Nutrition focused physical exams (NFPE) are a head to toe assessment of a resident’s physical appearance and function to help determine signs of nutrient deficiencies and to identify malnutrition.  This exam adds additional support to the comprehensive nutritional assessment and allows for appropriate interventions to support a resident’s nutritional status. While a resident’s lab values may be within normal limits, or their weight or meal intakes have not changed, a physical exam may determine if they in fact have nutrient deficiencies, decreased fat store or muscle wasting and provide additional pertinent information. This allows for a plan of care to be formulated to improve nutritional outcomes.

Malnutrition is defined as the presence of two or more of the following characteristics:  insufficient energy intake, weight loss, loss of muscle mass, loss of subcutaneous fat, localized or generalized fluid accumulation, and decreased functional status. Utilizing NFPE can provide the information for making these identifications.

Appropriate personal protective equipment (PPE) should be utilized for safety when conducting a NFPE. After conducting a general survey of a resident’s appearance and evaluation of their eating habits and weight history, a hands-on assessment is completed focusing on areas that include:

• Hair (appearance, texture, easily pluckable)
• Eyes (spots, changes in vision such as night blindness) and orbital region (observe for fat loss)
• Temporal region (signs of muscle wasting, sunken appearance)
• Oral cavity including lips, gums, tongue, dentition (review for color, sores, condition of teeth)
• Upper body-clavicle, deltoid muscle, scapular, upper arm region (observing for subcutaneous fat loss)
• Interosseous muscle of hand, grip strength, nail and nail beds (brittle nails and grooves could be signs of protein deficiencies or anemia)
• Skin – including signs of slow healing wounds, edema, pallor, yellowing, lack of fat under skin
• Lower extremities – including thigh and posterior calf (observe for muscle definition and edema to lower extremities)
• Other things to consider – respiratory status, is the patient short of breath, which could lead to fatigue while eating, and gastrointestinal status (including nausea, vomiting, or diarrhea)

With identification of potential deficiencies or concern for fat and muscle wasting, appropriate interventions including additional labs and dietary supplements along with a tailored plan of care can be implemented. Use of the NFPE as a tool to help identify malnutrition is beneficial for improved resident outcomes and nutritional status, as well as reducing health care costs and increasing potential reimbursement for facilities.

Sources:

Litchford M. Putting the nutrition focused physical assessment into practice in long-term care settings. Annals of Long-Term Care: Clinical Care and Aging. 2013;21(11):38-41.

Van De Walle, G. (2020, January 31). Nutrition-Focused Physical Exam (NFPE): A Beginner’s Guide. Retrieved from https://dakotadietitians.com/nutrition-focused-physical-exam/

Dennett, C. (2016). Nutrition Focused Physical Exams. Today’s Dietitian. Retrieved 2020, from https://www.todaysdietitian.com/newarchives/0216p36.shtml