CLINPHAR (MIDTERMS) - AB 2024
NUTRITIONAL ASSESSMENT
NUTRITIONAL HISTORY
• Counselling for proper nutrition
• The patients should be eating a balance diet meal
• Use of supplement and herbs.
NUTRITION
1. RDA – Recommended daily allowance
2. Basic Food Groups
3. Go, Glow, Grow Chart
4. Pyramid Chart
5. My Plate
VITAMINS COMMON DAILY RDA
NAME
A Retinol 150 µg/d
B1 Thiamine 3 mg/d
B2 Riboflavin 3 mg/d
B3 Niacin 17 mg/d
B5 Riboflavin 8 (?)mg/d
B6 Pantothenic 3 mg/d
B7 Biotin 32 µg/d
B9 Folic 400 µg/d
B12 Cobalamin 3 mg/d
C Ascorbic acid 90 mg/d Go foods – carbohydrates
D3 Cholecalciferol 20 µg/d
E Tocopherol 14 mg/d • Bread, rice, pasta
K2 Menaquinones 120 µg/d
Glow – vegetables and fruits
Grow foods – proteins
MINERALS DAILY RDA
20 mg/d
• Meat, fish, poultry
Calcium 1200 mg/d
Chromium 35 ig/d
Copper 900 µg/d
Fluoride 10 mg/d
Iodine 1000 ig/d
Iron 15 mg/d
Magnesium 375 mg/d
Manganese 75 µg/d
Molybdenum 45 µg/d
Nickel 1 mg/d
Phosphorus 700 mg/d
Selenium 75 µg/d
Silicon ND (not yet determined)
Sodium 2 g/d
Vanadium 1.8 mg/d
Zinc 12 mg/d
CLINPHAR (MIDTERMS) - AB 2024
No food 30-50 days Survive Waist-to - Hip ratio
No food 43-70 days Death (pwede na Interpretation Female Male
mamatay) Pear Less than 0.80 Less than 0.95
No water 3 days Dehydrated Avocado 0.81-0.85 0.96-1.00
No water 5-7 days Death due to Apple More than 0.85 More than 1.00
extreme
dehydration Formula for WHR: waist/hip
Mid arm muscle circumference
Interpretation Female
Normal More than 13.5 cm
Malnutrition Less than 12.5 cm
Skinfold thickness – measuring of fat or body fat
estimation.
Different “My plate” based on condition/s a person
might have.
Addtnl notes:
4 areas or body parts
• Biceps
ANTHROPOMETRIC MEASUREMENTS • Triceps
• Subscapular
• Measurement of man and human body. • Suprailiac
• To show growth and progression of body part.
1. Weight LABORATORY DATA
2. Height
3. BMI • Assessment of patient properly for his nutritional
4. Waist-to-hip ratio status.
5. Mid-am muscle circumference • More accurate
6. Skinfold thickness • Most abused specimen is BLOOD
BMI Interpretation Other specimens:
Below 18.5 Underweight
18.5-24.9 Normal • Sputum
25-29.9 Overweight • Saliva
More than 30 Obese
• Breath – use to detect Helicobacter pylori
(ulcer), if a person have vices (smoking/drinking)
• Tears
BMI Obese (Class)
30-34 Class I SIGNIFICANCE:
35-39.9 Class II
More than 40 Class III • Give Information on potential nutritional
problems
Formula for BMI: kgm^2 • Assist diagnosis for nutritional problem
CLINPHAR (MIDTERMS) - AB 2024
- Primary Malnutrition
- Secondary Malnutrition CBC – complete blood count/chemistry
A. HEMOGLOBIN
• Iron component of the blood TOTAL LYMPHOCYTE COUNT
• Measure electrolyte and level of Iron Hematocrit • Reflected by CBC by different count
• It gives information about immune system
Hemoglobin Level
function
Female 12.1-15.1 g/dL
Male 13.8-17.2 g/dL
• Lymphocyte makes up to 20% of the WBC
Hematocrit Level • Normal level: 1000-4800 per microliter
Female 36-48%
Male 40-52%
ANTIGEN SKIN TESTING
• Determines immune function
B. SERUM LIPID
• Cholesterol Level = <200 mg/dL 6. PREALBUMIN
• Triglyceride = <150 mg/dL • Thyroxine binding albumin
• LDL = <100 mg/dL • Transport protein for thyronine
• HDL = Female (50 mg/dL) ; Male (40 mg/dL) • Monitors any nutritional changes
• Produced by the liver
C. TRANSFERRIN • Decrease in pre-albumin = malnutrition
• Protein carrier which carries ferrous ion
• Transfer ferrous ion from GIT to RBC 7. ALBUMIN - storage of drugs (for acidic drugs)
• Ferrin – transporter of iron to the gastrointestinal • Transport protein, nutrients and hormone.
