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Nutrition Related Problems in Polytrauma Patients
SUNDAY, NOVEMBER 7
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY An Interdisciplinary Approach to Increasing Patients PO Intake and Improving Nutrition Status Author(s): R. Hoenig Fenton,1 L. J. Nuckolls2; 1Clinical Nutrition Service, Methodist Extended Care Hospital, Memphis, TN, 2Clinical Nutrition Service, Methodist LeBonheur Healthcare, Memphis, TN Learning Outcome: The participant will be able to state the role of ancillary disciplines in the resolution of feeding problems in a rehabilitation setting, and how teamwork improves nutrition status/ outcomes. The objective was to develop interventions for patients eating ⬍ 75%, resulting in improved nutrition status and achievement of rehabilitation goals. Data was obtained from the Methodist Extended Care Hospital in Memphis, TN. Admission data was reviewed. The following contributed to failure to achieve good nutrition status: 1) feeding assistance needed 2) lack of appetite 3) oral feeding issues 4) depression/lack of motivation to eat 5) distaste for hospital food 6) neurological problems. Since the reasons included issues beyond food preferences/diet, the Hospital’s Chief Executive Officer, Chief Nursing Officer, Quality Specialist, Hospital Registered Dietitian, and System Director of Clinical Nutrition met to discuss possible solutions. A Multidisciplinary Feeding Team was developed to resolve issues affecting oral intake. An algorithm was used to identify patients benefitting and exclude those not appropriate (e.g. total parenteral nutrition and enteral nutrition or those in palliative care/hospice.) The Registered Dietitian collected baseline data. 22 of 29 patients or 75% met criteria upon admission to the facility for feeding team intervention. Multidisciplinary staff (including everyone from family, Nursing, and Ancillary Associates) was trained in feeding assistance, correct evaluation and recording of oral intake, and prevention of aspiration. With the team, there is attention to food preference/meal delivery and individual needs are honored. This results in improved nutrition status with rehabilitation goals met. The team also has a positive effect upon the prevention and treatment of pressure wounds. Funding Disclosure: None
Nutrition Related Problems in Polytrauma Patients Author(s): S. Foley,1 R. Aine,2 D. Rea,1 A. Mehta,3 M. Steiner1; 1 Nutrition and Food Services, Hines VA Hospital, Hines, IL, 2Clinical Services, Huntington Memorial Hospital, Pasadena, CA, 3Physical Medicine and Rehabilitation, Hines VA Hospital, Hines, IL Learning Outcome: To gain knowledge on types of nutrition related problems veterans experience up to 3 years after diagnosis with polytrauma. Polytrauma is defined as having greater than two physical injuries resulting in physical, cognitive, psychological or psychosocial impairment. The purpose of this study was to determine if polytrauma veterans had nutrition-related problems past the acute phase of injury, to describe the most prevalent problems, and to identify if these were addressed. A retrospective descriptive study design was used. Electronic medical records of polytrauma patients were reviewed for nutrition problems including alterations in nutritional status resulting from complications associated with diabetes, hypertension, renal disease, gastrointestinal disorders, and depression. Descriptive statistics were used to analyze demographic and clinical variables. A total of 83 subjects were included in the study. Sixty-six percent had at least one nutrition-related problem (n⫽55). The most common nutrition problems included: constipation (n⫽32, 39%), triglycerides ⬎150 mg/dL (n⫽24, 29%), and BMI ⬎ 30 kg/m2 (n⫽18, 22%). The prevalence of other nutrition problems included: cholesterol ⬎ 200 mg/dL (n⫽16, 19%), dysphagia (n⫽10, 12%), albumin ⬍ 2.8 g/dL (n⫽10, 12%), hypertension (n⫽10, 12%), BMI ⬍ 18.5 kg/m2 (n⫽8, 10%), CVD (n⫽5, 6%), diabetes (n⫽3, 4%), and kidney disease (n⫽3, 4%). Forty-three percent of all polytrauma subjects were seen by a registered dietitian; 45% of traumatic brain injury patients, 94% of spinal cord injury patients, and 27% of post traumatic stress disorder patients. The prevalence of diabetes and dysphagia do not appear to be higher in the polytrauma population compared to national statistics.
