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TABLE OF CONTENTS
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| 2 | Guest Editor's Perspective
Marcia Kalista-Richards, MPH, RD, CNSC, LDN
As I progressed in my career, I was in awe of those individuals who shared
their professional expertise through presentations at national conferences
or published articles about their work. I still remember attending a
conference roundtable where the speakers encouraged the attendees
to put their work into writing. I felt I was extended a personal invitation
from an "expert" to share my knowledge. I have worked with the DNS
Writer's Mentoring Program for many years and seen them offer this
same invitation to many dietitians who wanted to be writers. |
| 2 | Chair's Column
Jennifer A. Wooley, MS, RD, CNSD
Seasons Greetings to each and every one of you! This time of year we
have the opportunity to reflect on a very simple but important concept
that centers on the acts of giving and receiving. Opportunities to give
and receive take shape in the eyes of the beholder. To quote Don
Miguel Ruiz, "You could say that the eyes are an expression of what you
feel." If you are uncertain and afraid, you will see the world with fear in
your eyes. If you are peaceful and confident, you will see the world with
wisdom and courage. Opportunities to give and receive come when
we're open, believe we're worthy, and are willing to take a risk. |
| 3 | Neurocritical Care 101: Learning the Lingo for Effective Nutrition Management
Amy J. Berry, MS, RD, CNSD
Traumatic brain injury (TBI) is a leading cause
of mortality and morbidity worldwide (1).
It affects up to 2% of the United States
population every year and is a major cause
of death and disability among young people
(2). Of the 300,000 people hospitalized
annually with TBI, approximately 17% die and
of those who survive, 50% have comorbidities
such as memory deficits, depression, anxiety,
fatigue, and loss of emotional well-being (1).
In the critical care literature, "head injury
patients were excluded" is a common
notation. They are termed "different" and
separated from other trauma patients.
Nutrition is of critical importance in the
neurocritical care patient population. Early
nutrition has been shown to have a direct
impact on decreasing short-term mortality
and improving neurologic outcome at 3
months after injury (3,4). Questions that
dietitians raise about this patient population
include: Do we assess these patients
differently from general trauma patients?
How do the various forms of head injury
differ and what are their nutritional requirements?
As an aid to answering these
questions, this article reviews the unique
medical terminology that is specific to the
neurocritical care patient population. |
| 12 | The Effects of Propofol on Nutrition Support
Irna de Leon-Knapp, RD, LDN, CNSC
Patients in the intensive care unit (ICU) often
require sedation and analgesia to minimize
anxiety and pain. The effect of sedatives and
analgesic drugs on nutrient metabolism
should be considered when parenteral
nutrition (PN) and enteral nutrition (EN) in
the form of tube feeding are provided for
nutrition support (NS). This article reviews
commonly used analgesic and sedation
medications, describing their impact on NS.
The nutrition support Registered Dietitian
(RD) needs to be aware of changes in analgesia
and sedation to manipulate nutrition
therapy during the nutrition care process.
Identifying and understanding the actions
of these drugs can assist in the proper nutrition
management. Sedation protocols
should include a nutrition component in which
the RD ensures adequate and appropriate NS.
The nutrition component of the sedation
protocol should include measurement of
serum triglycerides, adjustments in NS
formulation, and involvement of a RD,
preferably a Certified Nutrition Support
Clinician (CNSC), to ensure proper nutrition
management and care. Integrated use of
sedating drugs and the delivery of NS should
improve patient comfort and safety, reduce
adverse effects, and provide sufficient nutrition. |
| 19 | Nutritional Implications of Opioid-induced Bowel Dysfunction in Chronic Pain Management
Nora Decher, MS, RD, CNSC
Opioid analgesia is widely and effectively
used for treatment of chronic and cancerrelated
pain. Due to the presence of
opioid-receptors throughout the gastrointestinal
(GI) tract, opioid use often results
in myriad GI symptoms. Opioid-induced
bowel dysfunction (OBD), which commonly
presents as constipation, but may include
other debilitating effects, is a common
problem in treated patients. The delicate
balance between managing OBD and
maintaining adequate pain control is a
strategic challenge for clinicians. Opioid
adverse effects can have a severe impact on
nutritional status due to numerous physical
and emotional factors that may lead to
decreased oral intake. Although management
of OBD usually involves pharmacotherapy,
dietitians who are aware of the effects of
opioids on bowel function can make appropriate
nutrition recommendations to both
caregivers and patients. |
Copyright 2009 Dietitians in Nutrition Support, ADA.
All material appearing in SUPPORT LINE is covered by copyright and may be
photocopied or otherwise reproduced for noncommercial scientific or educational
purposes only, provided the source is acknowledged. Written consent from the
managing editor is required for any other purpose.
Viewpoints and statements in these materials do not necessarily reflect
the policies and/or official positions of The American Dietetic Association or DNS.
SUPPORT LINE (ISSN 1067-3768) is published bi-monthly. $60 for individual
non-member subscriptions, $120 for institutions per year (plus postage surcharges
for international subscriptions). Newsletter subscriptions are available to interested
parties who are ineligible for ADA membership. Published by Dietitians in
Nutrition Support, a dietetic practice group of The American Dietetic Association
(ADA), 120 S. Riverside Plaza, Suite 2000, Chicago, IL 60606. Send requests for
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2009, Fort Lauderdale, FL 33308. For address changes: Please submit name and
address changes directly to the Membership Team of the American Dietetic
Association using the address change card in the Journal of the American Dietetic
Association. SUPPORT LINE is indexed in the Cumulative Index to Nursing and
Allied Health Literature.
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FOR THIS ISSUE: EditorSusan Roberts, MS, RD, LD, CNSD
3911 Kramar Court
Arlington, TX 76016
214/820-6751
Managing EditorDeborah K. Kuhlman
921 N. Western Avenue
Park Ridge, IL 60068
847/692-3407
Associate EditorsTherese Austin, MS, RD, CNSD
Kathy Logan,, MS, RD, CNSD
Associate Editor, Continuing Education:Neha Parekh, MS, RD, CNSD
Associate Editor, Writer's Mentoring:Marcia Kalista-Richards, MPH, RD, CNSD
Contributing Editor, Inquire Here:Gail Cresci, MS, RD, CNSD
Membership/Subscriptions:Jamie Diamond, MMS, PA-C, RD
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