Parenteral Nutrition

When a patient cannot eat any or enough food because of an illness or health complication, sometimes other forms of nutrition are required to assist the patient towards better health. The stomach or bowel may not be working normally, or a person may have had surgery to remove part or all of these organs. When this occurs, and a patient or client is unable to eat, nutrition must be supplied in a different way. One method that can be applied is Parenteral Nutrition.

Parenteral Nutrition bypasses the normal digestion in the stomach and bowel. It is a special liquid food mixture given into the blood through an intravenous (IV) catheter (needle in the vein). The mixture contains proteins, carbohydrates, lipids, vitamins and minerals. This special mixture may be called Parenteral Nutrition or Total Parenteral Nutrition (TPN).

A special IV catheter will be placed in a large vein in the chest or arm. It can stay in place for as long as needed. Proper care is required to avoid infection and clotting. Different kinds of catheters may be used. Common types of catheters are Peripherally Inserted Central Catheter (PICC), triple lumen, double lumen, or single lumen catheters, and Ports. Nutrition is given through this large vein. Coordinated care, consisting of doctors, nurses, RDs, and pharmacists, will talk with the patient about the different types of catheters prior to administering anything.

Prior to initiating TPN, a nutrition assessment is necessary to determine nutrient needs and to anticipate any metabolic changes that may occur due to the patient’s underlying condition, medications or concurrent therapies, etc. Important factors to consider when assessing a patient for TPN are:

·         Anthropometric Data: CBW, Wt Hx, IBW

·         Lab Values: Mg levels, Phosphorus levels, TG levels

·         Patient Medical History (PMH): Anatomy resections, ostomies, pre-existing conditions like diabetes or renal failure

·         Diet History: Diet prior to admission, Food/Drug Allergies

·         Medications: Current medications and supplements

TPN_All tube feedings

RDN… Hmm, Interesting

Every RD is a Nutritionist. But NOT every Nutritionist is a RD.

What is this new credential they are calling a “RDN”?

Well, the Academy of Nutrition and Dietetics (AND) Board of Directors and the Commission on Dietetic Registration (CDR) have recently approved the optional use of the credential “Registered Dietitian Nutritionist” (RDN) used by Registered Dietitians now.

The new optional RDN credential will not affect licensure or other state regulations. Plus many state licensure/certification laws already use the term “Nutritionist” (i.e.: LDN or CDN)

Many people, and especially RDs, are wondering why the Academy is offering this new credential. The reasoning behind this is to further enhance the RD brand and more accurately reflect to consumers who RDs are and what they do. This makes sense, when the Academy puts it like this…

This will distinguish the demanding credential requirements and focus that all RDs are Nutritionists but NOT all Nutritionists are RDs.  

The inclusion of the word “Nutritionist” in the credential itself, communicates a larger concept of wellness and treatment of conditions. This option is also consistent with the inclusion of the word “nutrition” in the Academy’s new name. Again, this makes sense and definitely seems innovative for the future of the Academy.

There is an increased awareness of the Academy’s role as a key organization in food and nutrition by media, government agencies, allied health organizations and consumers. This provides additional rationale for the incorporation of the word “nutrition” into the RD credential resulting in the optional RDN credential.  

But, here lies a substantial question… Was there any AND member input considered?

In 2010, the Academy began exploring the option of offering the RDN credential. It was supported by participants in the 2011 Future Connections Summit and most recently by the Council on Future Practice in its 2012 Visioning Report. The recommendation was shared and discussed in the House of Delegates at the Fall 2012 meeting. The 2013 joint meeting of the major organizational units (CDR, Accreditation Council for Education in Nutrition and Dietetics (ACEND), Council on Future Practice, Education Committee, and Nutrition and Dietetics Educators and Preceptors (DPG)) supported moving forward.

But here is my question- Do RDs have to use the RDN credential now?

No. The RDN credential is offered as an option to RDs who want to emphasize the nutrition aspect of their credential to the public and to other health practitioners. Plus, the new RDN credential has the exact same meaning and legal trademark definitions as the RD credential.