Differences in 25-Hydroxyvitamin D Levels at Birth in Hispanic and Caucasian Infants Are Not Related to Neonatal Bone Mineral Status Author(s): K. M. Hawthorne,1 P. D. Hicks,1 S. P. Rogers,1 T. O. Carpenter,2 S. A. Abrams1; 1Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, 2Yale University School of Medicine, New Haven, CT Learning Outcome: The participant will be able to assess that even though vitamin D levels are lower at birth among Hispanic infants compared to Caucasian infants, there is no apparent effect on bone mineral status. Background: A newborn’s vitamin D status, as assessed by 25hydroxyvitamin D level (25-OHD) is dependent on the 25-OHD status of the mother. There are few data regarding the relationship between 25OHD and bone mineral outcomes in Hispanic (Hisp) infants. Objectives: To evaluate 25-OHD in breastfed newborn Hisp infants compared to Caucasian (Cauc) infants in a southern US setting and to determine if cord blood 25-OHD is related to bone mineral status. Methods: Cord blood was analyzed for 25-OHD and ionized calcium. Approximately 1 week after birth, infants received a dual-energy x-ray absorptiometry measurement to assess bone mineral density (BMD). Results: Thirty-eight mothers (20 Hisp, 18 Cauc) agreed to participate and provided cord blood. Of these, 24 returned (10 Hisp, 14 Cauc) for the 1-week follow up. 25-OHD was significantly lower in Hisp versus Cauc infants (17.2 ⫾ 5.7 ng/mL vs 24.1 ⫾ 6.8 ng/mL, p ⫽ 0.002). There was no difference in ionized calcium between Hisp and Cauc infants (1.45 ⫾ 0.08 vs 1.40 ⫾ 0.09, p ⫽ 0.1) or BMD (0.197 ⫾ 0.013 g/cm2 vs 0.196 ⫾ 0.011 g/cm2, p ⫽ 0.9). Using a value of 20ng/mL to indicate possible vitamin D insufficiency there was no difference in BMD of 19 infants with 25-OHD levels ⬍ 20ng/mL vs 19 infants with 25-OHD levels ⱖ 20ng/mL (BMD: 0.195 ⫾ 0.015 g/cm2 vs 0.197 ⫾ 0.011 g/cm2, p ⫽ 0.8). Conclusion: Hispanic newborns in a southern US setting have lower 25OHD than Caucasians without apparent effect on bone mineral status. Funding Disclosure: Marshall Klaus Perinatal Research Award (American Academy of Pediatrics)
Improving Accuracy of Lengths in the NICU: A Collaborative Approach Author(s): L. K. Wohlberg,1 A. Macek2; 1Clinical Nutrition, University of Maryland Medical Center, Baltimore, MD, 2University of Maryland Medical Center, Baltimore, MD Learning Outcome: To describe a development of a program to obtain accurate length measurements in the NICU. Measuring weight, length and head circumference is the primary method used to assess infant growth, but obtaining these measurements accurately on a serial basis can be challenging. Length measurement, not influenced by fluid status as is weight, reflects lean tissue mass and is a better indicator of long term growth. However, length is often more difficult to accurately determine and requires use of a recumbent length board and two examiners. Standard practice in our 40 bed Level III NICU was to use a tape measure to obtain length measurements done by the bedside nurse. To improve the frequency and accuracy of anthropometric measurements a collaboration was formed between the neonatal dietitian and a neonatal nurse practitioner. A proposal was submitted to the Medical Director identifying need, benefits, and costs to implement an anthropometric program. Six recumbent length boards were purchased to be housed in every clinical room. An educational poster was developed and displayed identifying the need for and outlining the method of practice change for nursing staff. Training was provided by the dietitian and nurse practitioner to the senior partners. Senior partners, with the assistance of the dietitian and nurse practitioner, then trained the 90 plus clinical nursing staff. To assess nursing accuracy, measurement technique was included in the nursing yearly competencies. Since implementation, accurate weekly serial data points have been available for the dietitian to plot. Growth data is then shared on rounds for clinical care decision making. Funding Disclosure: None
Funding Disclosure: None
Journal of the AMERICAN DIETETIC ASSOCIATION / A-35
