Role of the Registered Dietitian in the LTAC
A registered dietitian (RD or RDN) is a food and nutrition expert who has met specific criteria to earn the RD or RDN credential. Not to be confused with a nutritionist, a dietitian holds a degree in nutrition as well as having completed a 6-12 month accredited program and passing a national exam.
The dietitian works with the healthcare team to best formulate a care plan that ensures each patient is receiving adequate nutrition. All patients that come to the LTAC are seen by the dietitian. A dietitian evaluation includes review of height, weight, laboratory values, skin integrity, weight history, food intolerances/food allergies, current appetite of patient, and/or tube feeding tolerance.
There are three ways in which you can obtain nutrition:
- Eating by mouth (PO diet)
- This is the preferred method of feeding!
- Feeding via a feeding tube into the stomach or intestines ( aka Enteral nutrition)
- This method is preferred if a patient is not able to eat by mouth due to respiratory failure, dysphagia (difficulty swallowing), or confusion but has a functioning GI tract.
- Enteral feedings can also be used to supplement a PO diet if it is insufficient (the patient is not eating enough) or the patient has increased nutrition needs (patients with large wounds can fit into this category).
- Intravenous nutrition (aka Parenteral nutrition)
- This method of nutrition is most often used if the patient does not have a functioning GI tract.
Once a patient is assessed and the team is consulted, a method of feeding is determined. The dietitian will then make recommendations for the appropriate nutritional plan and follow each patient throughout their hospital stay to ensure they are receiving adequate nutrition. Changes in a nutritional plan are made based on a patient’s change in medical status. For example, the dietitian may put a patient on a low sodium diet if they have a history of high blood pressure or put a diabetic patient on a low carbohydrate tube feeding to better control blood sugars. If a patient is losing weight, the dietitian may liberalize the diet restrictions in order to encourage intake. Supplements may also be added to boost a patient’s nutritional intake at or between meals.
Throughout a hospital stay, a patient can receive nutrition via all three methods described above. It is the role of the dietitian to help transition patients between nutritional methods while maintaining adequate nutritional status. This may mean slowly weaning a patient off tube feedings as their appetite increases until they are able to eat enough to maintain appropriate nutritional status with a PO diet alone. As the patient progresses through these steps, the dietitian is there to educate the patient and patient’s family members regarding the diet or feeding method.
In short, the dietitian is the nutrition expert of the LTAC, making sure you or your loved one is adequately nourished in order to best heal!
By: Erica Harper MS, RD
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