malnutrition risks and associated signs. It also reviews the techniques of physical exams, universal precautions, and the importance of visual inspection in patient assessment.

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