Iowa State University Nutrition Focused Physical Exam

Summary

This webinar from Iowa State University’s Dietetics internship provides a comprehensive guide on performing a nutrition-focused physical examination. It covers techniques for assessing muscle, fat, and micronutrient status, including detailed steps for evaluating different body regions, such as the hair, skin, mouth, shoulders, arms, and legs. The process involves gently palpating areas like the cheekbones, clavicles, upper arms, and knees to detect fat and muscle loss. The session emphasizes the importance of evaluating changes in body composition and identifying signs of malnutrition, with tips for communicating findings to the client.

Takeaways

• 😀 Start the session by introducing yourself and asking for permission to evaluate the client's muscle, fat, and micronutrient status.
• 😀 Evaluate the client's hair, skin, mouth, shoulders, back, midsection, legs, and feet, and inquire about their weight and eating habits.
• 😀 For fat loss assessment, gently palpate areas like the cheekbones and temporalis muscle. Look for hollowed-out areas or a lack of fat padding.
• 😀 Check the client's vision for any changes or night vision issues, and examine the mouth for sores, cracking, and overall oral health.
• 😀 Examine the clavicle area to assess muscle loss by checking for visible or prominent bones. Both the clavicle and acromion process should appear rounded in well-nourished individuals.
• 😀 Evaluate upper arm fat by pinching the triceps with your fingers to assess fat depth. Well-nourished individuals will have ample fat, while those with fat loss will have less depth.
• 😀 In the scapular region, look for depressions when the client extends their arm and presses against a surface. Severe muscle loss will show prominent depressions between the scapula, ribs, and spine.
• 😀 The iliac crest region should be examined to assess fat loss. In well-nourished individuals, the ribs and iliac crest should not be prominent, but fat loss will make these areas more visible.
• 😀 Evaluate the dorsal muscle area by having the client make the 'okay' sign or squeeze their thumb. Severe muscle loss in this area will show visible depression.
• 😀 Assess the patellar region by having the client bend their knee. Severe muscle loss will make the kneecap prominent and square-shaped, with little muscle around the knee.
• 😀 Evaluate the gastrocnemius muscle by gently grasping the calf. Adequately nourished individuals will have firm, developed muscles, while severe muscle loss will show underdeveloped, spongy muscles.
• 😀 Assess for edema by pressing on areas like the top of the foot or tibial bone. Edema may occur in multiple areas, especially the sacrum, ankles, and feet, and can be staged from 0 to 4 depending on severity.

Q & A

What is the first step in conducting a nutrition-focused physical examination?

The first step is to introduce yourself and ask permission from the client to evaluate their muscle, fat, and micronutrient status.

Why might gloves be worn during the nutrition-focused physical examination?

Gloves may be worn depending on the healthcare setting to ensure hygiene and safety during the physical examination.

How should the hair be assessed for signs of malnutrition?

You should check if the hair is easily pluggable, dull, or has undergone any changes. Fat loss around the orbital socket should also be evaluated.

What are signs of fat loss around the orbital socket?

Mild to moderate fat loss in this area will make the face look hollow, while severe fat loss will feel like touching bone, with no padding.

How can you assess the temporalis muscle for muscle loss?

To assess the temporalis muscle, gently palpate the temple region while the client turns their head to the side. Mild to moderate muscle loss would show slight depression, while severe loss would create a clear indentation.

What should be looked for when examining the mouth during a nutrition-focused physical examination?

Examine the lips for cracking or lesions, and inquire about dentition, chewing ability, and any mouth sores. The tongue's color and texture should also be assessed.

What does the visibility of the clavicle and acromion process indicate?

A visible clavicle in males or an exposed clavicle and acromion process in females can indicate mild to moderate muscle loss, while severe muscle loss would cause these bones to protrude and appear square.

How do you assess the triceps for fat loss?

To assess the triceps, gently pinch the skin with your thumb and forefinger while rolling it to isolate fat from muscle. A well-nourished person will have ample fat in this area, while mild to moderate fat loss will show some depth to the pinch, and severe loss will make your fingers easily touch.

What does the scapular region reveal about muscle loss?

In a well-nourished person, the scapular region will show no significant depressions, but mild to moderate muscle loss will show slight depressions. Severe loss will make the scapula more prominent with depressions between the ribs, scapula, and spine.

How can you assess the patellar region for muscle loss?

To assess the patellar region, have the client bend their knee. In a well-nourished person, the patellar region will have rounded muscles with no visible kneecap, while muscle loss will make the kneecap more visible, and severe loss will show prominent bones and little muscle around the knee.

What is the significance of assessing for edema in the nutrition-focused physical examination?

Edema, or fluid accumulation, can indicate malnutrition or other underlying health issues. It is assessed by pressing firmly on the foot or tibial bone, and it can be staged from 0 to 4 based on the depth and duration of the pit left by pressure.