POSTER SESSION: PROFESSIONAL SKILLS; NUTRITION ASSESSMENT; MEDICAL NUTRITION THERAPY An Interdisciplinary Approach to Increasing Patients PO Intake and Improving Nutrition Status Author(s): R. Hoenig Fenton,1 L. J. Nuckolls2; 1Clinical Nutrition Service, Methodist Extended Care Hospital, Memphis, TN, 2Clinical Nutrition Service, Methodist LeBonheur Healthcare, Memphis, TN Learning Outcome: The participant will be able to state the role of ancillary disciplines in the resolution of feeding problems in a rehabilitation setting, and how teamwork improves nutrition status/ outcomes. The objective was to develop interventions for patients eating ⬍ 75%, resulting in improved nutrition status and achievement of rehabilitation goals. Data was obtained from the Methodist Extended Care Hospital in Memphis, TN. Admission data was reviewed. The following contributed to failure to achieve good nutrition status: 1) feeding assistance needed 2) lack of appetite 3) oral feeding issues 4) depression/lack of motivation to eat 5) distaste for hospital food 6) neurological problems. Since the reasons included issues beyond food preferences/diet, the Hospital’s Chief Executive Officer, Chief Nursing Officer, Quality Specialist, Hospital Registered Dietitian, and System Director of Clinical Nutrition met to discuss possible solutions. A Multidisciplinary Feeding Team was developed to resolve issues affecting oral intake. An algorithm was used to identify patients benefitting and exclude those not appropriate (e.g. total parenteral nutrition and enteral nutrition or those in palliative care/hospice.) The Registered Dietitian collected baseline data. 22 of 29 patients or 75% met criteria upon admission to the facility for feeding team intervention. Multidisciplinary staff (including everyone from family, Nursing, and Ancillary Associates) was trained in feeding assistance, correct evaluation and recording of oral intake, and prevention of aspiration. With the team, there is attention to food preference/meal delivery and individual needs are honored. This results in improved nutrition status with rehabilitation goals met. The team also has a positive effect upon the prevention and treatment of pressure wounds. Funding Disclosure: None
Nutrition Related Problems in Polytrauma Patients Author(s): S. Foley,1 R. Aine,2 D. Rea,1 A. Mehta,3 M. Steiner1; 1 Nutrition and Food Services, Hines VA Hospital, Hines, IL, 2Clinical Services, Huntington Memorial Hospital, Pasadena, CA, 3Physical Medicine and Rehabilitation, Hines VA Hospital, Hines, IL Learning Outcome: To gain knowledge on types of nutrition related problems veterans experience up to 3 years after diagnosis with polytrauma. Polytrauma is defined as having greater than two physical injuries resulting in physical, cognitive, psychological or psychosocial impairment. The purpose of this study was to determine if polytrauma veterans had nutrition-related problems past the acute phase of injury, to describe the most prevalent problems, and to identify if these were addressed. A retrospective descriptive study design was used. Electronic medical records of polytrauma patients were reviewed for nutrition problems including alterations in nutritional status resulting from complications associated with diabetes, hypertension, renal disease, gastrointestinal disorders, and depression. Descriptive statistics were used to analyze demographic and clinical variables. A total of 83 subjects were included in the study. Sixty-six percent had at least one nutrition-related problem (n⫽55). The most common nutrition problems included: constipation (n⫽32, 39%), triglycerides ⬎150 mg/dL (n⫽24, 29%), and BMI ⬎ 30 kg/m2 (n⫽18, 22%). The prevalence of other nutrition problems included: cholesterol ⬎ 200 mg/dL (n⫽16, 19%), dysphagia (n⫽10, 12%), albumin ⬍ 2.8 g/dL (n⫽10, 12%), hypertension (n⫽10, 12%), BMI ⬍ 18.5 kg/m2 (n⫽8, 10%), CVD (n⫽5, 6%), diabetes (n⫽3, 4%), and kidney disease (n⫽3, 4%). Forty-three percent of all polytrauma subjects were seen by a registered dietitian; 45% of traumatic brain injury patients, 94% of spinal cord injury patients, and 27% of post traumatic stress disorder patients. The prevalence of diabetes and dysphagia do not appear to be higher in the polytrauma population compared to national statistics.