The credentials should be used, identical as a RD credential.

So, for example: Jess Brantner, RD = Jess Brantner, RDN. —-> (In time my friends… In good time)

The new RDN credential should be prioritized just like a RD credential, when other credentials are involved. So, 1st– Graduate degree credential, 2nd– RDN or RD, 3rd– special certifications with the CDR (CSSD, CSO, CSP, CSG, CSR), 4th– licensure designation or other certifications like Certified Diabetes Educator (CDE).

Here is the twist to my story- the CDR registration identification cards WILL include both the RD AND RDN credentials. So, be on the lookout for your 2013-2014 CDR registration identification cards, because it will have both credentials listed! But, don’t worry about costs, because there will be no additional fee for all these changes.

The opportunity to use the RDN credential is offered to RDs who want to directly convey the nutrition aspects of their training and expertise.

“This option reflects who Registered Dietitians are and what we do,” says Registered Dietitian Nutritionist and Academy of Nutrition and Dietetics President Ethan Bergman. “The message for the public is: Look for the RD – and now, the RDN – credential when determining who is the best source of safe and accurate nutrition information,” Bergman says. “All Registered Dietitians are Nutritionists, but not all Nutritionists are Registered Dietitians. So when you’re looking for qualified food and nutrition experts, look for the RD or RDN credential.”

AND RDN

Happy RDN Day?

Happy RD Day!

Happy Registered Dietitian (RD) Day!!

March 13th celebrates Registered Dietitian Day! This celebration occurs every year during National Nutrition Month, which is March. RDs are the public’s go-to healthcare professionals when they need reliable nutrition information, in this field. RDs pull from their experience to create a personalized nutrition plan for people of every age. These are the professionals that are able to separate facts from fads and translate nutritional science into information you, the consumer/client/patient, can use!

Dietitians can improve the health of Americans and save money through healthcare costs. Medical nutrition therapy (MNT) provided by RDs is critical in preventing the top 3 chronic illnesses. It is well documented that MNT is associated with a decrease in utilization of hospital services of 9.5% for patients with diabetes and 8.6% for patients with cardiovascular disease. Also noteworthy is that participation in community-based programs that focused on improving nutrition and increasing physical activity had a 58% decrease in incidence of Type 2 Diabetes.

Registered Dietitians assist to promote a net decrease in healthcare utilization and costs for most people. The Robert Wood Johnson Foundation estimates that in Idaho, for every $1 spent in wellness programs, companies could save $3.27 in medical costs and $2.73 in absenteeism costs. Some interventions have been shown to help improve nutrition and activity habits in just 1 year and had a return of $1.17 for every $1 spent. Reducing the average BMI in the state of Idaho by 5% could lead to health care savings of more than $1 billion in 10 years and $3 billion in 20 years.

Well, unfortunately Wild and Wonderful West Virginia isn’t as lucky as ole Idaho. West Virginia still leads the nation in obesity, and was recently named the state with the highest number of overweight residents in the union. According to the 2012 Gallup-Healthways Well-being Index released last week, 33.5% of West Virginia’s population is considered obese.

Mississippi is the closest with an obesity rate of 32.2%. Arkansas has a rate of 31.4%, Louisiana is 30.9% and Alabama is listed at 30.4%, to round out the top five.

Residents of the Mountain State believe that a reason for the high obesity rate is the change in physical jobs and increase in availability of fast food. The combination of lack of physical activity and the ready access of fast food and junk food in homes has really contributed to the epidemic. On the flip side of our state, nutrition-related efforts seem to be working as West Virginia is no longer in the top five for childhood obesity!

With the help from schools and communities, West Virginia is increasing physical activity and need for healthier foods. As a unit we are advocating and promoting activity and nutrition. I think it seems to be helping! All thanks to those RDs out there!!!

Job outlook: According to the Bureau of Labor Statistics, Nutrition and Dietetics careers are expected to increase much faster (by 20%) than other jobs by 2020 and faster than many other industries within health care. In 2010, the median annual salary for RDs was $53,250, at $23.60 an hour. And the number of jobs available in the nutrition and dietetics field was 64,400.