tract • Helps in maintaining homeostasis
• Normal Level: 16-30 nanogram/dL
Normal level of transferrin: 215-380 mg/dL
• Part of TPN – Albumin (protein), Carbohydrates
High Level anemia
and Lipids
Low level Hemolytic
anemia/liver disease • Storage of Drug
- Kwashiorkor = edema (protein deficiency)
- Marasmus = protein, carbohydrates and fats
deficiency
ANEMIA 8. GLUCOSE
• Hyperglycemia
• Shelf life of RBC is 120 days • Post-prandial blood glucose – 2 hours after
• Dead RBC can be found in SPLEEN (graveyard of eating (<140 mg/dL)
RBC) • Urinalysis – presence of ketone means
uncontrolled DM and malnutrition (+ sign),
Types of Anemia • Fasting blood glucose: 70-110 mg/dL
• Pre-diabetes: >140 mg/dL – 190 mg/dL
1. Iron Deficiency Anemia
I. GLYCOSYLATED HEMOGLOBIN
• High transferrin level • Confirmatory test for DM
• Lack of Healthy RBC • Every 2-3 months
• HBA1C = glycosylated hemoglobin
2. Megaloblastic Anemia
• Large RBC GLYCOSYLATED HEMOGLOBIN
Interpretation Level
• Decrease number of RBC
Normal (NO DM) <5.7%
• Lack of transfer of oxygen and iron
Pre-diabetes 5.7-6.4%
3. Sickle Cell Anemia Diabetes More than 6.5%
• Abnormal shape RBC
• Hereditary (based on genes)
4. Pernicious Anemia
• Autoimmune type of anemia
• Decrease in VIT B12 absorption
5. Hemolytic Anemia
• Breakdown/destruction of BLOOD/RBC
CLINPHAR (MIDTERMS) - AB 2024
J. CREATININE HEIGH INDEX PRE-ADOLESCENT
• Excreted by the urine
• Test for muscle usage • Peer pressure
• Measures protein reserves in the body • Pick-up unhealthy vices
• Collecting 24-hour urine
ADOLESCENT
90-100% NORMAL
80-90% MILD
• Junior and Senior high school
70-80% MODERATE
• Peer pressure
<70% SEVERE
ADULT
SERUM CREATININE (SRCR) NORMAL LEVEL
Female 0.6-1.1 mg/dL
• Careful and conscious in choosing their foods
Male 0.7-1.3 mg/dL • Follow healthy lifestyle
GERIATIC
K. NITROGEN BALANCE
• Test that confirms Creatinine Height Index • Decrease enzyme production
• NB = Protein intake/6.25-(UUN/0.8+2.5 for every • Organs may not function well
L output) • Food depends on the state of the body
L. VITAMIN D PHYSICAL ASSESSMENT
• Along with Ca for bones and teeth development
• AKA Sunshine vitamins DESCRIPTION
• Precursor and needed in the synthesis of melanin
• Cephalocaudal manner
M. VITAMIN B12 • A thorough investigation or observation of the
• Development and synthesis of RBC physical aspects of the patient.
• Needed in the formation of myelin sheath
(nerves) SIGNIFICANCE:
• AKA Raindrop Vitamin
1. To establish the patient baseline
• 160-950
2. To provide subjective and objective information
3. Contributes to the patient's therapeutic plan
N. VITAMIN B9
4. Identify variations hom normal state
• Needed for the development of spinal cord in
children
A. POSITION DURING PHYSICAL EXAMINATION
• AKA Folic Acid
• 140/628 nanogram/mL (?) SITITING POSITION
• Spinal cord development in children
• To visualize the symmetry of upper portion
AGE DEVELOPMENT
• Position where vital signs are taken
CHILDHOOD
LYING DOWN
• Neonate • AKA Supine
- 0-1 year old • Position when pulse signs are determined or
- Underdeveloped organ taken
- Colostrum
• Toddler DORSAL RECUMBENT
- 1-3 years old
- Soft foods • Position where knees are bent while lying down
• Pre-school • In this position, the abdomen is fully relaxed
- 3-4 year old
- Follow parents diet LITHOTOMY POSITION
• School Age
- introduction of unhealthy foods • Position during childbirth
- Malnourishment
CLINPHAR (MIDTERMS) - AB 2024
• Internal examination of female reproductive • Producing the sound and evaluating sounds
system producerd
SIM’S POSITION TWO TYPES
• Position where left knee is bent • DIRECT OR IMMEDIATE
- Producing sound directly on the body
PRONE POSITION - Closed fist
• INDIRECT OR MEDIATE
• Position where patient is lying on their stomach - use of plexor or plexi hammer to elicit sound
• Assess the extent of the hip joint - using instrument
STANDING POSITION AUSCULTATION
• Position done for male patients only • Listening to the sound produced by the body
• To check the male reproductive organ
TWO TYPES:
C. METHODS OR TECHNIQUES
• DIRECT OR IMMEDIATE - place ears directly on
INSPECTION the chest or back of the patient
• INDIRECT OR MEDIATE - use of stethoscope
• Done by using of eyes, ears, and nose
• EYES: Inspecting physical oppearance example: What are listened to?
observe the color of the skin, appearance of nals
abnormal sounds • Breath sound
• EARS: Checking for abnormal sounds example: • Bowel sound
wheezing • Heart sound
• NOSE: Checking for smell coming from the
patient example: breath How to assess sounds?
