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Examination of nutritional status

Examination of nutritional status for medical student finals, OSCEs and MRCP PACES

Introduction

  • Wash hands
  • Introduce self
  • Ask patient’s name and date of birth
  • Explain examination and get consent

 

General Inspection

  • Patient
    • Well or unwell?
    • Approximate BMI
  • Around bed (if present look at quantity of fluids in/out)
    • In
      • NG tube/TPN, IV fluids, nutritional supplements, food/drink/NBM notes
    • Out
      • Catheter, stoma, NG tube, vomit/sputum bowels
    • Charts (ask for these if not provided)
      • Observations, fluid balance, drug chart (diuretics, TPN, supplements)

 

Hands and arms

  • Nails
    • Clubbing (cirrhosis, IBD, coeliac)
    • Leukonychia (hypoalbuminemia)
    • Koilonychia – uncommon (iron deficiency anaemia)
  • Palms
    • Temperature
    • Xanthomata (hypercholesterolaemia)
  • Pulse and blood pressure sitting and standing
    • Rapid pulse and postural BP drop suggest fluid depletion
    • To look for a postural drop perform BP lying, immediately on standing, and and 3 minutes)

 

Head and Neck

  • Eyes
    • Sunken (dehydrated)
    • Xanthelasma (hypercholesterolaemia)
    • Conjunctival pallor (anaemia e.g. bleeding, malabsorption)
  • Mouth/tongue
    • Glossitis / angular stomatitis (iron/B12 deficiency anaemia)
    • Aphthous ulcers (IBD)
    • Breath odour (e.g. faeculent in obstruction; ketotic in ketoacidosis; alcohol)
    • Dry mucous membranes
    • Gingivitis (vitamin C deficiency: scurvy)
  • Goitre (iodine deficiency)

 

Chest

  • Sternum
    • Capillary refill, skin turgor

 

Abdomen

  • Fat
  • Ascites
    • Hypoalbuminemia or abdominal disease
  • Loose skin (rapid weight loss)

 

Legs

  • Peripheral oedema (hypoalbuminemia)
  • Bowed legs (rickets/osteomalacia)

 

To complete exam

  • Thank patient, ask them if they need help getting dressed, turn to examiner with stethoscope behind back and say: “To complete my nutritional status assessment, I would like to…”
    • Take a full history, focusing on dietary intake and gastrointestinal symptoms
    • Look at the observations
    • Look at food and fluid balance charts
    • Calculate BMI
    • Do blood tests (FBC, U&E, LFT, bone profile, CRP, B12, folate, haematinics, vitamin D)
  • Summarise and suggest further investigations and/or diagnosis

 

Click here to download free teaching notes on examination of nutritional status

Perfect revision for medical students, finals, OSCEs and MRCP PACES