}ulie Kuiiz, MS, RD, CDE, CNIS

AZDA Confeience
}une io, :oii
Improve your Hands-On
Nutrition Physical Exam Skills:

Cb[ecuves:

Demonsiiaie (piaciice) ile basic nuiiiiion
plysical assessmeni slills io include ile
following:

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! Inspection
Critical observation of color, shape, texture, size. Uses
the senses of sight, smell, and hearing. Most frequently
used.
! Palpation
Tactile exam to feel pulsations and vibrations, assess
body structures (including texture, size, temperature,
tenderness and mobility.
! Percussion
Assessment of sounds to determine body organs
borders, shape and position.
8aslc nuLrluon-locused
hyslcal Lxamlnauon 1echnlques
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Loss of SubcuLaneous laL
Orbital Fat pad
hollow eye

Prominent
brow bone


SubcuLaneous laL loss
CrblLal faL pads
Teclnique: Inspeciion
Inspeci foi loss of bulge undei eye (fai pad); claiacieiized
by lollow eye

! Well-nouiisled - Sliglily bulged fai pad
"#$%#&'(%) &%*#%$+,
! Mild-Modeiaie fai loss- Dail ciicles, somewlai
lollow
! Seveie fai loss- pionounced, lollow, depiessed, dail
ciicles, loose slin
LeLs qulz your skllls?
CrblLal laL ad
Well-Nouiisled?
Mild-Modeiaie?
Seveie?
#1
#2
#3
#4
SubcuLaneous laL loss
1rlceps
Posterior view
Triceps
area on arm
most identified
with fat loss

SubcuLaneous laL loss
1rlceps
Teclnique: Palpaiion
Palpaie (pincl slin) beiween ilumb and foiefngei ovei ile
bacl of ile uppei aim ovei ile iiicep muscle
! Well-nouiisled - Ample fai iissue beiween folds of slin
"#$%#&'(%) -#%*#%$+
! Mild-Modeiaie fai loss- Fingeis almosi ioucl, some
depil io pincl
! Seveie fai loss- Veiy liiile space beiween folds oi fngeis
ioucling
LeLs qulz your skllls
1rlceps
Well-Nouiisled?
Mild-Modeiaie?
Seveie?
#1 #2 #3
Loss of SubcuLaneous laL
ChesL/Lower 8lbs
! Teclnique: Inspeciion
SubcuLaneous laL Loss
ChesL/Lower 8lbs
Obseive ile mid-axillaiy line ai ile cosial maigin oi
lowei iibs; obseive foi loss of fullness oi loose slin;

! Well-nouiisled - > ample fai iissue; clesi wall slould
noi be visible noi slould iibs be visible
"#$%#&'(%) &%*#%$+,
! Mild-Modeiaie fai loss: loose slin - somewlai
appaieni iibs
! Seveie - Slin is siieicled; piomineni well-defned
iibs



LeLs qulz your skllls - ChesL/
8lbs

Well-Nourished?
Mild-Moderate?
Severe?
#1
#2
#3
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8l-laLeral Muscle wasung
! Includes: muscle volume, ione, funciion and
gendei
! Uppei body moie suscepiible io muscle loss,
independeni of funciional siaius
! Muscle loss fiom inaciiviiy oi bediesi is mosi
piomineni in ile pelvis and uppei leg
! Muscle wasiing deieimined by palpaiion foi
volume and ione; ai aieas oi lollow aiea wleie
muscle slould be; piominence of bones
! Neuiological defciis (ilai may pieseni wiil
unilaieial wasiing); may pioduce false-posiiive
fndings
8l-laLeral Muscle Wasung
Temporal
Wasting

Prominent
brow bone

8l-LaLeral Muscle Wasung
1emple
Obseive paiieni siiaigli on; iuin lead fiom side io side;
lool foi piominence of biow bone; scooping oi
lollowing indicaied wasiing of iempoialis muscle

! Well-nouiisled - > can obseive well-defned muscle
"#$%#&'(%) .(/%0)1#)#2% -#%*#%$+,
! Mild-Modeiaie -> sligli depiession of iempoialis
muscle
! Seveie - Hollowing, scooping depiession
LeLs qulz your skllls
1emporal Wasung
Well-Nourished?
Mild-Moderate?
Severe fat wasting?
#2 #3 #1
G88-1 .%@H >(&*0- ?!&+/,4
D-0+%/@I 5<%(0@-1I C-*+%1/&I ;0!F/*0-

upper 8ody Muscle Wasung
Clavlcle
Obseive pecioial and delioid muscle !,@ lool foi
piomineni pioiiuding of bone; pioiiusion of bone
indicaies wasiing of pecioial and delioid muscles

! Well-nouiisled - > Clavicle bone noi piomineni in men
bui visible in women
"#$%#&'(%) .(/%0)1#)#2% -#%*#%$+,
! Mild-Modeiaie -> some pioiiusion of clavicle
! Seveie -> Pioiiuding]piomineni bone
upper 8ody Wasung - Shoulders
Obseive paiieni siiaigli on wiil aims ai side looling
foi squaiing of slouldeis; loss of ioundness ai junciion
of slouldei and necl; and slouldei and aim
(signifcance loss of delioid muscle)

Well-nouiisled -> Rounded, cuives ai ile junciion of
slouldei and necl; slouldei and aim
"#$%#&'(%) .(/%0)1#)#2% -#%*#%$+,
! Mild-Modeiaie -> some pioiiusion of aciomion
piocess
! Seveie -> Pioiiuding oi piomineni bone "squaiing of
slouldei"



LeLs qulz your skllls - upper
8ody Muscle wasung

Well-Nourished?
Mild-Moderate ?
Severe Wasting?
#4
#3 #2
#1
8llaLeral Muscle Wasung
lnLerosseous Muscle
Interosseous Muscles

lnLerosseous Muscle
Obseive inieiosseous muscle beiween ilumb and
foiefngei wiil palm down (bacl of land). Have paiieni
piess ilumb and foiefngei bacl and foiil wiil piessuie io
inspeci muscle

! Well-nouiisled - may bulge in male and be ai]bulge in
female
"#$%#&'(%) .(/%0)1#)#2% -#%*#%$+,
! Mild-Modeiaie - Sliglily depiessed oi ai
! Seveie - ai oi depiessed aiea beiween ilumb and
foiefngei




]


LeLs qulz your skllls -
lnLerosseous Muscle Wasung

Well-Nourished?
Mild-Moderate?
Severe?
#1
#2
#3
Conslderauons ln racuce
! J*K(/1/,4 +<- &L/00&
! Educaiion
! Plysical Examinaiion Teclniques and Pioceduies
! Geneial Suivey
! SGA
! Video's
! Foimal leaining - Seminai]Woilslops foi guided
piaciice expeiience
! Liieiaiuie
! Infoimal leaining - volunieei io woil wiil oilei
piofessionals ilai piaciice SGA oi plysical examinaiion
slills
8eferences
! McCann, Linda (iqq), Subjeciive Global Assessmeni. NKF
Spiing Clincial Nepliology Meeiing, Dallas, TX Apiil,
iy-:o, iqqy.
! liip:]]lealillinls.waslingion.edu]nuiiiiion]
seciionq.liml=b
! Lee Robeii and Nieman David. Nuiiiiional assessmeni

il
ediiion. New Yoil, NY: Mc Giaw Hill, :oio.
! McDonald, }ane. Tle Canadian Dieieiic Associaiion: A
Poclei Guide io Plysical Examinaiion and Nuiiiiional
Assessmeni Toionio, Canada: W. B. Saundeis. iqq(
! Ploios used wiil peimission of paiieni