Medically Fit For Exams
Medically Fit For Exams

Nutritional status examination

  • Wash hands and stethoscope and introduce self
  • Check the patient’s name and DOB
  • Explain the examination and gain consent

 

General inspection

  • Obvious weight loss/cachexia
  • Look for food items/supplements around the bedside
  • Patient wellness and comfort
  • Feeding tubes, IV lines, oxygen, PICC
  • Catheter, stoma, vomit/sputum bowls
  • Fluid/food charts

 

Hands

  • Capillary refill
  • Temperature
  • Clubbing (cirrhosis, IBD, coeliac)
  • Leukonychia (hypoalbuminaemia)
  • Koilonychia (anaemia)
  • Pulse (rapid pulse suggests fluid depletion)
  • State you would like to take BP, ideally check for orthostatic hypotension/postural drop

 

Face

  • Eyes
    • Sunken (dehydration, cachexia)
    • Conjunctival pallor (anaemia)
  • Mouth/tongue
    • Angular stomatitis/glossitis (iron deficiency anaemia)
    • Breath (ketoacidosis, alcohol, feculent)
    • Gingivitis (vitamin C deficiency)
  • Goitre (iodine deficiency)

 

Sternum

  • Capillary refill (dehydration)
  • Turgor (pinch the skin, dehydration if it doesn’t bounce back)

 

Abdomen

  • Subcutaneous fat
  • Ascites (liver pathology, hypoalbuminaemia, abdominal disease)
  • Loose skin (rapid weight loss)

 

Legs

  • Peripheral oedema (hypoalbuminaemia, heart failure)
  • Bowed legs (rickets: vitamin D or calcium deficiency)

 

 

  • Thank the patient

 

Further investigation

  • State you would like to take a full GI and dietary history
  • State you would like to do a full GI exam
  • State that you would like to calculate BMI and carry out MUST screening
  • State that you would like to carry out blood tests (FBC, iron studies, LFTs, U&Es, B12, folate, vitamin D, TFTs, CRP)

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