What’s an RD anyway?

Happy Registered Dietitian Day!!! What, you haven’t heard? Probably not. It doesn’t quite have the same ring as “Pi Day”, but yes, today is the day to celebrate the RD profession. That brings me to an important point…What exactly does an RD do all day? Of course, that’ll depend on where that dietitian works.

I think all registered dietitians can agree with me. This is usually what a typical conversation looks like when discussing our profession:

-”What do you do for a living?”
-”I’m a dietitian.”
-”Oh, like a nutritionist?”
-”No. They’re not the same. Registered dietitians have to get their degree, match to an internship, pass the internship, an RD Exam, and keep up with continuing credits.”
-(What they hear: “bla bla bla bla.”) “Oh ok. Well maybe you can help me lose 20 pounds!”

Haha. Truth. In fact, so many people think that I do menu plans or counsel overweight people all day. As a clinical dietitian though, my tasks may not be anything that you think. I decided to take today to discuss what my job entails.

The hospital where I work is a pediatric hospital with a clinic attached. Currently, we’re doing mostly inpatient which means we see the kids that are actually hospitalized. We’re slowly starting to see regular clinic visits as needed. For the inpatient side, I have three units that I’m responsible for: the NICU (Neonatal Intensive Care Unit), the CCU (Cardiac Intensive Care Unit), and a general floor.

NICU

I end up seeing every baby in the NICU. Although most people equate this unit with premature babies, not all of them are premature. Sometimes we get full term babies that have jaundice, feeding problems, or other issues that require a lot of care. Our NICU can have up to 36 babies at one time. Many of them require tube feedings (usually a tube from the nose through the stomach) for a number of reasons: some show signs of aspiration (when foreign material enters the lungs), some have a poor suck because they’re ill or they’re too little, and some may have a condition such as cleft palate or lip. Other babies may need TPN (total parenteral nutrition) or “feeding through the veins.” With TPN, the pharmacy mixes a specific mixture of fat, carbohydrates, and protein to meet calorie needs and is given by IV. This type of nutrition is used when a patient can’t use their their GI tract.

My job in the NICU consists of helping babies gain weight, selecting the correct formula, helping to calculate the nutrients in both TPN and tube feedings to meet the babies’ specific nutrient needs. Many of the babies start on TPN and transition to tube feeds and then to oral feeds. This takes careful calculating to make sure that the baby is getting enough calories, fluid, and protein in the process. Because babies gain weight so quickly, the feeds constantly increase. The extent of education that I do in this unit is usually formula mixing at time of discharge.

CCU

This unit involves people of all ages-premature and term infants, toddlers, teenagers, and even some adults. All of the patients in this unit have had a type of heart surgery due to a congenital defect, and many of this children end up needing more than one surgery. These heart conditions usually cause these children to be underweight because of the increase workload of the heart. After the heart surgery, the patients are intubated (on a machine that breathes for them) and on TPN. Within a couple of days, they may have the tube taken out. This patients will then either go to a regular diet (whether it be formula, breastmilk, or regular food) or they may need a low fat diet or special formula. This will depend on the surgery. If a special diet is needed, it’s my job to educate the family. It’s also my job to once again make recommendations for TPN and tube feeds when needed. One big challenge in this unit is the fluid restriction (a lot of fluid puts strain on the heart). With a limited amount of fluid, it’s very difficult to meet calorie needs.

If the patient leaves on a special formula, I need to help them set the formula up through WIC or through a special vendor or pharmacy. Many times these babies also need higher calories to help them catch up their weight gain. In these cases, I also need to educate the families on formula mixing.

General Floor

This floor can be anything from diabetics, eating disorders, RSV, pneumonia, broken arms, cystic fibrosis, or failure to thrive. I may not see every child on this unit. As you can see from the conditions that are covered, my tasks are varied greatly. I may need to educate a family on formula mixing,  a tube feeding schedule, or a special diet (such as low sodium or high iron). We also have to help coordinate the foods that the kitchen is sending up with any special diet needs, such as food allergies. I actually don’t see the diabetics because another RD does those patients, however those patients require intense menu planning and education.

Outpatient

As I mentioned before, we are slowly starting to see patients in the outpatient clinic. In particular, I do the cystic fibrosis clinic. Cystic Fibrosis is a genetic condition which causes the body to make very thick mucus. This mucus blocks ducts in the airway causes chronic lung infections. From a nutrition standpoint, the mucus also blocks ducts from the pancreas. These ducts release enzymes which help the body break down food. Because of this condition, many of these patients will require pancreatic enzymes to be taken with meals. They are dosed by weight, foods eaten, and level of pancreatic function. My job is to give recommendations to dose these enzymes. These children also need very high calorie needs because of the absorption and lung problems. It’s my job to help the parents do that by menu planning, setting them up with nutritional supplements, and even tube feeding recommendations when needed.

No matter what unit I’m doing, there are a couple of other things that I need to pay attention to. Many people don’t realize that dietitians need to be very familiar with labs and medications as well. We plot weights, heights, and head circumferences on growth charts and make recommendations based on percentiles and patterns. We recommend vitamin and mineral supplementation when needed. We also have to be familiar with medical terminology. We are a part of the care team along with speech and occupational therapists, social workers, psychologists, nurses, doctors, and even pharmacists. My job involves a lot more calculations and a lot less education as you probably think.

I hope this was easy to follow. I feel that the dietetics profession has come a long way and will continue to gain respect and expand in the future. Registered dietitians are THE nutrition experts, and I love what I do

Happy RD day to allow of my dietitian followers!!

Selene