A Day in the life of a Dietician
Examples of joint working
1. Weaning a patient from
PEG feeding to Oral feeding.
· If the patient is able to manage at least 3
days of good oral intake(>50% of required daily intake) the dieticians may
agree to reduce their PEG feed in order to stimulate appetite.
· A PEG may be used simply for fluids/hydration
needs.
1.
Supplements
· E.g. for a patient who will not tolerate an
NG-feed and is not eating enough of a puree diet (with fluids often the
doctor will prescribe sub-cut fluids).
· E.g. supplements which are the right
consistency for a patient to swallow.
· On the stroke unit all patients on a puree
diet are referred to the dieticians.
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Interpreting Dieticians Clinical Notes
A.
Assessment
– e.g. weight etc.
B.
Bloods
(e.g. electrolytes, raised CRP/WBC = inflammatory/ infection marker)
C.
Clinical
e.g. prescriptions
D.
Dietary –
observation chart
E.
Estimated
requirements
F.
Family
G.
Goals
H.
Aims/ plan
Body Mass Index
BMI = weight (kg)/
height (m2)
<18.5 =
underweight (probable poor protein energy status
20 – 25 = desirable
weight
25- 30 = overweight
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Estimating Nutritional requirements
1. Calculate the approximate basal metabolic
rate (BMR)
2. Determine the patients metabolic state e.g.
higher if metabolically stressed due to infection/ surgery etc… (increased
energy requirements due to disease processes).
3. Add an activity factor i.e. bed bound
immobile/ bed bound mobile (sitting)/ mobile on the ward.
4. Determine the goals of treatment e.g.
maintenance/ weight gain.
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Re-feeding syndrome
Definition: - a
group of clinical symptoms/signs that can occur when nutrition is
reintroduced to a malnourished individual.
· Over-rapid/ unbalanced provision of oral,
enteral or parenteral nutrition can lead to biochemical abnormalities
(elecrolyte disturbances).
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Electrolytes
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Respiratory symptoms
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Neuro-muscular symptoms
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Low Phosphorus (P)
|
Acute ventilatory
failure
|
Lethargy
Weakness/paralysis
Confusion
Coma
Diaphragm weakness
|
Low Potassium (K)
|
Respiratory
depression
|
Paralysis
Weakness
Muscle breakdown
|
Low Magnesium (Mg)
|
Respiratory
depression
|
Ataxia
Confusion
Muscle tremors
Tetany
|
Fluid/glucose
|
Respiratory
depression/
Pulmonary oedema
|
Coma
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Feedback from the dieticians
1.
Refer
patients to the dieticians more regularly if you feel they are at risk of
malnutrition/ re-feeding syndrome.
2.
Find
out patients’ food/drink preferences.
3.
Tea is
a diuretic, so if encouraging fluids due to dehydration encourage other drinks
as well.
4.
Information
to hand over to dieticians: a) Consistencies the patient can manage b) Prognosis
for their swallowing function.
5.
Fill
out food and fluid charts and encourage the nursing team to as well. Include if
the patient has refused food so that the dieticians know that someone hasn’t
forgotten to record the data.
6.
SLT’s
can prescribe build up soup e.g. the cal shake (made with milk).
7.
There
are thickened supplement dinks in grade 1 and 2 however they are slightly
thinner than thickened fluids of the same grade.
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