Transcript Document

Welcome to Seminar
on
Nutrition Assessment and
Management in
Family Medicine
Part-2
Meera Kaur, PhD, RD
Assistant Professor, Family Medicine
[email protected]
Biochemical Assessment
• Blood and Urine analyses
• Diagnostics and imaging
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Review of Systems
• General:
appetite changes; weight loss/gain; clothes
tighter/loser
– weakness, fatigue, fever, chills, night sweats,
– changes in sleep, daytime sleepiness
– edema and/or abdominal swelling
• Skin: appearance of a rash, dry skin
– breaking nails, hair loss, changes in texture of hair
• Neurological
– confusion, memory loss, difficulty with night vision
– gait change, loss of position sense, numbness, paresthesia
• GI symptoms/alimentary: abdominal pain, nausea, vomiting
– bowel changes- diarrhea, constipation
– difficulty/pain swallowing, early satiety, indigestion, heartburn
– mouth lesions- ulcers, tooth decay; sore tongue, gums
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Physical Exam and ObservationSubjective Global Assessment
• Assesses nutritional status based on
features of the hx and physical
examination.
• Can easily be taught to clinicians.
• Technique is reproducible
– Good correlation between subjective and
objective measurements.
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Subjective Global Assessment
(SGA) of Nutritional Status
Subjective Global Assessment (SGA) is a:
clinical technique, which assesses nutritional
status based on features of the history and
physical examination
a method of rating a patient's nutritional status,
with subjective observations being given values
on an ordinal scale. Factors assessed include
weight change, appetite or anorexia,
subcutaneous tissue and muscle, and GI
symptoms (Mosby's Medical Dictionary, 8th
edition. © 2009, Elsevier).
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Subcutaneous Fat
Special Tips
Below the eye
Severe Malnutrition
Mild-Moderate
Well-nourished
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Hollow look,
depression, dark
circles, loose skin
Slightly bulged fat pads
Arm bent; be careful
not to include muscle in
pinch, roll skin between
fingers
Very little space
between fingers, or
fingers touch
Ample fat tissue
Temple
Observe straight on
and have pt turn head
to side.
Hollow, depression
Slight depression
Can see well-defined
muscle
Clavicle
Look for prominent
bone
Protruding/prominent
bone
Some protrusion
Not visible in males.
May see in females,
but not prominent
Shoulder
Arms at side; look for
prominent bones,
shape
Shoulder-to-arm joint
looks square, bones
prominent
Acromion process may
protrude slightly
Rounded; curves at
junction of shoulder &
neck or arm
Scapula
Look for prominent
bones; have pt push
hands against solid
object
Prominent, visible
bone, depressions
between ribs, scapula
& shoulder or spine
Mild depressions or
bone may show slightly
Bones not prominent;
no significant
depressions
Interosseous muscle
Back of hand; move
thumb and forefinger
back & for the
Flat or depressed area
between thumb &
forefinger
Slightly depressed or
flat
Muscle protrudes;
could be flat in wellnourished females
Try to r/o causes other
than malnutrition.
Significant swelling
Mild-moderate swelling
No significant sign of
fluid accumulation
Triceps/Biceps
Muscle Wasting
Edema
Deficiency Symptoms (Fe)…
• YYY
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Deficiency Symptoms (Fe)…
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Deficiency Symptoms Vitamin C &D…
Deficiency Symptoms (Vitamin A)
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Physical Examination in Infants,
Children, and Adolescents
• Determination of height, weight, and head
circumference and plotting on pediatric
growth charts. (www.cdc.gov/growthcharts
for new growth charts)
• Evaluation of growth and development over
time.
• 5th to 95th%ile is normal.
• Crossing percentiles is abnormal. Dietary
intake should be assessed.
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Deficiency Symptoms (PEM)…
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Deficiency Symptoms (PEM)
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Deficiency Symptoms (Fe)
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Clinical Evaluation
• Anemia: Hgb, Hct, MCV, TIBC, folate, vitamin
B12
• Malnutrition: serum proteins, nitrogen balance
• CVD: cholesterol, lipoproteins, triglycerides
• Diabetes: glucose, HgbA1C
• Renal: BUN, creatinine, electrolytes
• Pancreatitis: triglycerides
• Malabsorption: fecal fat, hydrogen breath test
• Alcoholism: thiamin, folate, B12
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