September 6, 2017

So Much More

Posted in Dietitian, Journal tagged , at 7:40 pm by Jenn

Day to day I struggle with being called “Dietary” by various members of the healthcare team.  I spend a lot of time an energy correcting this when it happens…”I’m sorry, do you mean Food Service or Clinical Nutrition?”  People don’t realize how hard we work to become Registered Dietitians.  Years ago Registered Dietitians did spend a lot of time…most of their time in the Food Service department.  Over the years the practice has advanced and Clinical Nutrition has really come a long way.  Our clinical expertise is being acknowledged by the interdisciplinary team and we are FINALLY becoming recognized as experts in our field.  We use stethoscopes, we perform physical examinations, we conduct a detailed interview with patients and family members and our assessments form the foundation for the diagnosis of malnutrition.  Did you know that 1 in 3 patients is admitted to the hospital already malnourished?  I saw 8 patients today and 2 of them met the criteria for malnutrition.  One was likely deficient in B vitamins based on the clinical presentation.

As a dietitian I get excited about all sorts of strange things…deficiency is one of them. Really looking at the patient from head to toe is my job.  It isn’t all about telling someone what to eat or telling them they need to lose weight (most people already know they are overweight you know), it’s about looking at the person, listening to their story and putting the puzzle together.

This patient had angular cheilitis (red, irritated cracks at the side of the mouth), lips were a deep pink reddish color), poor dentition (loose, cracked and broken teeth, many cavities), the patient gave the description of “teeth going bad quickly”.  It was reported that the patient had been taking iron supplements in the past but had run out recently. The patient had lost 6% of body weight in the past 2 months and had mild to moderate fat wasting on physical exam.  I felt there was a high likelihood that there was some nutrient deficiency.  It wasn’t until I was typing my note and entering the past medical history that it hit me – B6.  This patient had a history of seizure disorder and had been on long term Keppra.

I placed a call to the MD and discussed my findings.  I recommended that the patient be worked up for B vitamin deficiency.  The provider agreed.  THIS is what I went to school for, THIS is the reason I attend conferences and continue my education.  THIS is reason that I correct people when the call me dietary.  I am so much more, I AM a Clinical Dietitian.


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