The Role of a Dietitian

Leisa Norman, Dietetic Intern Colorado Mesa University Oral Presentation-Senior Nursing Students

Dietetics
Dietetics is a branch of science that applies the art food science, health and nutrition to diet.
What is an RD? Registered dietitians, or RDs, are the food and nutrition experts, translating the science of nutrition into practical solutions for healthy living. The expertise, training and credentials that back a registered dietitian are vital for promoting positive lifestyle choices. When you need food and nutrition information based on fact or need to know how a healthy diet improves health and fights diseaserely on qualified professionals in the field.

Registered dietitians draw on their experience to develop a personalized nutrition plan for individuals of all ages. They are able to separate facts from fads and translate nutritional science into information you can use. A registered dietitian can put you on the path to a healthy weight, eating healthfully and reducing your risk of chronic disease

Qualifications of an RD
RDs have degrees in nutrition, dietetics, public health or a related field; completed an internship; passed an examination and complete continuing professional educational requirements Completion of a Bachelors, Masters, or PhD Completion of an Accredited Dietetic Internship Passing score on Registration Exam Continuing Professional Education Credits

Divisions of Dietetics

Clinical Community Food Systems Management Retail

RDs work in hospitals, schools, public health clinics, nursing homes, fitness centers, food industry, research, private practice and more. Many RDs have certifications in specialized fields such as sports, pediatric, renal, oncology or gerontological nutrition.

Nutritional Intervention
When nutrient intake is affested, an intervention can stop the progression of problems Modified food intake, supplements, education, counseling, disease specific medical nutrition therapy (MNT) Everyone with acute or chronic illness should be assessed for nutrition problems They have an increased chance for developing nutritional problems (nutritional risk) Nutrition in the Hospital Up to 65% of all hospital patients are malnourished to some degree The longer they stay, nutritional status worsens

Nutritional Screening
Quickly, briefly, identifies people at nutritional risk and the need for in depth nutritional assessment All admitted to a hospital or nursing home Done by dietitian, dietetic technician, nurse, physician Typically occurs within 24 hours of admission Typically, again within 7 days if no problem found in initial screen Information collected during a screening depends on: Setting Disease or population group Data available The definition of risk Goals of the screen Data possibly used for screening: Dx- Altered Functional Status Ht & wt /significant wt changes Abnormal lab status: alb, H/H Medications N/V/D Nutrition Support

Nutrition Care Plan

Assessment

Diagnosis
Intervention Monitoring Evaluation

Nutritional Assessment

Means of determining nutritional problems Performed on those found to be at nutritional risk (through screening)

Done by dietitian Comprehensive Determines nutrition diagnoses (problems) Develops the plan for intervention and for monitoring and evaluation of the efficacy of the intervention

Ultimate goal is to restore/maintain nutrition status

Nutrition Diagnosis
Nutrition Diagnosis is a critical step between nutrition assessment and intervention. The purpose of a standardized nutrition diagnosis language is to describe nutrition problems consistently so that they are clear within and outside the profession. In simple terms, the nutrition professional identifies and labels a specific nutrition diagnosis (problem) that, in general he or she is responsible for treating. This step of the NCP results in the documentation of the nutrition diagnosis statement (PES) statement. This statement is composed of three distinct components: the problem (P), the etiology (E), and the signs and symptoms (S).

Nutrition Intervention
Nutrition interventions are specific actions used to remedy a nutrition diagnosis/problem, and can be used with individuals, groups, or communities. Nutrition Interventions are intended to change a nutrition-related behavior, environmental condition , or aspect of nutritional health. A RD collaborates with the patient/client, and other health professionals during the nutrition intervention. Four domains of the nutrition intervention: Food and/or Nutrient Delivery Nutrition Education Nutrition Counseling Coordination of Nutrition Care

Monitoring and Evaluation

The

purpose of nutrition monitoring and evaluation is to quantify progress made by the patient/client in meeting nutrition care goals.

During the M/E process, nutrition care outcomesthe desired results of nutrition care- have been defined, and specific indicators that can be measured and compared to established criteria have been identified. Monitoring and Evaluation tracks patients outcomes relevant to the nutrition diagnosis and intervention plans and goals.

Nutrition Support
Enteral

Nutrition= enteral implies using the GIT, primarily via tube feeding. Nutrition= provides nutrients directly into the blood stream intravenously

Parenteral

Medical Nutrition Therapy

Cardiac Rehab-Heart Healthy Diet HTN- fluid and Na restriction Coumadin-vitamin K interactions Renal Diet-phos restriction, K, Na Diabetic Diet-CHO counting, plate method Diet Restrictions: Na, Fluid, CHO Celiac Disease- Gluten-Free Pancreatic Diets-Low Fat Neutropenic Diet Wound Healing

Diet Transitions
NPO

Dysphagia

Diets: Level I, II, II Clear Liquids Full Liquids Pureed GI soft Regular

Food-Drug Interactions

Food-drug interactions are important in the effectiveness of medication the overall health care provided Must be addressed to meet JCAHO requirements The RD considers food-drug interactions in the patient on several medications and in whom nutritional status cannot be maintained Patients get written education and counseling before discharge, when indicated Materials for use with patients should be approved by the medical team, including registered dietitians and pharmacists Documentation of education given is made in the medical record to include patient comprehension, ability, and willingness to follow instructions.

Effects Drugs play on Nutrition Status

Appetite changes

Organ system toxicity

Specific organs Hepatotoxicity Nephrotoxicity Hypoglycemia Hyperglycemia

Undesired weight changes Nutritional imbalance Growth retardation in children Appetite suppressants Stimulant drugs and hypertension CNS side effects Appetite stimulants: undesirable and desirable

Glucose levels

Side effects Oral, taste, and smell

Dysgeusia and hypogeusia Metallic or salty taste Antineoplastic drugs: mucositis Xerostomia