Chapter 072. Malnutrition and Nutritional Assessment (Part 5)

Nutritional HistoryA nutritional history is directed toward identifying underlying mechanisms that put patients at risk for nutritional depletion or excess. These mechanisms include inadequate intake, impaired absorption, decreased utilization, increased losses, and increased requirements of nutrients.Individuals with the characteristics listed in Table 72-3 are at particular risk for nutritional deficiencies.
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Chapter 072. Malnutrition and Nutritional Assessment (Part 5) Chapter 072. Malnutrition and Nutritional Assessment (Part 5) Nutritional History A nutritional history is directed toward identifying underlying mechanismsthat put patients at risk for nutritional depletion or excess. These mechanismsinclude inadequate intake, impaired absorption, decreased utilization, increasedlosses, and increased requirements of nutrients. Individuals with the characteristics listed in Table 72-3 are at particular riskfor nutritional deficiencies. Table 72-3 The High-Risk Patient Underweight (body mass index with the historic, anthropometric, and laboratory findings. For example, thefinding of follicular hyperkeratosis on the back of the arms is a fairly common,normal finding. On the other hand, if it is widespread in a person who consumeslittle fruit and vegetables and smokes regularly (increasing ascorbic acidrequirements), vitamin C deficiency is likely. Similarly, easily pluckable hair maybe a consequence of chemotherapy, but in a hospitalized patient who has poorlyhealing surgical wounds and hypoalbuminemia, it suggests kwashiorkor. Table 72-4 Physical Findings of Nutritional Deficiencies Clinical Findings Possible Possible Deficiencya Excess Hair, Nails Corkscrew hairs and unemerged Vitamin Ccoiled hairs Easily pluckable hair Protein Flag sign (transverse Proteindepigmentation of hair) Sparse hair Protein, biotin, Vitamin A zinc Transverse ridging of nails Protein Skin Cellophane appearance Protein Cracking (flaky paint or crazy Proteinpavement dermatosis) Follicular hyperkeratosis Vitamins A, C Petechiae (especially Vitamin Cperifollicular) Purpura Vitamins C, K Pigmentation, scaling of sun- Niacinexposed areas Poor wound healing, decubitus Protein,ulcers vitamin C, zinc Scaling Vitamin A, Vitamin A essential fatty acids, biotin Yellow pigmentation sparing Zinc Carotenesclerae (benign) (hyperpigmented) Eyes Night blindness Vitamin A Papilledema Vitamin A Perioral Angular stomatitis Riboflavin, pyridoxine, niacin Cheilosis (dry, cracking, Riboflavin,ulcerated lips) pyridoxine, niacin Oral Atrophic lingual papillae (slick Riboflavin,tongue) niacin, folate, vitamin B12, protein, iron Glossitis (scarlet, raw tongue) Riboflavin, niacin, pyridoxine, folate, vitamin B12 Hypogeusesthesia, hyposmia Zinc Swollen, retracted, bleeding Vitamin Cgums (if teeth present) Bones, Joints Beading of ribs, epiphyseal Vitamin Dswelling, bowlegs Tenderness, subperiosteal Vitamin Chemorrhage in children Neurologic Confabulation, disorientation Thiamine (Korsakoff psychosis) Drowsiness, lethargy, vomiting Vitamin A Dementia Niacin, vitamin B12, folate Headache Vitamin A Ophthalmoplegia Thiamine, phosphorus Peripheral neuropathy (e.g., Thiamine, Pyridoxineweakness, paresthesias, ataxia, foot drop, pyridoxine, vitaminand decreased tendon reflexes, fine B12tactile sense, vibratory ...