consistency modification took place and to provide them with information on how to carry out a soft diet in the home should they be discharged. 1 Respiratory Therapy -Respiratory therapy is -Good communication provided by a nurse who is a between respiratory therapists specialist in diseases of the and RDs is necessary in order respiratory system. 1 to provide the right amount of -He or she is knowledgeable nutrition to the patient. Energy in the various equipment used needs will depend highly on to provide supplemental the patient’s current situation oxygen to patients; as well as in regards to overall what indicators to monitor oxygenation, what mode of when accessing oxygen supplemental oxygen they are status.1 placed on, and their overall metabolic state. 1 Hemodialysis (HD) -HD requires access to the -HD has a significant impact blood either through an AV on overall nutrition status. fistula or graft. Once access is -Several studies looking at obtained, a patient is hooked elderly populations receiving up to a dialysis machine with a HD have found an increased semi-permeable membrane likelihood for malnutrition, referred to as a dialyzer. 1 frailty, and overall mortality.4, -Wastes and uremic toxins are 7 removed from blood by the dialyzer and the clean blood is returned to the body. 1 Continuous Renal -CRRT is often used with -With CRRT, energy Replacement Therapy (CRRT) acute kidney injury; especially especially protein needs, are in patients with multiple organ much higher. 1 failure.1 -As with HD, patients placed -Patients that typically go on on CRRT are at an increased CRRT include the risk for malnutrition simply hemodynamically unstable, due to the high levels of those with inadequate cardiac catabolism within the body. 1, output, and those who simply 8 cannot tolerate HD. 1 -In the case of this Veteran, he continued to be hypotensive during HD and thus was placed on CRRT. -CRRT is provided continuously at a much slower rate. This allows for a significant amount of fluid to be removed. 1
consistency modification took place and to provide them with information on how to carry out a soft diet in the home should they be discharged. 1 Respiratory Therapy -Respiratory therapy is provided by a nurse who is a specialist in diseases of the respiratory system. 1 -He or she is knowledgeable in the various equipment used to provide supplemental oxygen to patients; as well as what indicators to monitor when accessing oxygen status.1 -Good communication between respiratory therapists and RDs is necessary in order to provide the right amount of nutrition to the patient. Energy needs will depend highly on the patient’s current situation in regards to overall oxygenation, what mode of supplemental oxygen they are placed on, and their overall metabolic state. 1 Hemodialysis (HD) -HD requires access to the blood either through an AV fistula or graft. Once access is obtained, a patient is hooked up to a dialysis machine with a semi-permeable membrane referred to as a dialyzer. 1 -Wastes and uremic toxins are removed from blood by the dialyzer and the clean blood is returned to the body. 1 -HD has a significant impact on overall nutrition status. -Several studies looking at elderly populations receiving HD have found an increased likelihood for malnutrition, frailty, and overall mortality.4, 7 Continuous Renal Replacement Therapy (CRRT) -CRRT is often used with acute kidney injury; especially in patients with multiple organ failure.1 -Patients that typically go on CRRT include the hemodynamically unstable, those with inadequate cardiac output, and those who simply cannot tolerate HD. 1 -In the case of this Veteran, he continued to be hypotensive during HD and thus was placed on CRRT. -CRRT is provided continuously at a much slower rate. This allows for a significant amount of fluid to be removed. 1 -With CRRT, energy especially protein needs, are much higher. 1 -As with HD, patients placed on CRRT are at an increased risk for malnutrition simply due to the high levels of catabolism within the body. 1, 8
allison_k_fassler_clinical_case_study.docx