Nutrition Care Process Update: 5th Edition

October 8th, 2014





Are Your Feeding Tubes Clogging? Omeprazole May Be The Culprit

May 14th, 2014

By: Stephanie Temple RDN, LD


Recently, in two different facilities, I was approached by nurses who were having difficulty with clogged enteral feeding tubes.  Both times, I was told “I really have a hard time getting that Omeprazole to go through.” Omeprazole comes in a capsule and, when opened, the little beads inside are difficult to get through a feeding tube.  A helpful pharmacist at Zellmed Pharmacy provided some guidance (3).


Omeprazole: This is an antisecretory medication that is a proton pump inhibitor.  It suppresses gastric acid secretion by inhibiting the H+, K+ – ATPase enzyme system (the proton pump) in the parietal cells.  This suppresses gastric acid secretion and relieves gastrointestinal distress and promotes ulcer healing (1).


Prevacid Solutabs:  This is also an antisecretory  proton pump inhibitor, so it is the same classification as Omeprazole and acts in the same way (1).    It is  available as a solutab tablet (disintegrating), making it a better choice for enteral  tube administration.  Prevacid is also available as a packet of granules meant to be mixed with water in order to form a suspension.  This suspension, however, contains xanthan gum which can potentially expand in an enteral feeding tube causing blockage  (2)Prevacid Solutabs require prior authorization where Omeprazole does not (3).


Zantac Liquid:   Like Omepazole and Prevacid, this is an antisecretory medication.  It is an H2 receptor antagonist.  It inhibits histamine action at H2-receptor sites on parietal cells, blocking gastric acid secretion (1).  Because this is a liquid, it will not clog feeding tubes.  It is preferable to utilize a liquid dosage form whenever possible for enteral feeding tube administration, especially if the patient has a small-bore feeding tube (2).  Zantac Liquid does not require prior authorization (3).


Medications cause obstruction in about 15% of patients receiving enteral tube feedings (2).  We, as Registered Dietitian Nutritionists, can assist the nursing staff to avoid this complication. 



(1) BillieAnn, W., Margaret, S., & Kelly, S. (2013). Nurse’s Drug Guide. Boston: Pearson.


(2) Wyman, M. (). Medication Administration Through Enteral Feeding Tubes. Cleveland Clinic Pharmocotherapy Update, XI.


 (3) Zellmed Pharmacy

February: Heart Health Month

February 7th, 2014

Heart health photoBy:  Cyndi Guveiyian RDN, LD

February is Heart Health Month.  Special attention to heart disease is warranted as it represents the number one killer of women in the United States, claiming more lives than all forms of cancer combined.  In fact, while breast cancer claims 1 in 30 female lives, heart disease is responsible in the deaths of 1 in 3 females.

Today is National Wear Red Day! Since its inception in 2004, the American Heart Association’s Go Red campaign has assisted in saving 627,000 lives as a result of increased awareness.  To show our outgoing support of this worthy cause, our office wore RED today!

I encourage you to take a moment to review the following strategies to reduce your risk of heart disease:

  • Eat a healthy diet. Choosing healthful meal and snack options can help you avoid heart disease and its complications. Be sure to eat plenty of fresh fruits and vegetables—adults should have at least 5 servings each day. Eating foods low in saturated fat, trans fat, and cholesterol and high in fiber can help prevent high cholesterol. Limiting sodium in your diet also can lower your blood pressure.
  • Maintain a healthy weight. Being overweight or obese can increase your risk for heart disease. To determine whether your weight is in a healthy range, doctors often calculate a number called the body mass index (BMI).
  • Exercise regularly. Physical activity can help you maintain a healthy weight and lower cholesterol and blood pressure. The Surgeon General recommends that adults should engage in moderate-intensity exercise for at least 30 minutes on most days of the week.
  • Monitor your blood pressure. High blood pressure often has no symptoms, so be sure to have it checked on a regular basis. You can check your blood pressure at home, at a pharmacy, or at a doctor’s office.
  • Refrain from smoking. Cigarette smoking greatly increases your risk for heart disease. If you don’t smoke, don’t start. If you do smoke, quit as soon as possible. Your doctor can suggest ways to help you quit.
  • Limit alcohol use. Avoid drinking too much alcohol, which can increase your blood pressure. Men should stick to no more than two drinks per day, and women to no more than one.
  • Have your cholesterol checked. Your health care provider should test your cholesterol levels at least once every 5 years. Talk with your doctor about this simple blood test. You can find out more from
  • Manage your blood sugar. If you have diabetes, monitor your blood sugar levels closely, and talk with your doctor about treatment options.
  • Take your medicine. If you’re taking medication to treat high blood pressure, high cholesterol, or diabetes, follow your doctor’s instructions carefully. Always ask questions if you don’t understand something



