Clinical Nutrition

Patient Communication

Patient education about clinical nutrition should use simple language (6th-grade reading level). Verify understanding with teach-back: ask the patient to explain in their own words what was discussed. Provide written instructions to reinforce verbal education. Address cultural and language barriers using certified interpreters, not family members, for medical discussions.

Assessment Techniques

Pulse: Radial (most common), count 60 sec if irregular. Apical: left MCL, 5th ICS, count 60 sec. Pulse deficit: apical minus radial.. Normal: Normal adult: 60-100 bpm. Tachycardia over 100, bradycardia under 60.

Temperature: Oral (under tongue, lips closed, 3-5 min), tympanic (pull ear up and back for adults), temporal (across forehead). Normal: Oral: 97.8-99.1 F. Rectal: +1 F. Axillary: -1 F. Tympanic: close to core.

Documentation

Documentation of clinical nutrition in the medical office uses ICD-10-CM: Diagnosis coding with alphanumeric codes, 3-7 characters, maintained by WHO/NCHS.

Examples: J06.9: Upper respiratory infection; E11.65: Type 2 diabetes with hyperglycemia; S52.501A: Fracture of lower end of radius, initial encounter.

All documentation must be timely, accurate, legible, and include the provider signature. Late entries must be labeled as such with the date of the original event.

Exam Focus Areas

On the Medical Assistant exam(s), questions about clinical nutrition typically test:

1. Normal and abnormal laboratory values and their clinical significance
2. Correct procedure technique and documentation requirements
3. Medical terminology, abbreviations, and coding systems

Practical Example

Key Values & Ranges

Lipid panel:

• Total cholesterol: under 200 mg/dL desirable
• LDL: under 100 mg/dL optimal
• HDL: over 40 mg/dL (M), over 50 mg/dL (F)
• Triglycerides: under 150 mg/dL

Urinalysis:

• pH: 4.5-8.0
• Specific gravity: 1.005-1.030
• Protein: negative
• Glucose: negative
• WBC: 0-5/HPF
• RBC: 0-3/HPF
• Bacteria: negative