Clinical assessment;
The clinical examination is an evolution of the body and its functions using inspection, palpation (feeling with the hands), percussion (tapping with the fingers) and auscultation(listening) ''A through health assessment also encompasses collecting data about one's medical history, lifestyle, laboratory test and screening for diseases.
Hence, the medical history and physical examination are the two vital elements of clinical examination.
The Importance of Clinical Assessment:
Clinical assessment serves as the foundation for any treatment plan. It helps in early detection of illnesses, determining the severity of the disease, and tracking the progression or regression of a patient's condition. It also aids in designing a tailored treatment plan that aligns with the patient's unique health status and needs.
Components of Clinical Assessment:
Clinical assessment consists of several key components:
Patient History: This includes a thorough review of the patient's medical, family, social, and occupational history.
Physical Examination: This involves assessing the patient's vital signs, body systems, and overall physical health.
Diagnostic Testing: Tests are performed to confirm or refute potential diagnoses based on the findings from the patient's history and physical examination.
Clinical Assessment in Practice:
The real art of clinical assessment lies in the healthcare professional's ability to compile and interpret the gathered information accurately. Each patient is unique, and thus their assessment requires an individualized approach, guided by evidence-based practice, critical thinking, and clinical judgment:
The nutrition-focused medical history comprises of history of recent weight gain or loss, symptom of gastro - intestinal diseases(i.e. diarrheas, nausea, pain, and flatulence etc.) changes in the texture or colour of skin and examination of conjunctiva, buccal mucosa and hair.
A part, history of fatigue, dyspnea, muscular cramps, usage of medications, level of physical activity(work-related, leisure)and other lifestyle practices (place of residence or travel which can expose to, toxins, sunlight and food contaminant)are integral part of the assessment.
Likewise, in children and adolescents, the growth history includes body mass index , growth and neurodevelopment and general school performance while, the diet history comprises of past diet history, regular food intake, food preference food allergies/intolerances and alcohol consumption.
Physical examination;
As a general principal examination begins with the dietician inspecting subject' s body for unusual growth or body mark. Tje subject may be required to sit or stand during this part of the examination .
In the next step , the subjects are asked to lie down while the dietician feel their abdominal cavity and other part of the body to inspect the size, location, consistency, texture and tenderness
of individual organs. Purposely, the practitioner uses a stethoscope to listen the sounds originating from various body parts including lungs while the subjects take deep breaths.
Furthermore, the stethoscope is used to listen the vibrations of heart to ensure that there are no abnormal sounds. Often, ''percussion '' (which requires tapping of body like a drum) is a part of physical examination. Percussion helps in the discovery of fluid in body areas where it is not supposed to be.
Anthropometric measure are the vital constituent of physical examination. Weight and height measurements are by for the most frequent performed measures in nutritional assessment.
Although clinical examination carries limited utility in the diagnosis of specific nutritional deficiencies, it is in valuable to assess growth and adequacy of present or past dietary regimes in infant, children and adolescent. Moreover, it is useful to identify under-nutrition and obesity in adults.
Trained personnel are required to carry out measurement by following prescribed standards. A part from anthropometry , the physical examination entails signs and symptoms of nutrition deficiencies or excesses. These signs often git visible when the deficiency has already advanced, the major drawback of clinical assessment.
Furthermore, the time required for clinical manifestation of various nutrient deficiencies very considerably, depending on the fact whether the nutrient is stored in the body and the level of its initial reserves .
Numerous signs of nutritional deficiencies may become visible on the skin and hair. Usually, skin displays a relatively swift turnover, impaired proteins synthesis may lead to flack, fragile, and discolored skin.
Dry and hyper-keratotic pellagra exhibits patchy areas of hypo-or hyper- pigmentations, particularly in sun-exposed parts of the body, leading to hardened and broken surfaces. During protein energy malnutrition, hair may become thin, brittle easily pluckable.
Fluctuations in the hair protein synthesis may cause discoloration with alternating pale and normal colours, resulting in the ' banner sign' a typical characteristic of kwashiorkor. petechiae, ''the tiny circular, purple, red or brown spots on the skin that appear when tiny blood capillaries break open '' are the consequent of proteins energy malnutrition vitamin E or vitamin K deficiencies. Certain clincal sign for malnutrition deficiency are visible on the eye .
For example vitamin A deficiency result in series modifications in the conjunctiva(''clear thin membrane that cover part of the front surface of the eye and the inner surface of the eyelids'') and the cornea that not only reavel vitamin A deficiency but also grade its severity.
The most common classification of vitamin A deficiency relies primarily on eye examination. Conjunctiva pallor is a classical symptom of anemia, but its sensitivity is substantially ambient lighting and experience of the practitioner.
The mouth and tongue: are other areas of typical manifestations of clinical deficiencies of micronutrient. A red tongue is common attribution to deficiency of riboflavin but is also the result of niacin deficiency, the letter may accompany fissures.
Conversely pale tongue is an indication of iron deficiency, while, glossitis with or without colour changes is associated to pyridoxine deficiency. Angular stomatitis and lip lesions are attributed to ascorbic acid or riboflavin deficiencies. Extensive swelling and bleeding of guns is another typical symptom of nutritional deficiencies(scurvy).
Atrophy of the papillae is often the result of niacin, folate and vitamin B12 deficiencies . Excessive intake of vitamin A may lead to discoloration of the gingival mucosa. Rib beading (aviso known as rickets rosary) is the typical manifestation of vitamin D deficiency in children.
Likewise, epiphyseal enlargement and bowlegs are the classic feature of rickets, while distended blotted abdomen is a characteristic of proteins- energy malnutrition in children in the lower limbs, inspection is directed to ascertain the presence of edema, which is the outcome of proteins- energy malnutrition.
Before undergoing physical examination, the subject must get ready to answer following question in order to make most out of his time with practitioner;
1) Description of any pains or symptoms the subject is experiencing
2)Prescription or use of current medication or herbal supplements
3) Results from recent diagnosis tests
4) Any medical history or surgical procedure the subject has undergone
5)If the subject has any device implanted such as defibrillator, get a copy of the from and back of the device card
6) Any other questions, the subject needs to be answered
Conclusion:
Clinical assessment is a pivotal part of patient care. By ensuring a thorough and accurate evaluation, healthcare professionals can contribute significantly to patient health outcomes, tailoring treatments that cater to the unique needs of every individual they serve. As technology evolves, we can expect further improvements in this critical process, optimizing patient care in the future.
What symptoms has the patient reported, and how long have they been present?
Can you provide a summary of the patient's medical history and any pre-existing conditions?
What findings have you observed from the physical examination of the patient?
Have any diagnostic tests been conducted, and if so, what are the results?
Based on the current clinical assessment, what is your provisional diagnosis and recommended treatment plan?
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