Mary Ellen Posthauer's blog

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By Mary Ellen Posthauer RDN, CD, LD, FAND

In response to Dr. Michael Miller's February blog, I would like to educate readers on the role and responsibility of the registered dietitian (RD) on the wound care team. The RD's educational and professional requirements include completing a bachelor's degree in nutrition from an accredited university, completing an accredited supervised practice program (usually 12 months) and passing the national examination to become a registered dietitian with the Commission on Dietetic Registration. All registered dietitians must maintain continuing professional educational requirements. Many RDs have a master's degree and/or have completed additional certifications in specialized areas of practice, such as certification for nutrition support (CNSD). The alphabet soup of letters for RDs is no different than the multiple initials behind many other professionals' names, including Dr. Miller's. Sorry, there is no secret handshake. Certification and licensure are state dependent just as in other health care professions. Dietetic registration and state licensure requirements also define scope of practice and define continuing education requirements. My own practice includes both the state of Indiana where I am certified to practice, and the state of Illinois, where I am licensed to practice.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

The NPUAP/EPUAP Pressure Ulcer Prevention and Treatment Guidelines published in 2009 have been widely circulated around the globe and translated into 17 languages. Successful implementation of any guideline requires a "buy-in" by all the members on the interprofessional team. As a member of the wound care team at a long-term care facility, I participate in weekly wound care rounds. Prior to our meeting, the wound care nurse has measured the wounds and documented them on an information sheet that also includes the type of wound (pressure vs. circulatory etc.) plus support surfaces and nutrition interventions.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Did you ever notice that 4 or 5 of the ten most popular New Year's resolutions involve food? We either want to eat more or less of certain foods, usually in an effort to lose weight or improve our appearance with exercise and diet. What about your clients who visit your wound care clinic and are struggling to heal chronic wounds? What advice should you give them? Your advice should be practical, achievable and cost-effective for them. Consider these options for your resolutions in guiding your patients in their own:

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Microbiota are living organisms that coat the lining of the stomach, small intestine and the colon, which has the highest concentration. They serve as the front line of defense by protecting against incoming microbes, modulating the immune system, exerting anti-inflammatory activity and maintaining intestinal cell activity. While many factors disturb the intestinal microbiota such as age, stress, and poor hygiene, the wide spread use of broad-spectrum antibiotics has led to the increase and severity of Clostridium difficile (C. diff). C. diff is a spore-forming bacterium that releases toxins in the intestine, causing mucosal inflammation, intestinal damage and diarrhea.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Frequently I am asked to review medical records to determine if an individual’s pressure ulcers failed to heal because of inadequate or inappropriate nutritional care. The majority of the cases involve long-term care facilities and the patients are older adults who had unintended weight loss (UWL) and pressure ulcers. After devoting 35 years as a consultant dietitian to nursing homes, I am well aware of the challenges faced by providers as they strive to provide care for our frail elderly.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Since we are fast approaching the deadline for the national elections, I decided to join the fray and campaign for accurate completion of the Braden Scale nutrition sub-score. The Centers for Medicare and Medicaid Services (CMS), Minimum Data Set (MDS) 3.0 Section M, Skin Conditions requires pressure ulcer risk assessment. Nursing facilities may use a formal assessment instrument such as the Braden or Norton tool to determine pressure ulcer risk. The most commonly used pressure ulcer assessment tool is the Braden Scale and one of the sub-scales is nutrition. Studies completed by Bergstrom and Braden in skilled nursing facilities found that 80% of pressure ulcers developed in two weeks after admission and 90% within three weeks of admission.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

During the wound healing process, aggressive nutritional support can reverse the body's hypermetabolic state, which occurs when lean body mass is used for energy rather than tissue repair. When energy stores are rapidly depleted in a healthy adult, this can lead to acute malnutrition. In the already compromised individual, however, it can lead to severe protein-calorie malnutrition. Malnutrition increases the risk of morbidity and mortality, and decreases function and quality of life. When the return to the previous quality of life is anticipated, individuals with continued compromised intake along with the burden of increased nutrient needs from stress and chronic wounds may benefit from enteral nutrition (tube feeding). Parenteral nutrition should be used only when the GI tract is not functional, cannot be accessed, or when the individual cannot be adequately nourished by enteral nutrition.

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By Mary Ellen Posthauer RDN, CD, LD, FAND

"Our food should be our medicine and our medicine should be our food."
-Hippocrates

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By Mary Ellen Posthauer RDN, CD, LD, FAND

My first year in practice, I volunteered with the local dietetic association when they launched “Dial a Dietitian”. The goal of the program was to capture the attention of the community and encourage people to phone a dietitian and seek help to solve their nutritional problems.

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By Mary Ellen Posthauer, RDN, CD, LD, FAND

Fat-soluble vitamins A, E, and K dissolve in fat and are transported in the body attached to lipids and require pancreatic enzymes and bile for absorption. They are stored in the liver and fatty tissue, which is why an excess concentration of fat-soluble vitamins can be toxic. When blood concentrations of fat-soluble vitamins decline, the body simply retrieves them from storage. Individuals with pancreatic insufficiency, cirrhosis or malabsorption syndrome may have low concentrations of fat-soluble vitamins. Consuming sources of fat-soluble vitamins daily is not necessary, but average intake of these vitamins consumed over time is beneficial. The impact of these fat-soluble vitamins in the management of wounds and other conditions will be discussed.

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