[HNF123] Module 7: Clinical Assessment

• Methods Used to Detect Signs

  1. Medical Record
  2. SOMR: Source Oriented
  3. POMR: Problem Oriented
  4. Physical Examination
• Classification of physical signs

  1. Group One: considered to be of value in nutritional assessment
  2. Group Two: need further investigation
  3. Group Three: no relation to malnutrition
• VITAMIN A (XEROPHTHALMIA)

  • Conjunctival and corneal xerosis: drying of conjuctiva and corneal
  • Loss of goblet cells
  • Bitot’s spots: white deposits of keratin
  • Keratomalacia: cornea is oedematous and thickened
• VITAMIN D: children who kept bundled or not exposed to sun light, low fat diet

  • Rickets
  • Bowed-legs
  • Osteomalacia
  • Low back pain
  • Rachitic Rosary
• VITAMIN E: antioxidant protects PUFA in cell membranes, vitamin A and C from oxidation

  • Skeletal Myopathy (weakness, dysfunction)
  • Peripheral neuropathy (nerves are damaged or diseased)
  • Pigmented Retinopathy (migration and proliferation of retinal pigment epithelial)
  • Spinocerebellar ataxia (poor coordination of hands, eyes, speech)
• Vitamin K

  • Hemorrhagic disease - bleeding
• Folate (Vitamin B12): regeneration of the amino acid methionine and synthesis of DNA and RNA, sheath that surrounds and protects nerve fibers

  • Angular Stomatitis
  • Glossitis
  • Pallor of skin and mucous membrane
  • Neural tube defect
  • Neuropathy
  • Dementia
• RIBOFLAVIN: destroyed easily when exposed to light

  • Angular Stomatitis
  • Cheilosis of lips
  • Ariboflavinosis
  • nasolabial dyssebacea: dry greasy filiform
• PYRIDOXINE (B6): very rare

  • peripheral neuritis
  • isoniazid: large dose of this may increase vitamin b6 needs
• THIAMIN (B1): affects energy metabolism

  • Wet beriberi - heart enlargement, edema, heart failure
  • Dry beriberi - polyneuritis/peripheral neuritis
  • Infantile beriberi - two to six months of age
• NIACIN (B3): from amino acid tryptophan

  • Diarrhea
  • Dermatitis
  • Dementia
  • Death
  • Pellagra
• COBALAMIN (B12)

  • pallor
  • papillary atrophy: manifestations in the tongue
  • megaloblastic anemia
• VITAMIN C

  • Scurvy: tiredness and weakness, swollen gums
  • Petechiae: small hemorrhagic spots
• CALCIUM

  • common to both rickets and osteomalacia
• IRON

  • phytic acid: decrease the absorption of iron from meals
  • palmar pallor: identified in the palm of the hand, pale palm
  • koilonychia: spooning of nails
• IODINE: synthesis of thyroid hormones

  • IDD: Iodine Deficiency Disorders
  • Goiter
  • Cretinism
• ZINC

  • associated with PEM
  • poor growth
  • dwarfism: shorter than normal skeletal growth
• EXCESS FLUORINE

  • fluorosis: mottled dental enamel
• PROTEIN

  • muscle wasting
  • oedema
  • parotid gland swelling