Get These Patient Care Tips for Diabetes, Elderly and Post-Surgery

Interactive CME Helps PAs Gain New Nutrition Insights

December 9, 2021

Nutrition needs are different for all patients. Across specialties, many PAs have reported challenges with providing nutritional recommendations to patients with diabetes, those undergoing surgery and the elderly. New highly interactive learning activities in AAPA’s Learning Central featuring animations, videos, and downloadable content, provide insights into nutritional management. Here, faculty for the CME discuss what’s in it for PAs.

Diabetes and Nutrition
Presenters for the Diabetes and Nutrition CME, Wanda Andrews, PA-C, and Ellen D. Mandel, DMH, MPA, MS, PA-C, RDN, CDCES, discuss the role of PAs in providing nutritional recommendations to patients with diabetes.

According to Andrews and Mandel, the most important takeaways for PAs in this module are: 1) being able to assess dietary and nutritional needs; 2) learning to create a nutritional plan for patients with diabetes; and 3) being able to review the nutritional needs of individuals and counsel them appropriately.

They recommend PAs address nutritional health by seeing patients in their office, doing labs and reviewing body weight. Those healthcare providers who can provide more specific counseling on nutrition are dietitians, medical nutritional therapists, and diabetes educators. Primary care providers can also provide assessment and nutritional counseling.

Surgery: Perioperative Nutrition and Wound Healing
In the CME Surgery: Perioperative Nutrition and Wound Healing, presenters Corri Wolf, PA-C, MS, RDN; Erin Sherer, Ed.D, PA-C, RD; and Veronica Victorian, PA-C, discuss subsets of patient populations, including those patients undergoing surgery, that present unique nutritional management challenges.

In this module, presenters say PAs will learn how to screen for malnutrition prior to surgery and become more comfortable with how to optimize their patient’s nutritional status prior to surgery. They will gain a better understanding of the role of nutrients in wound healing and will learn more about managing post-operative nutrition concerns to enhance recovery.

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Asked how PAs can make sure patients are optimally prepared for surgery, faculty say PAs can improve surgical outcomes by performing a nutrition screening exam before surgery. This is important because it can help identify patients who may have poor nutritional status. For patients with signs of malnourishment prior to surgery, treatment may be as simple as using oral supplements prior to surgery. Depending on the degree of malnutrition, PAs may also consider delaying surgery by one to two weeks to improve nutritional status with supplements.

Poor nutritional status can also impede wound healing. Wound healing requires a well-balanced diet that includes enough calories, protein, carbohydrates and fat. Additionally, specific nutrients are vital to wound healing such as vitamin C, zinc, glucosamine, and certain herbs. Patients are invested in their own care but are often not knowledgeable; educating patients on the nutrient requirements for wound healing and how it affects their recovery can lead to improved outcomes.

Special Considerations for Nutrition for the Elderly
Darrin Cottle, PA-C, RD, and Kris Pyles-Sweet, DMSc, PA-C, presenters in the CME Special Considerations for Nutrition for the Elderly, discuss subsets of patient populations, including the elderly, that present unique nutritional management challenges.

PAs will gain the following from the module, say Cottle and Pyles-Sweet: an understanding that malnutrition is common in older adults and PAs can manage this issue; they will be able to Identify comorbidities that affect nutritional status; and they will learn strategies to improve nutritional status in older adults.

Presenter recommendations are for PAs to address problems by first assessing for loss of appetite in older adults simply by asking them about their appetite. Second, they suggest identifying what is causing the loss of appetite (medication side effects, dry mouth, dentition, swallowing concerns, nausea, vomiting, boating, constipation, mood, cognitive status, etc.). And third, they say, is to identify realistic solutions that consider things such as mobility, transportation, financial and family resources.

Some ways to bump up appetite may be to enhance the flavor of the food, offer meal supplements, and verbal encouragement. Even sprucing up the dining area can help improve appetite and making eating with family or others part of the daily routine.

One consequence of poor nutrition is sarcopenia or losing muscle mass. Sarcopenia can be prevented if PAs utilize appropriate nutritional screening tools to identify at risk patients and then make appropriate nutritional recommendations that include adequate protein and calorie intake. Adequate protein and calorie intake can be achieved through dietary intake, supplementation and/or meal replacement products.

Find each of the Nutrition CME modules here.

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