Transcript dietitian ppt

Role of a Dietitian
Cassie Bradford RD,LD
About me..
Graduated High School- Marietta, OH 2002
 Graduated College- Ohio State 2006
 Dietetic Internship 2006-2007- Ohio State
 Obtained certification of RD- 2007
Job History Ohio State Medical Center 2003-2007
 Mount Carmel East 2007-present
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Who is a dietitian?
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Registered Dietitians are the food and nutrition
experts who can translate the science of
nutrition into practical solutions for healthy
living.
RD / LD
 RD= Registered Dietitian (national)
 LD= Licensed Dietitian (state)
Where can you find a dietitian?
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Hospitals (30%)
Food service operations
Sports nutrition and wellness programs
Community and public health settings (WIC)
Research areas (food and pharmaceuticals)
What does my job entail?
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Screening hospital patients for nutritional risk
Completing nutritional assessments for those
patients with identified risks
Implementing care plans to improve nutritional
status and/or prevent further risks
Education
Who is at risk?
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Body Mass Index < 16
Nutrition support (TF or TPN)
Chewing/swallowing problems
Pressure ulcers and nonhealing wounds
Significant weight changes
Anyone that is unable to meet his or her daily
requirements to heal, maintain weight, etc.
Malnutrition
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protein-energy malnutrition--the lack of enough
protein (from meat and other sources) and food
that provides energy (measured in calories)
micronutrient (vitamin and mineral) deficiency
(example-obesity)
Protein-energy malnutrition (PEM) is the most
lethal form of malnutrition/hunger
 released on October 14, 2009 by FAO, says that
1.02 billion people are undernourished
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Impairments
Problems can exist at
any level.
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Starting with the swallow..
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Some 50 pairs of muscles and many nerves work
to move food from the mouth to the stomach
Problems:
Weak tongue or cheek muscles
 not being able to start the swallowing reflex because
of a stroke or other nervous system disorder
 weak throat muscles cannot move all of the food
toward the stomach
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National Dysphagia Levels
Dysphagia diet level 1
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for people with moderate to severe swallowing
difficulty and have a poor ability to protect their air way
allows pureed food (pudding like consistency) that is
smooth and easily stays together
It may be difficult to meet calorie and nutrition needs
on this diet. It is important to use high calorie, nutrient
dense food such as cheese sauce, gravy and whole or
butter milk in this diet. Eating more frequently through
the day can also help increase intake.
Continued…
Dysphagia diet level 2
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step up from the pureed diet. Some chewing ability is
required. The level 2 diet is for people with mild to
moderate swallowing difficulty.
This diet consists of foods that are moist, soft and
easily formed into a bolus (soft wad of food). Avoid
foods that are difficult to chew, dry and coarse
Meats should be ground or minced and should be keep
moist with sauces and gravies.
Continued…
Dysphagia diet level 3
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This diet is a step down from a regular diet and is for
individuals with mild swallowing problems.
This diet consists of all foods, except very hard sticky
or crunchy foods. Foods should be moist and should
be cut up into bite size pieces.
Liquids
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Thin
Nectar/Syrup
Honey
Pudding
Oral Supplements
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Ensure Plus- 350 kcal, 13 g protein
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Glucerna- 220 kcal, 10 g protein
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Enlive- 250 kcal, 9 g protein
Continued…
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Magic cup- 290 kcal, 9 g protein
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Never melts beyond pudding thick
liquid
After the swallow…
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Stomach:
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Gastric Bypass Surgery(gastrectomy)
Diet progression
 Life time changes:
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Small frequent meals
Low in concentrated sugar and low fat
Drinking between meals
Vitamin supplementation (iron, calcium,
b12, magnesium)
Gastroparesis
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Gastroparesis is a condition that affects the
ability of the stomach to empty its contents
Gastroparesis occurs when the vagus nerve is
damaged and the muscles of the stomach and
intestines do not work normally. Food then
moves slowly or stops moving through the
digestive tract.
Diabetic Gastroparesis
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People with diabetes have high blood glucose,
which in turn causes chemical changes in nerves
and damages the blood vessels that carry oxygen
and nutrients to the nerves. Over time, high
blood glucose can damage the vagus nerve.
Diet
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6 small meals day
Low fat
Low fiber
Soft, easy to digest foods (severe cases may
require liquid or pureed diets)
Inflammation
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Crohn’s disease is an ongoing disorder that
causes inflammation of the digestive tract
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can affect any area of the GI tract, from the mouth
to the anus, but it most commonly affects the lower
part of the small intestine
Diverticulosis/Diverticulitis
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low-fiber with low-residue diet or a special liquid diet
may be beneficial in minimizing abdominal pain and
other symptoms
Bowel Resections
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Stomach absorbs 20% of the alcohol ingested, as well as some
short-chain fatty acids.
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Duodenum absorbs Vitamins A and B1, iron, calcium, glycerol,
fatty acids, monoglycerides, amino acids, monosaccharides, and
disaccharides.
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Jejunum absorbs glucose, galactose, amino acids, glycerol and
fatty acids, nonoglycerides, diglycerides, dipeptides, copper, zinc,
potassium, calcium, magnesium, phosphorus, iodine, iron, fatsoluble Vitamins D, E, and K, most of the B complex, Vitamin
C, and the rest of the alcohol.
Continued…
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Ileum absorbs disaccharides, sodium, potassium, chloride,
calcium, magnesium, phosphorus, iodine, Vitamins C, D, E, K,
B1, B2, B6, B12, and most of the water.
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Colon absorbs sodium, potassium, water, acids, gases, some
short-chain fatty acids metabolized from plant fibers and
undigested starch, and vitamins synthesized by bacteria (biotin
and Vitamin K).
Celiac
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Celiac disease is an inherited, autoimmune
disease in which the lining of the small intestine
is damaged from eating gluten and other
proteins found in wheat, barley, rye, and
possibly oats
Diet- Gluten Free (composite of two proteins
called gliadin and glutenin)
Following the Diet
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Reading the label:
Especially the list of
ingredients
Beware of cross
contamination
Nutrition Support
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A.K.A- artificial nutrition
#1 rule- If the gut works… use it 
Nutrition Support
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Tube feedingNasogastric (NG)
 Nasojejunal (NJ)
 Orogastric (OG)
 *Percutaneous endoscopic gastrostomy (PEG)
 *Jejunostomy (PEJ)
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(*long term)
Formulas
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Fiber/ no fiber- Jevity vs Osmolite
Diabetic- Glucerna
“Renal”- Nepro
Oxygenation (vented pt)- Oxepa
Wound Healing- Pivot
Elemental- Peptamen
Nutrition Support
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TPN (Total Parenteral Nutrition)
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Central
Central venous catheter- internal jugular, subclavian,
femoral veins
 PICC- peripherally inserted central catheter (placed in the
arm and ran up bigger veins until reaches the superior
vena cava)
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Peripheral
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Tip of catheter is not located at the vena cava site
TPN Formula
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2 in 1 (run lipids separately)
3 in 1
Protein: provides 4 kcal/g and 15-20% of
energy
CHO: provides 3.4 kcal/g instead of 4 kcal/g
and 50-60% of energy
Fat: lipid emulsion of oil and lecithin
(phospholipids from egg yolk); MCE uses 20%
solutions or 2.0 kcal/ml and 20-30% of energy
Conclusion
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Dietitians play a key role in the hospital setting
with nutritional needs of the patients.
Each diagnosis leads to its own nutritional
recommendations.
The field is always changing with new research.
Questions?