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Nutrition Focused Physical Exam
Anne Coltman, MS, RDN, LDN, CNSC
Edited by Mary Ann Cockram, MS, RD, LD and Wolf J. Rinke, PhD, CSP, RDN

C315
10 CPEUs
HARD COPY

$104.95

C315E
10 CPEUs
ELECTRONIC
$94.95

Manual with 1 reporting form, 83 pgs.
Details all aspects of the Nutrition Focused Physical Exam (NFPE) including assessment of somatic muscle, fat stores, fluid status, micronutrient deficiencies, and functional status, and provides an explanation of the Academy’s malnutrition guidelines, along with the appropriate identification of both the etiology and severity of malnutrition incorporating NFPE findings. More specifically you will discover how to:

  • Determine normal, mild, moderate, and severe loss of specified areas of fat and muscle for various adult patients.
  • Classify alterations in fluid status, including edema, ascites, and dehydration.
  • Locate areas of micronutrient deficiencies when completing a head-to-toe exam.
  • Categorize patients using appropriate degrees of malnutrition for all components of NFPE.
  • Describe appropriate methods and terms for malnutrition coding and the resulting effects on institution reimbursement.

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C315F
15 CPEUs
REPORTING FORM
$40.00

Nutrition Focused Physical Exam
Anne Coltman, MS, RDN, LDN, CNSC
Edited by Mary Ann Cockram, MS, RD, LD and Wolf J. Rinke, PhD, CSP, RDN

© 2018 Wolf Rinke Associates, Inc. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, without the prior written permission of the Publisher.

OVERVIEW AND INSTRUCTIONS

The Nutrition Focused Physical Exam (NFPE) has become an essential component of nutrition assessment of patients in a variety of practice settings. A thorough understanding of the technique along with interpretation of findings and incorporation into a malnutrition diagnosis is essential for Registered Dietitians Nutritionists (RDNs) to stay current in clinical practice.
This CPE program explores and details all aspects of NFPE, including assessment of somatic muscle, fat stores, fluid status, micronutrient deficiencies, and functional status. Each chapter explains appropriate methodologies, normal appearances, as well as the accurate interpretation of abnormal findings in a variety of patients. This CPE concludes with an explanation of the Academy of Nutrition and Dietetics malnutrition guidelines, along with the appropriate identification of both the etiology and severity of malnutrition incorporating NFPE findings.
This CPE program is a level 2 Continuing Professional Education (CPE) program approved for ten (10) continuing professional education units (CPEUs). That means that the reader has general knowledge of literature and professional practice in the area covered. The focus of the program is to enhance knowledge and application.
To get the most benefit from this program, we suggest you adhere to the following four steps:
Step 1: Review the objectives for the CPE program.
Step 2: Study each chapter. As you read, think of patients from your own practice who fit the situation described.
Step 3: Assess what you have learned by completing the self-assessment instrument at the end of this CPE program.
Step 4: Compare your answers to the answer key that has been provided. If you score at least 80% (40 questions) correct, you are ready to transfer your answers to the CONTINUING PROFESSIONAL EDUCATION REPORTING FORM. If you scored less than 80% correct, re-read the appropriate sections of the book and re-test yourself until you score at least 80% (40 questions) correct.
After you have successfully completed the program, complete the CPE REPORTING FORM and:
Submit online at www.easyCPEcredits.com,
Or fax to (410) 531-9282,
Or mail to Wolf Rinke Associates, Inc., 13621 Gilbride Lane, Clarksville, MD 21029.

Upon receipt of your CPE Reporting Form, we will email you a Certificate of Completion within 3-5 business days.

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OBJECTIVES

Upon completion of this CPE program you will be better able to:

  • Discuss the rationale for completing NFPE as part of nutrition assessment.
  • Determine normal, mild, moderate, and severe loss of specified areas of fat and muscle for various adult patients.
  • Classify alterations in fluid status, including edema, ascites, and dehydration.
  • Locate areas of micronutrient deficiencies when completing a head-to-toe exam.
  • Assess functional status using both objective and subjective measures.
  • Categorize patients using appropriate degrees of malnutrition for all components of NFPE.
  • Describe appropriate methods and terms for malnutrition coding and the resulting effects on institution reimbursement.
  • Demonstrate an understanding of NFPE as a result of successfully completing various case studies.


TABLE OF CONTENTS

Chapter 1. Introduction to Nutrition Focused Physical Exam
RATIONALE FOR NFPE
Nutrition Care Process
Academy of Nutrition and Dietetics Scope of Practice
Academy Standards of Practice
Tools for Assessment
Techniques for Assessment
LIMITATIONS
ADVANTAGES
GETTING STARTED
CASE STUDY
Chapter 2. Assessment of Muscle Stores
TEMPLE
CLAVICLE
SHOULDER
SCAPULA
INTEROSSEOUS
THIGH/PATELLA
CALF
CASE STUDY
Chapter 3. Assessment of Fat Stores
ORBITAL
BUCCAL
TRICEPS
RIBS/MID-AXILLARY LINE
CASE STUDY
Chapter 4. Assessment of Fluid Status
EDEMA
ASCITES
DEHYDRATION
Chapter 5. Assessment of Micronutrient Deficiencies
HAIR
SKIN
NAILS
EYES
ORAL EXAM
SPECIFIC VITAMIN/MINERAL DEFICIENCIES AND ASSOCIATED FINDINGS
Copper
Essential Fatty Acids
Folate
Iron
Niacin
Riboflavin (Vitamin B2)
Selenium
Thiamine
Vitamin A
Pyridoxine (Vitamin B6)
Vitamin B12
Vitamin D
Vitamin E
Vitamin K
Zinc
CASE STUDY          
Chapter 6. Functional Status
HANDGRIP DYNAMOMETRY
SUBJECTIVE ASSESSMENT
CASE STUDY
Chapter 7. Malnutrition Assessment
ACADEMY/ASPEN GUIDELINES
Inadequate Energy Intake
Involuntary Weight Loss
Loss of Muscle Mass
Loss of Subcutaneous Fat
Fluid Accumulation
Functional Status
Acute versus Chronic Malnutrition
CASE STUDY
Chapter 8. Billing and Coding of Malnutrition
INPATIENT BILLING AND CODING
OUTPATIENT BILLING AND CODING
SUMMARY
CASE STUDY
Chapter 9. Summary and Further Steps
References
For Your Continuing Education
List of Abbreviations
Glossary
Resources
Self-Assessment Questions
Answer Key
Explanation to Questions
About the Author
About the Editors

