I am new to LTC and have a complicated resident recently admitted to the facility. Resident had a gastric bypass revision, which unfortunately resulted in compartment syndrome and a BKA as well as necrotic tissue on the other leg. Resident has 2 wound vacs. The resident is around 345#, has good meal intake but refuses any protein supplements (no carb pro source QID as well as 1 pkt j
I work with a SNF, and am in the process of reviewing/updating our Pressure Ulcer P&P. We currently have certain vitamins and supplements being added for different stages. Would anyone be willing to share their facilities policy for decub nutrition interventions?
Hi. I'm moving from the world of out pt diabetes education to home health. The question that keeps coming to mind is how to manage pts with multiple co-morbidities. For ex. how to counsel pts with CKD -- low pro, limited fluids, but with pressure ulcers that require hi pro, increased fluids. The MNT conflicts. Not sure how to manage. Also, for pts on fluid restrictions what do you recommend for m
I wanted to see what other dietitian's experiences have been with passing meds with an oral supplement. I am in a hospital setting, not LTC, so I didn't know if anyone has implemented this and, if so, how you determine which patients to use the supplement with. I know Ensure/Boost is common, but I have thought about trying Prostat. My boss has said 'no' citing cost. Any thoughts/input would be gr
I am a relatively new RD. I am at a small community-based hospital with a census of 35-40. As soon as I came, the other RD left (after a week) so I am the only clinical dietitian at this facility. We have no affiliates. On our formulary we have Juven and Liquacel. We also have the standard Ensure/Glucerna/Nepro. A lot of my pts have multiple pressure sores and I am wondering the best route to g
I get a lot of patients with vascular ulcers. Assuming the patient has fair to good intake (averaging 60-80% of meals), would you focus on the etiology of the ulcers (heart healthy diet)or would you treat them more like other poorly healing wounds (optimize calorie, protein and micronutrient intake)?
I currently have a challenging case. One of my patients is a 47 y/o male, 74" 518#. He has a stage IV sacral wound. He currently has a wound vac and cannot go to a NH unless he is under 500# which means he will have to lose 18#. What calorie/protein needs would you provide to help heal the wound but also aid in wt loss?
I have had a hard time finding required needs for DTIs. My understanding is that DTIs are likely to evolve into stage 3/4 wounds. What are other people doing as far as kcal/protein needs for pt's with DTIs?
Hi, My hospital is going to be starting a new surgery unit and is looking to do various surgeries minor and major. So, i am the only RD here and want to keep myself prepared to do nutrition assessment and interventions on the patients.
So I have a few questions and I really appreciate if anyone of you can guide me.
Just wondering how many of you work with surgeons who do flaps in patients with pre albumin levels less than 10.. at the bigger hospitals- we use level of 20. We had a surgeon who performed surgeries on patients with low pre albumin and they did not do well...
I have a patient who has a surgical wound on her leg. She has chronic kidney insufficiency. Her creatinine is 1.9 and eGFR is 26 which denotes stage 4 kidney disease.Not on dialysis.
My concern is should i give her high protein 1.2 and above adjusted body weight?( she is obese). Won't a high protein diet affect her kidneys further? She is also on arginaid BID but doesnt drink it consistently.
Does anyone know of a correlation between wound vacs and low sodium levels? I have a resident on po diet and tube feed, stage 4 wound and hx of low sodium. Resident now refusing to take meds by mouth and insists they go through her tube, which increases the water received via tube. One of our RNs has been overheard telling staff that she is losing sodium because the wound vac is "sucking it ou
Lately I am tired of having "poor nutrition" blamed for low albumins and Stage III or higher wounds not healing. This is after Vit C, zinc sulfate, protein powders, supplements, MVIs, appetite stimulants, and Arginaid. So, I started rec. Juven as a last resort and got the response "It's too expensive, can we just use protein powder?" This is happening in LTC and short term acute rehab units. I do