Nutrition Focused History And Physical Examination

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NUTRITION FOCUSED HISTORY AND PHYSICAL EXAMINATION

Nutrition focused history and physical examination is essential in order to provide an accurate nutritional plan for care. The nutrition history provides subject information from the patient and/or significant other in regard to nutrition related problems. The goals of nutrition focused physical examination include determining the status of nutrition processes during ingestion, digestion, absorption and metabolism and identifying signs and symptoms of nutrition depletion or excess.

GENERAL INTRODUCTION:

To start the physical examination, and nutrition focused history of a person, the general introduction is much more important. Because it includes the basic information of a person like: sex, age, family size and socio economic status. Diet plan is planned on the basis of general introduction i.e the required calories/day of a male differs from female. Age and socioeconomic status also have a great role on nutritional status and have a considerable part in planning of a diet plan.

PHYSICAL APPEARANCE:

Physical appearance refers to the outward phenotype or looks of human beings. It differs from person to person. Some differences are genetic, others are the result of age, life style and disease.

IMPORTANCE:

Identify problems – so the corrective action can be taken to improve nutritional status.

EFFECT OF NUTRITION ON PHYSICAL APPEARANCE:

Physical signs are last to appear in the progression of malnutrition.

Hair:

Healthy hairs are shiny, smooth, and silky. The major factor that causes dullness in hair and make them thin and dry, that is easy to pluck, is deficiency of Protein.

Vitamin C and Protein are the two basic necessary nutrients for hair nourishment. Changes in hair occurs due to excess of Vitamin A.

Nails:

Normal  nails are of pink color. Reddish color of nails is directly related to high level of blood in body. Healthy nails are more darker in color, glowing and strong.

Unhealthy nails are not glowing, pale in color, have less strength, and easily breakable. And the major factors that causes unhealthy nails, is Calcium and Vitamins.

Skin:

Smooth, shine and moisture are the qualities of healthy skin. Skin without moisture and glow causes irritability and these symptoms occur due to deficiency of Vitamin C and Water.

Scaly skin around nostrils, is due to deficiency of Riboflavin. The pallor color of skin is due to deficiency of Iron. Dermatitis occurs due to the deficiency of Niacin. And the deficiency of Vitamin A causes a skin disease “xerophthalmia”

Teeth:

White, shiny and strong teeth are healthy teeth. Teeth without enamel are pale in color and not glowing. The necessary nutrients for teeth are Calcium, Fluorine, Phosphorus, Vitamin A and D,

Gums:

Gums contain many of the blood veins through which essential nutrients provided to teeth. Any type of carelessness can cause dental disease.

Spongy gums, bleeding through gums and receeding gums may be occur due to deficiency of Vitamin C.

Lips:

Smooth, shiny and moisturizing lips are good. Dryness in lips can cause due to less intake of water, or dehydration. Desquamation of lips cause due to deficiency of Biotin. Cheilosis (cracks at corners of lips) are cause due to deficiency of Riboflavin.

Eyes:

Fresh, and shiny eyes are looks healthy, but to see things clearly is a major function of eyes. The most essential nutrient for eye is Vitamin A.

Dullness and dryness of cornea, and  Bitot’s spots occur due to the deficiency of Vitamin A.

Fissuring of eye corners occur due to deficiency of Riboflavin, B-6.

Mouth And Throat:

Mouth should be free from bad taste. Because any type of disturbance in the body can cause bad taste in mouth.

Magenta Tongue causes due to deficiency of Riboflavin.

Atrophy or Hypertrophy of taste buds causes due to deficiency of Folic acid and Niacin. Thyroid enlargement occurs due to deficiency of Iodine.

OTHER INFORMATION:

Other information includes the normal condition of a person about temperature, pulse rate, respiratory rate, blood pressure, vision and hearing.

Temperature:

Temperature is the state of hotness of body. Normally human body is maintained in a state of hotness called Normal Body Temperature, that is 37°C and 98.6°F.

Temperature of the body can be taken through Thermometer.

Pulse rate:

Pulse is the feeling of heart beat.

Normally, Pulse is felt at wrist joint, but it can be felt at any point where artery passes, Superficially over a bony surface.

 Pulse rate differs through age to age, The normal pulse rate of adults is 60-80times/min.

Blood pressure:

Blood pressure is the force of blood at the walls of vessels at which the blood is pushed out of heart.

There are two types of blood pressure.

1. Systolic blood pressure

2. Diasystolic blood pressure.

Normal Blood Pressure of adults is 120/80mmHg.

Vision:

The manner in which an individual sees or conceives of something, known as vision . Vitamin A is good to maintain vision in dim light. And its deficiency causes an eye disease NYCTALOPIA (night blindness).

Hearing:

The faculty or sense by which sounds is perceived Related audio. Normal range of hearing of human beings is from the frequency of 20 – 20,000 hertz.

It can be differ in old age, that some old people can’t hear the voices which are above the frequency of 15,000 hertz due to less vibrate ability of Ear drum.

