Hnf 123 - Clinical

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Clinical Assessment

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Method used for advanced stages of nutritional deficiency which involves checking for signs at specific body parts and asking patient for symptoms that might suggest deficiency

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Sooner, sooner

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The ___ the diagnosis of nutritional status is made, the ___ clinical public health interventions can be formulated

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Symptom

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Any subjective evidence of a disease thatcan only be perceived by the patient

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Anxiety, low back pain, fatigue

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Sign

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Objective evidence of disease which is apparent to patient, physicians and others

Hint 4

Blood coming out of nose

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Signs and symptoms

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May not correlate with dietary intake data or biochemical values and can only develop during advanced stages of nutritional depletion

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Group One

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Signs that are considered to be of value in nutritional assessment, often associated with nutritional deficiency status

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Group Two

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Signs that need further investigation

May be related to malnutrition, perhaps of a chronic type often found in populations of developing countries where other health and environmental problems such as poverty and illiteracy

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Group Three

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Signs that have no relation to malnutrition

They may be similar to physical signs found in persons with malntrition & must be carefully delineated from them

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Age of person being examined

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Plays role in the way signs present themselves and in the interpretation of the signs

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Vitamin C clinical signs among infants and young children

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Scurvy

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Vitamin C clinical signs among adults

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Scurvy affecting skins and gums

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Thiamin clinical signs among infants and young children

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Wet or dry beri-beri

Heart failure

Neuropathy

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Thiamin clinical signs among adults

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Wet or dry beri-beri

Wernicke-Korsakoff syndrome

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Riboflavin clinical signs among infants and young children

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Oral lesions

(Angular stomatitis, cheilosis, loss of tongue papillae)

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Riboflavin clinical signs among adults

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Oral and genital lesions esp. in late pregnancy

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Niacin clinical signs among infants and young children

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Pellagra

(Skin and other epithelial lesisons)

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Niacin clinical signs among adults

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Pellagra

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Vitamin B6 clinical signs among infants and young children

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Convulsions in infants

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Vitamin B12 clinical signs among adults

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Megaloblastic anemia

Spinal cord degeneration & neuropathy

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Medical History

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Method used to detect signs that can be obtained through interview of form records

Description of the patient and relevant environmental, social & family factors

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Vitamin B12 clinical signs among infants and young children

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Megaloblastic anemia

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Folate clinical signs among infants and young children

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Megaloblastic anemia

Oral lesions

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Folate clinical signs among adults

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Megaloblastic anemia esp. in elderly

Risk factor for neural tube defects in early fetal development

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Biotin clinical signs among infants and young children

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Skin rash

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Diffuse depigmentation

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General lightening of color of the pgiment of the skin of the face

Interference with melanogenesis

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Flag signs

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Alternating bands of light and darkly pigmented hair

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Dyspigmented hair

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Signs in hair due to melanogenesis

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Nasolabial dyssebacea

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Signs in the dace characterized by dry greasy filiform excrescences, greyish, yellowish pale in color which is produced by plugging of the ducts of enlarged glands by retained sebum

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Moon face

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Rounded prominence of the cheeks, mouth pursed in appearance

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Grade One (WHO pointing for Goiter)

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One lobe greater than the size of the phalanx of the subject’s thumb

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Physical Examination

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Methods used to detect signs that validates findings from medical history and gives information on the etiology of malnutrition

Includes functional tests for immune function, muscle strength, mobility & cognitive function

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Grade Two (WHO pointing for Goiter)

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A gland that is visible worh the neck extended

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Grade Three (WHO pointing for Goiter)

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A gland that is visible with the neck in normal position

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Grade Fourth (WHO pointing for Goiter)

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A gland that is visible from a considerable distance such as from across the room

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Normal (WHO pointing for Goiter)

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One lobe the soze of the first phalanx of the subject’s thumb

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Pale conjuctivae

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Pale eye membranes

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Conjuctival injection

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Redness of membranes pf the eyes

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Angular palpebritis

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Redness and fissuring of eyelid corners

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Cpnjuctival xerosis

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Dryness of eye membranes

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Corneal xerosis

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Cornea has dull appearance

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Keratomalacia

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Cornea is soft

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Vitamin A clinical signs among infants & young children

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Conjuctival and corneal xerosis

Loss of goblet cells

Xeropthalmia

Bitot’s spots

Keratomalacia

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Circumcorneal injection

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Ring of fine blood vessels around eye corner

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Cheilosis

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Redness or swelling of mouth or lips

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Magenta

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Purplish color of the tongue

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Xerosis

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Generalized dryness of the skin

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Type 1 follicular hyperkeratosis

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Lesions occur in mouth of hair and forming plaques that resembles spines

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Type 2 follicular hyperkeratosis

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Lesions have a similar appearance but mouth of the hair follicles contain bloos or pigment

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Petechiae

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Small harmorrhagic spots in the skin or mucous membrane

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Koilonychia

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Spooned nails

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Vitamin D clinical signs among infants and young children

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Ricket

Bowed legs

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Vitamin D clinical signs among adults

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Osteomalacia

Low back pain esp. in older people

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Vitamin E clinical signs among infants and young children

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Neuropathy

Paralysis

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Vitamin E clinical signs among adults

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Infertility

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Vitamin K clinical signs among infants and young children

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Haemorrhagic disease of newborn

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Vitamin K clinical signs among adults

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Possibly contributes to osteoporosis