Nutritional Assessment

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By Mary Ellen Posthauer RDN, CD, LD, FAND

We have all heard the terms Marasmus and Kwashiorkor used to classify malnutrition that stems from the classic 1974 The Skeleton in the Closet article. Current research on this topic led to the collaboration and 2012 publication of a consensus statement of the Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.): Characteristics Recommended for the Identification and Documentation of Adult Malnutrition (Undernutrition).

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By Mary Ellen Posthauer RDN, CD, LD, FAND

Part 3 in a series discussing nutritional status and diabetic foot ulcer risk.
To read Part 1, Click Here
To read Part 2, Click Here

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

After reading Laurie Swezey's blog, "Diabetic Foot - Risk Factors and Prevention", I decided to weigh in on the issue of poor glycemic control. Teamwork is an essential ingredient since achieving glycemic control is a challenge for all clinicians including the registered dietitian (RD).

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By Mary Ellen Posthauer RDN, CD, LD, FAND

As the ethnic diversity in the United States continues to increase, clinicians should understand how food, culture and religious practices impact the nutrition interventions we recommend. According to the Census Bureau in 2010 Hispanics were the largest minority group in the US followed by African Americans and then Asians. Estimates are that by 2050 the minority population will reach 54% of the US population. The Hispanic population is anticipated to triple and the number of Asians will double.

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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 Michael Miller DO, FACOS, FAPWCA, WCC

Life is 10% reality and 90% perception. There are many conundrums in wound care that may never have an answer. How can one product produce remarkable healing for one caregiver and yet is, in the hands of another, lackluster. Fortunately, one of the unquestionable constants in the vast universe of wound care is that wounds do not heal in the face of abject starvation. For all the hype of the essential nature of nutrition to wound healing, let’s face it, most people pay lip service to the topic and nothing more. Of course, there are entities lurking about in hospitals, long-term care, and high school cafeterias who profess to hold one of the keys to healing. Like many secret societies, their methods and actions are steeped in ancient rituals and secret handshakes passed down from generation to generation. In our society, they are better known by the title, dietician.

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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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