As you have likely noticed, there is a huge push for dietitians to get more hands-on with their patients (literally!). As nutrition assessment techniques have evolved, we now know that a targeted physical assessment can provide a wealth of knowledge related to a patient’s nutrition status and can help guide your malnutrition care plans. If you’re considering booking a nutrition-focused physical exam (NFPE) training, go for it! Here’s what you can expect.
Dietitians On Demand Founder Alicia Davis, RD, has her hands checked for evidence of interosseous muscle wasting by fellow dietitian Irene Czapary, RD, LD during an NFPE training.
It’s not as scary as you think.
Sure, maybe you decided to become a dietitian so you wouldn’t have to *touch* patients. But in reality, this is the absolute best way to assess your patient’s nutrition status. Without the NFPE, you aren’t seeing the full picture. The exam isn’t invasive and can be completed with a gowned patient. In my experience, patients usually have no qualms when I ask for permission to complete a NFPE.
It takes 10 minutes or less.
Concerns that the NFPE is too time-consuming to be used on a regular basis is nothing but #fakenews. However, many dietitians opt to perform the exam only when there is a “red flag” during the nutrition interview, like a report of unintentional weight loss, reduced appetite, etc.
It’s not just for acute care.
Yes, you can (and should) use the NFPE in long-term and ambulatory care. The majority of the exam can be completed while the patient is fully-dressed, perhaps with the removal of jackets, shoes, or bulky clothing.
Consider the NFPE as part of the bigger picture.
When performing the exam, think about other causes for edema or muscle wasting. These physical findings are not always rooted in nutritional etiologies. Put the NFPE results in context with the patient’s age, diagnosis, and medical history.
Let the patient help you!
Every human body is built and structured differently. As you move through the NFPE, engage the patient and ask him/her what changes they have noticed in their physical appearance, energy level, and fit of their clothing. This will make it easier to identify any relevant changes that may indicate a change in nutrition status.
If you are looking to incorporate NFPE into your nutrition assessments, I would highly encourage you to seek out a training session. After all, this is more of a “learn by doing” activity. Choose a session that allows for actual hands-on practice, whether this is with a cohort of real or pretend patients, or even amongst the other trainees. It may be a little awkward at first, but don’t be afraid to step out of your comfort zone. Remember, you’re doing this to provide even better care for your patients.
Sara Glanz, MS, RD, LD, CNSC worked as a traveling dietitian for Dietitians On Demand for two years before joining the team as the corporate dietitian. In this role, she has championed the continuing education program to empower dietitians everywhere to achieve their professional goals.
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