Resource type: Article

Dietitian

What does a dietitian do on the wards?

The Dietitian works closely with the ward staff to make sure that you are able to take in enough nutrition to support your recovery. This might involve things like checking your weight and what you are eating, arranging for you to have additional snacks or supplements (usually high calorie or protein drinks) and giving advice on the types of things you should eat after you go home.

Some patients continue to need nutritional support through a tube that is passed through the nose and into the stomach (nasogastric tube) or directly into the bloodstream (TPN or total parenteral nutrition). The dietitian will provide advice on things like how much support you need and when the tubes can come out. It is not unusual to lose a little more weight when these tubes come out, but the dietitian will keep a close eye on this and help you to keep this to a minimum.

Some patients will need to go home with nutritional supplements (usually high calorie or protein drinks) and the dietitian will arrange this for you. Others might go home with a feeding tube in place (either through the nose and into the stomach, or directly into the bloodstream). The dietitian will organise advice and training on how to look after the feeding tube and how to operate the feeding pump that you will need. They will usually provide you with all the equipment you will need.

Why might I need to see a dietitian after Intensive Care?

Patients in Intensive Care are often unable to eat and drink normally, especially if they have needed support from a ventilator or breathing machine. Despite providing liquid nutrition through other means (through a tube that is passed through the nose and into the stomach, or directly into the bloodstream), it is very common for patients to lose weight during their time in Intensive Care. Some of the weight that patients lose is muscle,and it is very important to make sure that you are taking in enough of the right kinds of food to help regain any muscle that was lost.

There are a number of other reasons why some patients may struggle with eating after Intensive Care. The most common issues include poor appetite, food not quite tasting as it should (with either a salty or metallic taste), feeling full quickly and feeling very tired. Others have told us that changes in their normal sleep pattern and feeling low after having been very ill can have an impact on eating.The dietitian can offer advice and support on all of these issues.

When should I expect to see a dietitian?

Some patients will need to be seen by a dietitian and others may not.Patients who came into Intensive Care after surgery (or after complications during surgery) will be transferred to the care of a surgical dietitian.Patients who ended up in Intensive Care following a non-surgical problem will normally be referred to a new dietitian. The Intensive Care dietitian will give her or him a detailed handover on your illness, your progress and the types of things you will need help with.

What is involved in the various nutritional assessments and recommendations?

  • Weight history: the dietitian will have an informal chat with you about your normal weight,the weight you are now and will work with you to set goals.
  • Food charts: the dietitian may ask the nurses to write down everything that you are eating and drinking in order to get a better idea of how you're doing.You can often help to fill this in by yourself.
  • Extra snacks: The dietitian may suggest you have extra snacks (such as yoghurts, fruit, cheese and biscuits) to help maintain or increase your weight.She or he will ask you about the kinds of things you might like to eat and will do their best to see that these are organised for you.It is very important that you ask the nurses to bring these snacks to you as they may be stored in the ward fridge, out of sight and easily forgotten about.
  • Nutritional supplements: The dietitian may also recommend nutritional supplements (usually high calorie or protein drinks). Again, it is very important that you ask the nurses to bring them to you, as they may be stored in the ward fridge, out of sight and forgotten about.Some patients may struggle to take them because they feel full too quickly or don't like the taste. It's important that you try to persevere with them, however, as they will help minimise weight loss and help build muscle.
  • Calorie calculations: The dietitian will work out how many calories you need on a day to day basis to maintain or gain weight and will compare this with what you're taking in, as recorded on your food chart. If needed, she or he will work with you to try to make sure that you take in enough calories.
  • Protein calculations: Protein is the building block of muscle, and regaining muscle is a very important part of the recovery process.The dietitian will also work out how much protein you need in your diet and compare this with what you are taking in, as recorded on your food chart.
  • Review of blood tests: The dietitian may also look over any blood tests you may have had to see if there is anything else that might be affecting your nutritional state.

What kind of help can I get after I go home?

Patients who go home with nutritional supplements (the high calorie and protein drinks) may or may not be referred to a community dietitian, depending on how much extra monitoring or support you need.You should be aware that you may sometimes have to wait up to 12 weeks to be seen.Patients who go home with any sort of tube feeding (either through a tube in the nose or directly into the bloodstream) will be referred to a community dietitian. You should expect to be seen within 5 working days of hospital discharge.The dietitian on the ward will give you a number to call if you are not seen within this time.

What if I need more help after I get home than I thought I would?

If you find that you are continuing to lose weight after you get home (you might notice your clothes becoming looser and looser), but have had no specific advice and aren't in contact with a dietitian, you should consult your GP.