Differences in 25-Hydroxyvitamin D Levels at Birth in Hispanic and Caucasian Infants Are Not Related to Neonatal Bone Mineral Status Author(s): K. M. Hawthorne,1 P. D. Hicks,1 S. P. Rogers,1 T. O. Carpenter,2 S. A. Abrams1; 1Children’s Nutrition Research Center, Baylor College of Medicine, Houston, TX, 2Yale University School of Medicine, New Haven, CT Learning Outcome: The participant will be able to assess that even though vitamin D levels are lower at birth among Hispanic infants compared to Caucasian infants, there is no apparent effect on bone mineral status. Background: A newborn’s vitamin D status, as assessed by 25hydroxyvitamin D level (25-OHD) is dependent on the 25-OHD status of the mother. There are few data regarding the relationship between 25OHD and bone mineral outcomes in Hispanic (Hisp) infants. Objectives: To evaluate 25-OHD in breastfed newborn Hisp infants compared to Caucasian (Cauc) infants in a southern US setting and to determine if cord blood 25-OHD is related to bone mineral status. Methods: Cord blood was analyzed for 25-OHD and ionized calcium. Approximately 1 week after birth, infants received a dual-energy x-ray absorptiometry measurement to assess bone mineral density (BMD). Results: Thirty-eight mothers (20 Hisp, 18 Cauc) agreed to participate and provided cord blood. Of these, 24 returned (10 Hisp, 14 Cauc) for the 1-week follow up. 25-OHD was significantly lower in Hisp versus Cauc infants (17.2 ⫾ 5.7 ng/mL vs 24.1 ⫾ 6.8 ng/mL, p ⫽ 0.002). There was no difference in ionized calcium between Hisp and Cauc infants (1.45 ⫾ 0.08 vs 1.40 ⫾ 0.09, p ⫽ 0.1) or BMD (0.197 ⫾ 0.013 g/cm2 vs 0.196 ⫾ 0.011 g/cm2, p ⫽ 0.9). Using a value of 20ng/mL to indicate possible vitamin D insufficiency there was no difference in BMD of 19 infants with 25-OHD levels ⬍ 20ng/mL vs 19 infants with 25-OHD levels ⱖ 20ng/mL (BMD: 0.195 ⫾ 0.015 g/cm2 vs 0.197 ⫾ 0.011 g/cm2, p ⫽ 0.8). Conclusion: Hispanic newborns in a southern US setting have lower 25OHD than Caucasians without apparent effect on bone mineral status. Funding Disclosure: Marshall Klaus Perinatal Research Award (American Academy of Pediatrics)
Improving Accuracy of Lengths in the NICU: A Collaborative Approach Author(s): L. K. Wohlberg,1 A. Macek2; 1Clinical Nutrition, University of Maryland Medical Center, Baltimore, MD, 2University of Maryland Medical Center, Baltimore, MD Learning Outcome: To describe a development of a program to obtain accurate length measurements in the NICU. Measuring weight, length and head circumference is the primary method used to assess infant growth, but obtaining these measurements accurately on a serial basis can be challenging. Length measurement, not influenced by fluid status as is weight, reflects lean tissue mass and is a better indicator of long term growth. However, length is often more difficult to accurately determine and requires use of a recumbent length board and two examiners. Standard practice in our 40 bed Level III NICU was to use a tape measure to obtain length measurements done by the bedside nurse. To improve the frequency and accuracy of anthropometric measurements a collaboration was formed between the neonatal dietitian and a neonatal nurse practitioner. A proposal was submitted to the Medical Director identifying need, benefits, and costs to implement an anthropometric program. Six recumbent length boards were purchased to be housed in every clinical room. An educational poster was developed and displayed identifying the need for and outlining the method of practice change for nursing staff. Training was provided by the dietitian and nurse practitioner to the senior partners. Senior partners, with the assistance of the dietitian and nurse practitioner, then trained the 90 plus clinical nursing staff. To assess nursing accuracy, measurement technique was included in the nursing yearly competencies. Since implementation, accurate weekly serial data points have been available for the dietitian to plot. Growth data is then shared on rounds for clinical care decision making. Funding Disclosure: None
Funding Disclosure: None
Journal of the AMERICAN DIETETIC ASSOCIATION / A-35