- Fruity odor - Ketoacidosis
- Mousy odor -Liver disease or Conline toxicity • According to intensity
- Fetid odor - Lung infection • According to pitch
• According to quality
PALPATION • According to duration
• Done by using the hands to confirm findings D. EQUIPMENT USED FOR PHYSICAL EXAMINATION
during inspection
• Place to palpate: 1. STHETHOSCOPE
- area of tenderness 2. SPHYGMOMANOMETER
- body cavities 3. THERMOMETER
- abdominal areas where fluid accumulates 4. REFLEX HAMMER
5. TONGUE DEPRESSOR
TYPES: 6. PEN LIGHT
7. TAPE MEASURE
• Light Palpation 8. WEIGHING SCALE
- using the hands, parallel to the floor, 1 cm 9. TUNING PORK
deep b. 10. SNELLEN CHART
• Moderate Palpation 11. SKIN CALIPER
- using the side of the hands 12. OTOSCOPE
• Deep Palpation 13. OPTHALMOSCOPE
- using palms to assess deeper structure of the 14. TIMER/WATCH
abdomen 15. PULSE OXIMETER
• Ballottement 16. HEIGHT CHART
- assess floating objects 17. NASAL SPECULUM
18. VAGINAL SPECULUM
PERCUSSION 19. GLOVES
20. LANCET
21. MICROFILAMENT/MONIFILAENTS
CLINPHAR (MIDTERMS) - AB 2024
22. LUBRICANT STATURE
GENERAL ASSESSMENT • HYPERSTHENIC
- Thick set, muscular body
1. Age • HYPOSTHENIC
2. Gender - Slender built
3. Ethnicity • ASTHENIC
4. Body Shape and Stature - Very slender
5. Posture
6. Gait POSTURE
7. Symmetry
8. Face • Consider the body alignment
9. Body Movement • Normal postures is called MILITARY POSTUE
10. Speech
11. Hairs and Nails CONDITIONS:
12. Odor
• Scoliosis - Abnormal S-curvature of the spine
AGE • Lordosis - Inward abdominopelvic
• Kyphosis - Inward thoracic cavity
• APPARENT AGE
- Assumption of age based on the appearance GAIT
• ACTUAL AGE
- AKA Chronological age • How the person walks
- This is the true age • FACTORS:
• MENTAL AGE 1. Pace
- Based on the behavior 2. Wide
- use of psychological test 3. Swaying of arms
FACTORS: SYMMETRY
• Genetics or Hereditary • The dominant part. Left or right
• Gender • CONDITIONS:
• State of health - Macrocephalus
• Life experiences - Microcephalus
GENDER FACE
• Male • Proportionality of the face
• Females • FACTORS:
1. Symmetry
ETHNICITY OR RACE 2. Contour or shape
3. Expression
FACTORS:
BODY MOVEMENT
• Diseases associated with certain race or
ethnicities • Intentional
• Rate of metabolism • Unintentional
• Diet
• Social habit SPEECH
BODY SHAPE AND STATURE SHAPE • Cornerstone for diagnosis of both emotional and
physical illness or disease
• MESOMORPH • FACTORS:
- Medium body shape - Face
• ENDOMORPH - Clarity
- Soft and round built of body - Vocabulary
• ECTOMORPH - Sentence structure
- Lean and delicate body built - Tone
CLINPHAR (MIDTERMS) - AB 2024
- Strength • Obtained by: Sphygmomanometer
HAIRS AND NAILS HEIGHT AND WEIGHT
• in relationship with the disease or condition of
the patient
ODOR
VITAL SIGNS AND STATISTICS
SIGNIFICANCE:
• Diagnosis of disease
• Physiologic function of CVS
VITAL SIGNS
A. Temperature
B. Pulse Rate
C. Respiration
D. Blood Pressure
E. Height and Weight
TEMPERATURE
FACTORS AFFECTING:
- Hormone
- Activity
- Diet
- Drugs
- Age
- Environment
PULSE RATE
• based on cardiac function and perfusion
• EVALUATION:
- Rate
- Rhythm
- Symmetry
- Amplitude or volume
RESPIRATION RATE
• RATE: Physiological finction of circulatory system
and respiratory system
• PATTERN
- Normal (12-20 cycles)
- depth of inspiration
- depth of expiration
BLOOD PRESSURE
• the force exerted by blood when it moves along
the blood vessel.
