6
Screening and Assessment
Physical Exams
• In addition to examination of the patients feet and ulcer, a physical exam
should also concentrate on skin quality, muscle tone, obesity, or low body
weight, as well as hair quality and cheilosis.
• At each visit, anthropometric questionnaires/measurements should be
administered and/or measured, and should include the following:
▶ Current vs. normal body weight
▶ % Weight loss or % weight gain over time
▶ Under/overweight amount and %
▶ BMI
▶ Edema
▶ Skin integrity
Patient History
• Obtain information of social issues that predispose to malnutrition.
▶ Depression, living on a fixed income, living alone, and geriatric age group are all
risks factors for malnutrition.
• More detailed history of eating habits is likely to divulge a diet low in protein
and high in carbohydrates — e.g., high caloric snack foods such as chips,
cookies and crackers require no preparation and may dominate the diet.
▶ Specific questions should be asked regarding fruit, vegetable, and protein intake to
determine adequacy of nutritional components.
• Ensure a patient's dietary intake exceeds 75% of the estimated energy,
protein, and water needed for wound healing.
▶ Some important tools than can be used to determine appropriate daily nutrition
intake are:
› Conducting 24-hour dietary recalls
› Meal frequency questionnaire
› Determining safe access to food and need for specialized or modified diet
› Evaluating socioeconomic status and home dynamics
