ROLE OF A DIETITIAN & KEEPING HYDRATED. Emily Capener Haematology Dietitian UHW

Transcription

1 ROLE OF A DIETITIAN & KEEPING HYDRATED Emily Capener Haematology Dietitian UHW

2 We will cover: PART 1 What is a dietitian Where do dietitans work About an acute dietitians role - Screening - Food charts - Nutritional supplements - Enteral feeding PART 2 Keeping hydrated Importance of hydration in the elderly

3 Part 1: What is a dietitian? British Dietetic Association definition: Registered Dietitians are the only qualified health professionals that assess, diagnose and treat dietary and nutritional problems at an individual and wider public health level. They work with both healthy and sick people. Uniquely, dietitians use the most up-to-date public health and scientific research on food, health and disease which they translate into practical guidance to enable people to make appropriate lifestyle and food choices

4 Where do dietitians work? NHS (acute or community setting) private practice Industry Catering Education Research Sport Media Public relations Publishing Government and Non Government Organisations BDA: Dietitians advise and influence food and health policy across the spectrum from government, to local communities and individuals.

5 Acute Dietitians Work with inpatients and outpatients in wards, clinics, units, group sessions Patients referred to us via nurses, specialist nurses, doctors, consultants and other healthcare professionals. Hospitals use a screening tool to help staff appropriately refer patients.

6 Ward referral process for malnourished patients UHW WAASP screening tool - Weight: BMI, weight loss - Appetite: - Ability to eat: needs encouragement, dysphagia?salt, - Stress factor: based on diagnosis - Pressure areas: Graded 1-4

7 Ward referral process for malnourished patients (2) Adding the results from all sections will give a score of between 0 29: 0 2 Low malnutrition risk. To be reviewed weekly 3 6 Moderate malnutrition risk. Assist with food choices Food record chart Encourage snacks between meals To be reviewed within 3 days 7 29 High malnutrition risk Refer to the Dietitian plus above To be reviewed weekly

8 Nutritional monitoring: Food charts Fundamentals of Care: Standard People s nutritional needs & physical ability to eat & drink are regularly assessed If eating & /or drinking cause people difficulties, they receive prompt assistance, encouragement & appropriate aids or support All Wales Food Record Chart - Recommendation of the Free to Lead Free to Care report June Contributes to the One Wales commitment to improve food and drink in hospitals

9 Nutritional monitoring: Food charts (2) What do we record on food charts? Meals Desserts Drinks Snacks Supplements Portion sizes Amount taken Flavour preferences Reason if not eaten

10 Nutritional monitoring: Food charts (2) Why do we use food charts? Calculating nutritional intake Monitoring changes in intake/appetite Patients who are unable to recall / relay intake Likes and dislikes Patterns Food and symptoms

11 Nutritional Supplements Any product used to enhance an inadequate diet in respect of one or more nutrients and / or energy Why do dietitians use nutritional supplements? Inadequate dietary intake Swallowing problems Nutritional deficiencies Elevated nutritional requirements Specific clinical conditions Food first!!

12 Nutritional supplements (2) Prescribable / Non-prescribable Different: concentrations, volumes, presentations, flavours, nutritional content Specialised: eg: electrolyte restricted Modules: Carbohydrate and / or protein fortifier powders or liquids: e.g. Maxijul, Vitajoule, Pro-cal powder, Polycal

13 Enteral feeding Enteral feeding is the delivery of nutrition this maybe of nutritionally complete feed, or just boosting the individual nutrients the patient needs directly into the stomach or jejunum. It can also be used to give medications and fluid Tube feeding plays a major role in the management of patients with: poor nutritional intake, chronic neurological or mechanical dysphagia, gut dysfunction and in patients who are critically ill.

14 Enteral feeding (2) At UHW we use nasogastric tubes & nasojejenual tubes as short term enteral feeding. Gastrostomy and jejunostomy tubes as longer term enteral feeding. We have both inpatients and outpatients with these feeding tubes. We have a range of feeds to choose between like with our nutritional supplement come in different: sizes, concentrations, amounts of calories, protein, fat, carbohydrates and electrolytes. Also specialist feeds available.

15 Part 2: Keeping Hydrated

16 Importance of Hydration Water is essential for life. Accounts for about 60% of our body weight Water performs crucial roles such as: - Carrying nutrients and waste products between our major organs - Helping to regulate body temperature - Lubricating our joints - Acting as a shock absorber. We should be aiming for around 1.5L - 2L fluid per day (around 6 8 x 250ml glasses).

17 Importance of Hydration (2) Mild dehydration can occur when 1% of our body weight is lost due to water restriction. Symptoms include: Constipation Dark yellow or brown urine Dry, sticky mouth Few or no tears when crying Headache Increased thirst Muscle tiredness Sleepiness or tiredness

18 Importance of Hydration in the elderly Elderly people in particular are at increased risk of dehydration, due to a number of factors: - Thirst sensation lessens with age - Medications can affect water balance meaning they might become dehydrated more easily or without realising. - It can be more difficult for elderly people to physically reach or handle drinks. - Some actively restrict the amount they drink due to worries about not reaching the toilet on time. Persistent dehydration can lead to confusion and even hospitalisation unless dealt with promptly, therefore, health professionals and caregivers should encourage the elderly to drink.

19 Useful Websites Bladder Problems: British Dietetic Associsation: Natural Hydration Council: Age UK: Nutrition, Malnutrition & Hydration

20 Thank you for listening Any Questions?