The Dietetic Detectives by the DGRI Dietetic Team

As Dietitians’………………….. we are Detectives
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The patient in front of us has a nutritional problem –they are underweight, they have lost weight and they are struggling to eat – but why? It’s a mystery! Could the mystery be they are malabsorbing due to chronic bowel inflammation, bowel obstruction, or pancreatitis? Or do they have difficulty swallowing due to stroke, neurological disorders or head and neck cancer? And the list goes on…

Cue the acute Dietitian!
To get to the bottom of this, we need to look for clues. Clues come in all forms;
anthropometry
biochemistry
presenting medical problem
current symptoms
past medical history
current medications
environment and the patient’s own beliefs
psychological factors
As Dietitians we gather this information and put it together to solve the mystery.

But then what?

We then need to work with the patient, carers and family as well as the multidisciplinary teams to translate our gathered finding (clues). We use our clues to calculate nutritional requirements, this allows us to individualise patients needs – their calorie, protein and fluid needs. We then draw from the evidence base and our own experience, incorporating the tools of our trade some of which are:
Oral nutrition – Fortified diet, nourishing drinks, snacks and oral nutritional supplements.
Enteral (tube) Feeding – Into the gastrointestinal tract
Parenteral (intravenous) Feeding – Into the blood stream via venflons or central lines

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Here in Dumfries and Galloway Royal Infirmary our focus is on malnutrition.  People may think malnutrition is a thing of the past in this country, but according to a recent publication by the British Association of Parenteral and Enteral Nutrition (BAPEN) 25-34% of patients admitted to hospital in the UK are at risk of malnutrition (under nutrition).  Malnutrition is associated with less favourable outcomes such as increased length of hospital stay, impaired wound healing and reduced ability to fight infection. It is therefore important to identify and treat malnutrition as soon as possible.
Elsewhere in the other areas there are different patient groups receiving expert nutritional advice, projects being carried out and contributions to national research going on.
The evidence base regarding diet and health continues to grow; treating and preventing malnutrition in the hospital and community setting, gastroenterology, paediatrics, weight management, diabetes, renal, catering and mental health to name a few.

A few myths about dietitians:-
We never eat chocolate
We never drink alcohol
We judge you when we meet you in the local takeaway
Detox diets are good for you
Superfoods exist and are recommended
All we give is weight loss advice
Dietitians will inspect your poo (although we will ask about it)

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So hopefully you see there is more to dietetics than the common misconceptions – that we’ll be spying on your trolley at the supermarket, and of course we never eat cake, we always have our five a day and we do in fact we always have the perfect diet!
We hope this gives you a small insight into our profession.

And so this morning we’re off to the wards again,

NG tubes, Fortisips and TPN,

We’ll calculate needs, and make sure they’re met,

We won’t stop until food charts are used, you can bet.

Ensuring good nutrition, we can’t get enough,

Though we know sometimes it’s gonna be tough,

So we’ll chat, and we’ll laugh but we’ll work till we’re blue,

So when the cake comes out remember, we’ll have some too!

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This weeks blog was a joint effort by the Dietetic Team at Dumfries and Galloway Royal Infirmary