Nutrition Focused Physical Assessment (NFPA)

The preconference workshop of the 2016 Texas Academy Annual Conference and Exhibition covered the topic of Nutrition Focused Physical Assessment (NFPA). Being able to conduct a NFPA is once again becoming an important skill in the dietetics profession as it can provide evidence of malnutrition. NFPA is not completely the same as Subjective Global Assessment (SGA). However, SGA can be included in NFPA. The examination may start out broad, or global, and then become more defined and focused based on the patient’s medical and nutrition history. The findings of NFPA alone cannot be used to diagnose malnutrition. It must be supported by evidence of malnutrition that come from components of nutrition assessment such as diet history, intake, weight

This usually involves palpating various areas of the body where fat and muscle store depletion can easily be detected. This may include under the eyes, the temples, the shoulders, under the ribs, the arms, the hands, the thighs, and the calves. Patients may also be asked to hold their arms out and test their grip strength with a Grip Strength Meter or by a simple handshake to test their physical strength. Questions about weight changes and food intake may also be asked. It may be helpful to interview the patient while conducting the exam. Together, the components of SGA are useful in assessing both recent changes and changes that have occurred

The results of NFPA can allow for reimbursement as well as benchmarking, and can support the need for more aggressive nutrition therapy. Collaborating with other key stakeholders, such as doctors, is important in order to get malnutrition put on the list of problems if it exists. Additionally, documentation of findings should be as clear as possible so that the correct medical code can be entered. The use of Nutrition Care Process Terminology is important as well because it provides a standard language that can be understood at any hospital despite different electronic medical record (EMR) systems. It may also be useful to develop a malnutrition-specific template to use when entering information into an