Clinical Practice

1
Clinical Practice

• Acute Chronic Care

2
Clinical Work Settings

• Health care facilities
• Acute care/in-patient care - short term care
  delivered to patients who experience sudden
  illness or trauma
• Long term care managing chronic conditions
• Ambulatory clinics managing chronic conditions
  or disease prevention in community dwelling

3
Responsibilities in Clinical Dietetics

• Nutrition Screening
• Nutrition Assessment
• Nutrition Care Plan
• Monitoring Progress
• Nutrient Analysis

4
Responsibilities in Clinical Dietetics

• Nutrition Screening
• Upon admission
• Screening process to identify nutritional risk
• Diagnosis, medical record, measurements, lab
  results collected during admission

5
Nutrition Screening Example

• Disease
• Eating poorly
• Tooth loss or mouth pain
• Economic hardship
• Reduced social contact
• Multiple medications
• Involuntary weight loss or gain
• Need for assistance in self care
• Elder years (gt80)

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Responsibilities in Clinical Dietetics

• Nutrition Assessment
• Collection of information to evaluate nutrition
  status and needs
• Medical, social, and diet histories
• Anthropometric data
• Biochemical analyses
• Physical examinations

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Nutrition Assessment Example

• 24 hour recall
• Guided interview to recall all foods and
  beverages consumed in past 24 hours (or typical
  day)
• Times, amounts, preparation methods
• Prompting

8
Responsibilities in Clinical Dietetics

• Nutrition Care Plan
• Based on diagnosis made a care plan of nutrition
  intervention
• i.e. special diet therapy, meal plan
• Includes ongoing monitoring and evaluation
  (follow up)
• Nutrient Analysis
• Evaluate nutritional content of foods consumed

9
Work time in Clinical Dietetics

• Average time involved in tasks
• 51 client-related activities
• 10 managerial functions
• 1 professional activities
• 5 non-professional activities
• 20 transit time

10
Nutrition Professional as Team Member

• Team approach
• Need integrated efforts to achieve desired
  outcomes
• No one can work entirely on their own

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Advancement Opportunities

• Entry-level dietitian
• Specialization
• Team/Service Leader
• Clinical Nutrition Dept Manager

12
Future of Clinical Dietetics

• ? self-employed dietetic counselors
• ? out-patient services
• Client education changing
• venues
• timing
• ? need for long-term care
• ? employment by MD offices

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Specialized Nutrition Support

• Enteral nutrition
• receiving nutrients via GI tract
• oral, tube, catheter, stoma
• Parenteral nutrition
• receiving nutrients via vein
• large, central OR smaller, peripheral

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Goals of Health Care

• What are the two major goals of health care?
• Maximize human flourishing
• Curative medicine
• Minimize human suffering
• Palliative care care of the terminally ill
  aimed to improve quality of life

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Goals of Health Care

• What are the two major goals of health care?
• Maximize human flourishing
• Curative medicine
• Minimize human suffering
• Palliative care care of the terminally ill
  aimed to improve quality of life

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Ethical Issues

• Explain the 3 ethical theories that affect
  attitudes towards health care delivery and
  services.
• Utilitarian
• Formalist
• Virtues
• Which of the 4 bioethical principles leads all
  ethical debate?

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Ethical Issues

• Is provision of nutrition morally obligatory or
  morally optional?
• Does this change with length of support?
• Does this differ for children, older adults,
  pregnant women, etc.?

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Dietitians Roles

• Responsibilities of RD?
• What knowledge, skills, attitudes needed for
  debate?