ABOUT THE AUTHOR

Anne Coltman, MS, RDN, LDN, CNSC is the Clinical Nutrition Coordinator at Loyola University Medical Center, as well as on the graduate faculty for the Dietetic Internship and Master of Science in Nutrition and Dietetics programs within the Marcella Niehoff School of Nursing at Loyola University Chicago.
She received her BS in Dietetics at the University of Illinois-Urbana Champaign and her MS in Clinical Nutrition, and her dietetic internship at Rush University in Chicago, IL.
Anne has previous experience as a nutrition support dietitian in surgical critical care, as well as a faculty member, specializing in nutrition assessment, physical exam, and micronutrient deficiencies in gastrointestinal, surgical, and critical care nutrition.
Anne is proudly involved with several professional organizations. She has previously served as the mentorship chair for the Dietitians in Nutrition Support practice group of the Academy of Nutrition and Dietetics (Academy). She currently serves as the president of the Chicago Area Society for Parenteral and Enteral Nutrition. She is also currently working on the Academy Evidence Analysis Library Workgroup for nutrition screening and serves as a member of the Quality Leadership Alliance for the Academy.

ABOUT THE EDITORS

Mary Ann Cockram, MS, RD, LD is a Research Scientist in the Scientific and Medical Affairs group at Abbott Nutrition where she provides clinical nutrition education and brand support internally to Sales and Marketing and externally to clinicians and consumers for Abbott’s critical care and surgical products. Her area of interest is enteral feeding.
Mary Ann received a Bachelor of Science degree in Home Economics from Valparaiso University in Valparaiso, IN, and a Master of Science degree in Clinical Nutrition from Rush University in Chicago.
She is a member of the American Society for Parenteral and Enteral Nutrition (ASPEN) and the Society of Critical Care Medicine. Mary Ann has served as chair of the Medical Nutrition Practice Group, and as the assistant editor and editor of Medical Nutrition Matters, the newsletter of this practice group. Mary Ann continues to write continuing professional education test questions for the articles in Medical Nutrition Matters. She participated as an evidence analyst on the Evidence Analysis Team for Adult Weight Management for the Academy of Nutrition and Dietetics, and she attended the test item writer workshop sponsored by the Commission on Dietetic Registration.

Wolf J. Rinke, PhD, RDN, CSP is the president and founder of Wolf Rinke Associates, Inc., a company that has provided high-quality CPE programs to dietetic practitioners since 1990.
Dr. Rinke earned a BS at Drexel University, a MS at Iowa State University, a PhD in Continuing and Vocational Education (Adult Ed) at the University of Wisconsin and interned at Walter Reed Army Medical Center. He participated in a test item writer workshop sponsored by the Commission on Dietetic Registration (CDR).
Dr. Rinke is a past Adjunct Associate Professor, Graduate School of Management & Technology at the University of Maryland, and a former Adjunct Faculty Member of the School of Continuing Studies at The Johns Hopkins University.
He has served as past president of the District of Columbia (DC) Dietetic Association and has been honored by the Academy of Nutrition and Dietetics with the Award for Excellence in the Practice of Management, the Outstanding Dietitian of the Year Award, and the Outstanding Service Award, in addition to delivering the Lenna Frances Cooper Lecture.
Dr. Rinke has served in numerous leadership roles at the Academy of Nutrition and Dietetics: Chair of the Scholarship Committee for Dietitians in Business and Communications; Chair of the Communication Committee, Honors Committee, and Licensure Panel and Ethical Practices Task Force for the Commission on Dietetic Registration; Chair of the Area Coordinating Committee and Chair for the Code of Ethics; Member of the Resource for Education Programs Committee; Member of the House of Delegates; and Member of the Board of Directors.
Dr. Rinke is the author of more than 500 articles, numerous CPE self-study programs, and several popular books including Make It a Winning Life: Success Strategies for Life, Love and Business; Winning Management: 6 Fail-Safe Strategies for Building High-Performance Organizations; and Don’t Oil the Squeaky Wheel and 19 Other Contrarian Ways to Improve Your Leadership Effectiveness.

ACKNOWLEDGMENTS

Special thanks to the following individuals for their careful review of this CPE program.

Susan Palczynski, MS, RDN, LDN, CDE
Regional Manager, Clinical Nutrition and Wellness
Trinity Health
Livonia, MI

Sarah Peterson, PhD, RDN, LDN, CNSC
Assistant Professor
Rush University
Chicago, IL

Hannah Roosevelt, MS, RDN-AP, CD, CNSC
Clinical Dietitian II
Seattle Children’s Hospital
Seattle, WA

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