Search Ask the Dietitian
What is nutrition therapy and where can I find a dietitian who practices it?
The Medical Nutrition and Nutrition Entrepreneurs dietetic practice groups of the American Dietetic Association provide nutrition therapy based on your diagnosis. If you need nutrition support as tube feedings or IV solutions, then the Dietitians in Nutrition Support would be the best resource and you can also contact the nutrition support team at your local hospital. Dietitians often have their own private practice nutrition counseling services in addition to services provided in a clinic or hospital. You can find a dietitian at the American Dietetic Association. Include your zip code or city / state, the type of service you want (individual consultation) and expertise needed.
Can you tell me how to calculate calories and hydration for tube feedings? Can you tell me the steps to what goes in to a patient assessment if they were in the hospital? Thank you.
You would need to take a look at their current weight, usual weight, stress factors (fever, infection, burns, etc) and lab values to determine their current nutritional status.
Hydration can be measured by testing the blood for sodium, potassium and hemoglobin levels as they increase with dehydration. But other factors such as reduced kidney function can affect these blood values also. There is a simple test for skin turgor to determine quickly and non-evasively whether a person is adequately hydrated.
With regard to tube feedings, you did not mention whether this was a naso-gastric tube, gastrostomy, iliostomy or where the tube is entering the patient's body. All make a difference in terms of what tube feeding to use, strength and rate of administration.
So before you get in over your head, find a Registered Dietitian at the hospital where this patient is and ask them to do a nutritional assessment with tube feeding recommendations.
I started a nutritional support service when I worked in an acute care hospital and would not try to make recommendations remotely. You need a Registered Dietitian to assess the patient and read their chart which I cannot do from here.
I am about to have some surgery that will require that I be on a clear liquid diet for an extended amount of time. I must shop for these things before surgery as I live alone. Could you please let me know if there is anything I can have on this diet other than broth, Jello, 7 up and apple juice? Thank you very much.
Also, you will probably not be able to eat after midnight the night before surgery to make sure that your stomach is empty. You could vomit and inhale the vomit if the doctor puts a tube down your throat when you are given anesthesia and your stomach is full. Sorry to be so graphic, but it is important to follow your surgeon's instructions before and after surgery. After all, it is a lot to go through.
I am currently taking a nutritional assessment class and cannot find a term in my text. What does "SOAP" stand for?
SOAP refers to a style of documenting in medical charts.
Good luck in school.
Is there any benefit to cycling lipids rather than giving continuous infusion to children?
I am a Dietary Service Supervisor in California. Can you tell me who is authorized to sign what in an in-house patient's chart?
There always seems to be the question here as to which of my charting assignments needs to be co-signed by a registered dietitian. I write MD's suggested diet changes; I perform all assessments and basically do all of the necessary charting for our Dietary Department. Where can I find the necessary guidelines? Thanks.
Would you like me to post your question to a dietitian's listserv? If yes, please reply. Perhaps a consulting dietitian could provide you with the current regulations in your health care facility.
Generally, it varies with each facility's medical director, but there are also JCAH (Joint Committee on the Accreditation of Hospitals) regulations that cover medical record documentation.
Where can I find a dietitian who works with transplant patients?
What is treatment of a disease through a diet is called? The regular hospital diet is comparable to a ??? diet? The diet that reduce fiber to a minimum is the ??? diet.
Medical nutrition therapy (formerly called diet therapy) Healthy Soft or low fiber (formerly called low residue)
I'm writing for you from Uluda University in Turkey. I'm dietitian like you. I have a little English. Sorry my mistakes. Which receipts are you using in intensive care for your patients. Could you write me?
I work with consumers online only and do not have a patient practice. I have not worked in a nutrition support service (TPN, TF or enteral formulations) since early 1980's. If you would like to subscribe to some listserv for nutrition support I will send you information on how to join these online discussion groups (listserv) and you can ask the group by posting a message to the listserv. If you have problems subscribing (joining) a listserv, write to the owner of the listserv for help.
