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Nutrition and the hospitalized patient

Copyright © 2006 Society of Hospital Medicine

Optimal nutrition in the hospital can facilitate better patient outcomes. Malnutrition in hospitalized patients can lead to poor wound healing, impaired immune function resulting in infectious complications, increased hospital length of stay, and overall increased morbidity and mortality. The prevalence of malnutrition has been reported in up to 50% of hospitalized patients. Early screening for nutritional risk allows for appropriate intervention in the hospital setting, as well as planning for appropriate home services and follow‐up for outpatient nutritional care. Hospitalists use a multidisciplinary approach to evaluate and address the nutritional needs of hospitalized patients. Hospitalists lead, coordinate or participate in multidisciplinary initiatives to improve the nutritional status of hospitalized patients.

KNOWLEDGE

Hospitalists should be able to:

  • Describe methods of screening for malnutrition.

  • Identify when a nutrition evaluation by a registered dietitian is required.

  • Differentiate between basic modified diets and explain the indications for each (sodium, diabetic, renal, and different dietary consistencies).

  • Explain the indications and contraindications for enteral nutrition.

  • Describe the indications for parenteral nutrition.

  • Describe potential complications associated with enteral and parenteral nutrition.

  • Explain risk factors for the re‐feeding syndrome.

SKILLS

Hospitalists should be able to:

  • Use objective criteria to determine if a patient is malnourished.

  • Determine appropriate laboratory measures to ascertain presence of malnutrition.

  • Utilize individualized modified diets and/or nutritional supplements, which may include total parenteral nutrition, based on the patient's medical condition.

  • Choose an appropriate enteral nutrition formula when indicated.

  • Treat for electrolyte abnormalities associated with the re‐feeding syndrome.

  • Monitor electrolytes as indicated in the setting of enteral and/or parenteral nutritional support.

ATTITUDES

Hospitalists should be able to:

  • Recognize the importance of adequate nutrition in hospitalized patients.

  • Recognize when a nutrition evaluation by a registered dietitian is required.

  • Consult a nutrition specialist for a comprehensive nutritional evaluation when indicated.

  • Collaborate with clinical nutrition staff to implement the nutrition care plan.

  • Utilize a team approach for early discharge planning for patients requiring home parenteral or enteral nutrition.

  • Recognize that specialized nutritional supplementation may be required in certain patient populations, which may include patients with extensive wounds or increased catabolic needs.

  • Implement routine nutrition screening to identify malnourished patients early in admission.

  • Lead, coordinate or participate in the development of care pathways for patients requiring enteral or parenteral nutrition.

  • Coordinate follow‐up nutrition care as part of discharge plans for those patients requiring nutritional support.

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