Clinical Observations for Nutritional Assessment

Fundamental Review 11-1

Clinical Observations for Nutritional Assessment

Body Area	Signs of Good Nutritional Status	Signs of Poor Nutritional Status
General appearance	Alert, responsive	Listless, apathetic, and cachexic
General vitality	Endurance, energetic, sleeps well, vigorous	Easily fatigued, no energy, falls asleep easily, looks tired, apathetic
Weight	Normal for height, age, body build	Overweight or underweight
Hair	Shiny, lustrous, firm, not easily plucked, healthy scalp	Dull and dry, brittle, loss of color, easily plucked, thin and sparse
Face	Uniform skin color; healthy appearance, not swollen	Dark skin over cheeks and under eyes, flaky skin, facial edema (moon face), pale skin color
Eyes	Bright, clear, moist; no sores at corners of eyelids; membranes moist and healthy pink color; no prominent blood vessels	Pale eye membranes, dry eyes (xerophthalmia), increased vascularity, dull or scarred cornea
Lips	Good pink color, smooth, moist, not chapped or swollen	Swollen and puffy (cheilosis); angular lesion at corners of mouth or fissures or scars (stomatitis)
Tongue	Deep red, surface papillae present	Smooth appearance, beefy red or magenta colored, swollen, hypertrophy or atrophy
Teeth	Straight, no crowding, no cavities, no pain, bright, no discoloration, well-shaped jaw	Cavities, mottled appearance, malpositioned, missing teeth
Gums	Firm, good pink color, no swelling or bleeding	Spongy, bleed easily, marginal redness, recessed, swollen, and inflamed
Glands	No enlargement of the thyroid, face not swollen	Enlargement of the thyroid (goiter), enlargement of the parotid (swollen cheeks)
Skin	Smooth, good color, slightly moist; no signs of rashes, swelling, or color irregularities	Rough, dry, flaky, swollen, pale, pigmented, lack of fat under the skin, fat deposits around the joints, bruises, petechiae
Nails	Firm, pink	Spoon shaped (koilonychia), brittle, pale, ridged
Skeleton	Good posture, no malformations	Poor posture, beading of the ribs, bowed legs or knock-knees, prominent scapulas, chest deformity at diaphragm
Muscles	Well developed, firm, good tone, some fat under the skin	Flaccid, poor tone, wasted, underdeveloped, difficulty walking
Extremities	No tenderness	Weak and tender, presence of edema
Abdomen	Flat	Swollen
Nervous system	Normal reflexes, psychological stability	Decrease in or loss of ankle and knee reflexes, psychomotor changes, mental confusion, depression, sensory loss, motor weakness, loss of sense of position, loss of vibration, burning and tingling of the hands and feet (paresthesia)
Cardiovascular system	Normal heart rate and rhythm, no murmurs, normal blood pressure for age	Cardiac enlargement, tachycardia, elevated blood pressure
GI system	No palpable organs or masses (liver edge may be palpable in children)	Hepatosplenomegaly, enlarged liver or spleen

Source: Adapted from Dudek, S. G. (2022). Nutrition essentials for nursing practice (9th ed.). Wolters Kluwer; Jarvis, C., & Echkardt, A. (2020). Physical examination & health assessment (8th ed.). Elsevier.

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Fundamental Review 11-1