Money Bags

Bureau of Labor Statistics

Academy of Nutrition and Dietetics

Fat West Virginia

Nutrition in the Community

RD Day 2013

RD Day

Who are Community Dietitians?

Community RDs

What is a Community Registered Dietitian?

A Community Dietitian counsels individuals and groups on nutritional practices designed to prevent disease and promote health. They work in places such as public health clinics, home health agencies, and health maintenance organizations, community dietitians evaluate individual needs, develop nutritional care plans, and instruct individuals and their families. Dietitians working in home health agencies provide instruction on grocery shopping and food preparation to the elderly, individuals with special needs, and children.

Community RDs educate the public on topics related to food and nutrition. They often work with specific groups of people, such as pregnant women. They work in public health clinics, government and non-profit agencies, health maintenance organizations (HMOs), and other settings.

Community RDs work with wellness programs, public health agencies, home care agencies, and health maintenance organizations. These dietitians apply and distribute knowledge about food and nutrition to individuals and groups of specific categories, life-styles and geographic areas in order to promote health. They often focus on the needs of the elderly, children, or other individuals with special needs or limited access to healthy food. Some community dietitians conduct home visits for patients who are too physically ill to attend consultations in health facilities in order to provide care and instruction on grocery shopping and food preparation

College students interested in this field should consider courses in foods, nutrition, institution management, chemistry, biochemistry, biology, microbiology, and physiology. Other courses include business, mathematics, statistics, computer science, psychology, sociology, and economics, and communications. WVU’s own DPD program awards degrees in a (1) Bachelors of Science in Human Nutrition and Foods or a (2) Bachelors in Agriculture with an Emphasis in Nutrition.

Dietitians need at least a bachelor’s degree in dietetics, foods and nutrition, food service systems management, or a related area. Those who have a master’s degree or have specialized training in renal or diabetic diets should experience good employment opportunities. Students interested in research, advanced clinical positions, or public health may also need an advanced degree. Requirements vary by State. As a result, interested candidates should determine the requirements of the State in which they want to work before sitting for any exam. Although not required, the Commission on Dietetic Registration (CDR) of the Academy of Nutrition and Dietetics (AND) awards the RD credential to those who pass an exam after completing their academic coursework and supervised experience.

Greg Silverman hosted the annual Supermarket Dietitians Symposium in Savannah, GA

 

How much does a RD actually earn every year?

Entry level: $ 35,940

Median RD pay: $55,800

Community Dietitian:

–          Median salary working education and research: $60,200 and up

–          Median salary working in food and nutrition management: $60,000 and up

Top pay: $76,000

Total jobs, as of 2010: 64,400

Employment of RDs is expected to grow 18-26% for all occupations through 2014 as a result of increasing emphasis on disease prevention through improved dietary habits. A growing and aging population will boost the demand for meals and nutritional counseling in hospitals, residential care facilities, schools, prisons, community health programs, and home health care agencies. Public interest in nutrition and increased emphasis on health education and prudent lifestyles also will spur demand, especially in management. In addition to employment growth, job openings will result from the need to replace experienced workers who leave the occupation.

Betty Forbes, the previous Community Dietitian at WVU, retired last year. This is her teaching a HNF 472: Community Nutrition class.

 

Geography of a RD

The top five best-paying states for dietitians, according to the Bureau of Labor Statistics are:

–          Connecticut

–          Maryland

–          New Jersey

–          California

–           Hawaii

–          Dietitians in these states earned median wages of between $59,390 and $62,260 annually.

 

High-paying metropolitan areas that the BLS identified include:

–           the Bethesda, Maryland area

–          the San Jose/Sunnyvale, California area

–          the Oakland/Fremont, California area

–          Waterbury, Connecticut

–          Leominster/Fitchburg/Gardner, Massachusetts

–          These city areas pay dietitians median wages between $69,380 and $83,320 annually

 

For more info go to: www.eatright.org