I will forward subscribing information on: firstname.lastname@example.org email@example.com
It depends on the diagnosis of intensive care patients. For instance if they are on a respirator, PulmoCare is good because it is lower in carbohydrate and therefore less demanding on oxygen needs. There are many enteral (oral) liquid meal replacement products out there and I would recommend talking to someone in the group above to find the best for a patient's diagnosis.
I logged onto your site in hopes to finding information on aspiration testing. We currently use a blue dye in our tube feedings. We have heard of a glucose test. I cannot find any information on that subject in reference to aspiration testing. From a physiological view point I do not understand how a glucose test would work, but was trying to find information before being convinced I was right. If you have any information on the subject, I would appreciate you sharing it with me. Thank you.
A blue dye (food coloring) was previously added by hospital staff to tube feedings to detect aspiration of stomach contents in the lungs. The thought was that any sputum containing a blue tint would indicate formula in the lungs, which is a cause of aspiration pneumonia. This practice is no longer recommended due to limited sensitivity of blue dye to aspiration of liquids from the stomach into the lungs. Further, FD&C blue number 1 toxicity (12.0 milligrams/kilogram body weight/day of FD&C Blue No. 1 is a safe level for humans) is possible since a non-standardized amount of blue food coloring may be added by hospital staff to the tube feeding formula. See Reports of blue discoloration and death in patients receiving enteral feedings tinted with the dye, FD&C blue no. 1. Tube formulas are not manufactured with a blue food coloring.
To reduce aspiration pneumonia, it is generally recommended to place feeding tubes after the valve at the bottom of the stomach (pyloric valve) and feed the patient in a sitting position rather than lying down position. If you have a nutrition support team in your hospital, I would highly recommend contacting them for your hospital's protocol for tube feedings.
Glucose testing would be on suctioned tracheal secretions, not blood, to determine if formula had been aspirated into the lungs from gastric contents. Since tube feedings contain some form of sucrose or glucose, the rationale was that a glucose strip used for blood testing would register any glucose found in lung secretions. This practice has not been adopted as a gold standard test for aspiration pneumonia.
Another is the glucose oxidase test strips on tracheal secretions, but it doesn't detect with 100% accuracy even if the tube feeding formulas have been enriched with additional glucose. This practice is not recommended because the glucose in tube feeding formulas is similar to the glucose in suctioned tracheal secretions.
I am a RN working in an intensive care unit at a local hospital. For our patients on a ventilator we must calculate the calories required. To do this we use the Harris Benedict formula. My question is what is the correct formula. We have been told to use the factor of 655 when calculation for a female. Some of my research has shown that the factor of 65.5 should be used.
Which is correct? If it were correct to use 65.5 would you give me a source that I can show at the hospital.
Thanks in advance for any information.
The correct factor for women are 655 and for men 66, but the Harris Benedict formula is much more involved than that. This calorie calculation includes weight, height and age.
The Harris Benedict formula can be found in most clinical nutrition textbooks. Also, the Harris Benedict formula doesn't include activity calories or stress / fever factors due to illness which can range from 10 to 100% over basal energy expenditure (Harris Benedict).
So if you want to correctly calculate the required calories for this ventilator patient, I would suggest that if you have a clinical dietitian working in your hospital, that you get her / him involved in this patient's care even if you need a doctor's referral. There are some formulas /diets that stress patients on ventilators because of the high carbohydrate content. High carbohydrate intakes increase oxygen consumption and the patient take a longer time getting weaned off the ventilator if his / her diet is wrong. This patient needs nutrition therapy from a Registered Dietitian.
In case you haven't tried the Healthy Body Calculator,you can use it to calculate calories and nutrients for your patients. It does not however include a stress factor, which you will have to add calories and other nutrients due to disease or metabolic processes. But it does most of the basic calculations for you.
Search Ask the Dietitian