Download Typical Clinical Nutritionist/Dietician Services

CLINICAL NUTITIONIST/DIETICIAN
What is a Clinical Nutritionist?
Clinical Nutritionists provide basic nutrition education to patients and their families;
certifies patients for specific public health program benefits
Typical Clinical Nutritionist/Dietician Services
1. Evaluate and assesses nutrition status of patients, and screen patients for
nutritional risk in accordance with established protocols and standards.
2. Plan and initiate medical nutrition therapy to patients if indicated by patient
requirements and clinical protocol.
3. Certify patients for specific program benefits.
4. Educate and counsel patients and families on nutritional issues, either individually
or in groups.
5. Communicate individual nutritional care plans to other health care providers as a
member of a health care team.
6. Order and maintain inventory of supplies, including patient checks, for all clinics.
7. Perform various administrative duties related to public health nutrition programs.
About Clinical Nutritionists/Dieticians
Clinical Nutritionists/Dietician must effectively communicate medical information, test
results, diagnoses and/or proposed treatment in a manner easily understood by the client.
They must posses a knowledge of clinical nutrition theory and practice including
supplies, equipment, and/or services used in practice. Clinical Nutritionists/Dieticians
must maintain a knowledge of sponsored nutritional programs and patient certification
requirements. They should be able to develop and deliver presentations, as well as draw
conclusions and make recommendations based on research data and findings.
A Minimum of Bachelor's degree in Nutrition, Dietetics, or an equivalent field is needed.
State Licensing required for Dietitian (LD) or Licensed Nutritionist (LN) or ADA
Registered Dietician (RD).
Case Studies in How Clinical Nutrition Works
Case 1:
Ms. Day is and 80 year old widow from Cabbagetown. She was brought to the ER with 5
4 days of shortness of breath, anorexia, and vomiting. Socially, she lived alone and was
an ex-smoker. She was found to have a left lower lobe pneumonia.
She weighed 45 kg on admission and was subsequently discovered to have swallowing
dysfunction. Parenteral feeding was initiated, and energy requirements calculated by the
Dietician. She was monitored by urinalysis, glucose checks, phosphate and magnesium
levels, and liver function tests.
A nasogastric tube was inserted on hospital day 10. At this point the Dietician, again
using her calculated energy needs, determined that Ms. Day should be started on a
standard enteral feed (1 kcal/ml) at 30 ml/hour and then slowly increased to 85 ml/hour.
On Day 2 of NG feeding, the delivery rate was maintained at 85 ml/hour for 18 hours.
As her activity increased her feedings were increased to account for her increased energy
requirements were increased and requirements were re-assessed as follows:
The nasogastric tube was removed on hospital day 21 and the dietician commenced the
patient on a modified diet with oral nutritional supplements. The dietician worked with
the Kitchen and nursing staff to remove from her tray solid foods and thin liquids that
would increase her chance of aspiration. When discharged on Hospital day 30 she
weighed 53kg.
Case 2:
Mr. Kean was a 64 year-old obese (289 lbs) widowed man was referred from the
nephrology clinic. His kidney damage resulted from poorly controlled diabetes in spite
of a total of 180 units of insulin per day. He suffered complications of Type 2 diabetes,
including two heart attacks and neuropathy leading to Charcot joint damage in his right
ankle. His glucose readings averaged between 350 – 400. This was the case “no matter
what I eat,” he said.
Mr. Kean said that he had the diabetic diet explained to him in the past, and “mostly”
followed it. The dietician contacted Mr. Kean’s children who check in on him but had
not paid much attention to his diet. The dietician brought the family members in to
explain to the diet to them in the presence of Mr. Kean. The dietician and Mr.Kean spoke
by phone frequently over the next few weeks. At his two week visit Mr. Kean had lost 10
pounds and was on 158 units per day of insulin. By 5 months he had lost 50 pounds
lighter, and was taking 110 units of insulin daily. He continues to do well on his diet
with family support, and has been able to reduce his blood pressure medications as well.