Deficiency of Vitamins increase voice susceptibility and a decrease in Sensory function.

Vitamin A, B complex, C, D, E, biotin, ALA an Omega3 essential fatty acid, copper, iodine, iron and magnesium are necessary for normal hearing in all ages.

CLINICAL HISTORY:

Clinical History gives information on body composition. Initial measurements provides baseline to monitor changes in Nutritional Status. Also detects obesity and under nutrition.

ANTHROPOMETRIC MEASUREMENTS:

Anthropometric  Measurements are compared to standard measurements to evaluate a result.

Weight:

Weight-beam balance, If taken electronically, then most accurate observations will received.

Observations shows the status of weight of a person: over weight – under weight – normal.

Height:

Height is the length wise measurement of the body. Height of a person determines his weight. According to height, desirable weight can be mention.

Body Mass Index (BMI):

BMI is the balance of a person’s weight according to his height.

       BMI= weight (kg) / height (meter).

Body frame size:

Body frame size can be measured by using this equation.

                                  •ht(cm)/wrist circ.(cm)=r=

                                                   men                        women

               Small                     >10.4                                >11. 6

                 Medium                        9.6 – 10.4                          10.1 – 11.0

                 Large                            <9.6                              <10.1

FOOD INTAKE:

Food intake history includes the total no. of meals/day. As pre breakfast, breakfast, lunch, supper, dinner and post supper. And check the status of meals on none, regular and alternative basis. And the time between two meals also observed.

Diet history:

Diet history includes the daily food elements. One’s intake about food items is observed on daily, weekly and monthly basis in diet history.

Water intake also observed in diet history.

HEALTH HISTORY:

Health history is about the physical health of a person. Whether a person is physically fit or have some kind of disease or disorder, i.e: Hypertension, Tuberculosis, Allergies/intolerance and any other disease.

Diseases:

The term disease broadly refers to any condition that impairs normal function.

Cancer:

Any uncontrolled growth and cell division is called cancer. Cancer or Carcinoma is basically a Malignant Tumor. It has unlimited growth. It expands locally by Metastasis. The tumor replaces the lung tissues. Therefore, cancer can occlude the respiratory passage.

Causes:

Cancer specially caused by smoking.

Tuberculosis:

It is the disorder of respiratory system. It is a group of disease caused by Mycobactrium.  It damaged the lungs. It causes cough and fever.

Causes:

Mal nutrition and poor living conditions promotes the growth of Mycobactrium.

Hypertension:

The condition of high blood pressure is called Hypertension. The prolonged high blood pressure damages the lining of the blood vessels. It also affects the heart muscles. It imposes continuous strain on heart muscles. So these muscles become thick and weak. It declines the efficiency of pumping action of heart. So blood is retained in the heart and lungs. It causes a fatal condition called Congestive heart failure.

Causes:

Hypertension can cause due to renal diseases, heart attack or strock.  

Diabetes:

Diabetes is a long life chronic disease in which there are high level of sugar in the blood. The higher blood sugar level can cause Blurry vision, excess thirst, fatigue, and frequent urination.

Causes:

The general cause of diabetes is reduce production of Insulin from pancrease.

Hepatitis:

Hepatitis is a medical condition defined by the inflammation of Liver and characterized by presence of inflammatory cells in the tissue that is most commonly caused by viral infection.

Causes:

Hepatitis can be due to toxins, other infections or from autoimmune process.

General symptoms:

General symptoms includes the basic symptoms that are not a disease itself but have a great relation with disease. Such as chills, early satiety, dizziness etc.

LABORATORY TESTS:

A test under controlled conditions that is made to demonstrate a result.

Blood test:

Blood tests determines blood group, level of plasma, blood cells and cell like bodies.

Types of blood test:

1. SMA – (simultaneous multiple analysis)

2. CBC – (complete blood test)

Urine test:

Urine test indicates:

1. Specific gravity – hydration status

2. Nitrogen balance

3. Creatinine excretion

Hemoglobin test:

Iron, hydration status is checked in hemoglobin test.

Normal level of hemoglobin in males is:                         14.0 – 17.5

Normal level of hemoglobin in females is:                     12.3 – 15.3

24 HOUR DIETRY RECALL:

Name:                                           Ayesha siddiqua

          Time

    Food items

     Quantity

        Calorie

       Breakfast

          08:00am

Paratha         egg

1 serving     1serving

400     +      155

        Brunch

         11:00am

    Fruit salad

      1 serving

          275

           Lunch

          02:00pm

Chapatti   chicken karahi

1 serving 1 serving

120            150

        Supper

         05:00pm

Tea        samosa

1 cup    1 serving

60             400

        Dinner

        08:00pm

Chicken pulao 

yougurt

1 plate    1cup

160          143

     Post supper

       10:00pm

            x

              x

            X

       Bed time

        11:00pm

          Milk

1 cup

           150

Water intake:                   10 -12 glass.

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