Total Parenteral Nutrition

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

Several years ago when my nutrition blog began, I discussed the issue of relying on laboratory values – in particular albumin, pre-albumin and transthyretin – as markers of nutritional status. Recently, during a discussion of nutrition and wound care, a dietitian expressed her frustration with a surgeon who kept postponing corrective abdominal surgery until a patient's nutritional status improved, as evidenced by the albumin being in the normal range. However, the patient was receiving adequate calories per enteral feeding and had gained weight. The albumin level was not reflective of the nutritional status. This discussion prompted me to revisit the issue of serum proteins as markers of nutritional status.

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

Lindsay Andronaco's blog, "How Can Wound Care Nurses Provide Culturally Sensitive Care" prompted me to reflect on similar situations that I have encountered in the nutrition arena. In particular, when individuals with non-healing wounds are either not ingesting or unable to ingest adequate calories to promote healing, the interdisciplinary team meets with the individual and/or caregiver or surrogate to discuss the consideration of enteral nutrition. While the burden and benefit of enteral nutrition is discussed, the team is often challenged by both the cultural and religious beliefs that impact the final decision. Consider this case study.

By Mary Ellen Posthauer RDN, CD, LD, FAND

In last month's blog, I discussed recent research and publication of the 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).

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.

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.

RAMBLINGS OF AN ITINERANT WOUND CARE GUY, PT. 18

By Michael Miller DO, FACOS, FAPWCA, WCC

One of the problems with writing a blog is not the lack of material on which to vent, vex or vociferate. Rather, I deal with the much desired situation in which there are simply so many aberrancies that appear before my now trifocaled vista, that I have to decide which of many potential entities to offend.

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.

By Lydia A Meyers RN, MSN, CWCN

I have been thinking for awhile about what to do for this month’s blog. During the time I worked for CTI nutritional I realized that many wound care nurses, including myself, are not well trained in nutrition. I also noted the impact that nutrition has on patients and their quality of life.