1. History
a. Typical daily food intake? (Describe.) Supplements (vitamins,
type of snacks)?
b. Typical daily fluid intake? (Describe.)
c. Weight loss or gain? (Amount.) Height loss or gain?
(Amount.)
d. Appetite?
e. Food or eating: Discomfort? Swallowing? Diet
restrictions?
f. Heal well or poorly?
g. Skin problems: Lesions? Dryness?
h. Dental problems?
2. Examination
a. Skin: Bony prominences? Lesions? Color changes?
Moistness?
b. Oral mucous membranes: Color? Moistness? Lesions?
c. Teeth: General appearance and alignment? Dentures?
Cavities? Missing teeth?
d. Actual weight, height.
e. Temperature.
f. Intravenous feeding–parenteral feeding (specify)?

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