Adapted from information provided by the Centers for Disease Control (CDC) and



Favorite Foods of a Dietitian

October 28th, 2013

By: Larissa Brophy  MS, RDN, LD

There are a collection of go-to-foods in my arsenal. Not all are “natural” or “wholesome”, but they work on those busy days. It is not always easy to eat healthy (requires preplanning), but I find it to be tasty and rewarding. Food with flavor is far superior than the fat laden alternatives, seriously. And healthful eating can be more economical and easier than most convenience foods. You just need to pack a lunch bag with snacks or stock your purse, desk, and/or car with some of these items.


  • Always start the morning with a greener banana and lots of coffee
  • Egg white omlet with soy cheese and lots of vegetables, served with whole wheat wrap or toast
  • Kashi® Autumn Harvest or Go Lean cereals (very high fiber) with vanilla soy milk
  • Peanut butter and banana wrap (high fiber, whole grains)

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Ways to Eat Healthier at Work

August 6th, 2013

By: Diana Weathers RDN, LD



Some workdays can be busier than others.  On those busy days, we often find ourselves working through lunch usually eating at our desks.  It is always encouraged to eat away from your desk, but this is not always possible with our hectic schedules.  There are some measures you can take to make sure you don’t go for the quick, fast food options that can throw your healthy eating completely off for the week!

  1. Make sure to meal plan.  Set yourself up for success by taking one day on the weekend to plan out your lunches for the week.  Try to pack your lunch the night before so it is all ready to go in the morning.  It is easier to turn down that cheeseburger proposal when you know you took the time to pack yourself a good healthy lunch.
  2. Pack  yourself some snacks during the day and small meals.  If you are working through lunch, there is no need to eat just because it is noon. Eat when you are hungry.  Having snacks on hand during the day can help keep you from overeating at one sitting.
  3. Make sure to pack a well-balanced lunch. Try to have some carbohydrate, protein, and fat in your lunch to help keep you fuller longer.  It is also important to make healthier choices when packing your lunch as well.  For example, pack grilled chicken for your salad versus fried chicken and pack a light vinaigrette salad dressing over a full fat creamy dressing.
  4. Keep track of the beverages you are consuming. It is easy when you are hard at work to mindlessly consume cups of coffee mixed with cream and sugar or bottles of soda.  Bring a water bottle to work so you can stay well hydrated throughout the day.
  5. Stock your office.  If you know you are someone who is forgetful, stock your office with some healthy snack options that can hold you over throughout the day.

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New Registered Dietitian Nutritionist (RDN) Credential

July 9th, 2013

By: Cyndi Guveiyian RDN, LD

The Academy of Nutrition and Dietetics’ Board of Directors and the Commission on Dietetic Registration recently adopted the optional use the credential of “registered dietitian nutritionist’ (RDN) for registered dietitians.

The Academy began exploring the option of offering the registered dietitian nutritionist credential in 2010.  It was supported by participants in the 2011 Future Connections Summit and most recently by the Council on Future Practice in its 2012 Visioning Report. The recommendation was shared and discussed in the House of Delegates in 2012. The 2013 joint meeting of the major organizational units (Commission on Dietetic Registration, Accreditation Council for Education in Nutrition and Dietetics, Council on Future Practice, Education Committee, and Nutrition and Dietetics Educators and Preceptors DPG) supported moving forward. Hence, the RDN credential is now available for optional use by registered dietitians.

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Nutrition Care Process Update: 4th Edition

June 4th, 2013

By: Cyndi Guveiyian RD, LD



The Academy of Nutrition and Dietetics recently published the 4th edition of the International Dietetics and Nutrition Terminology (IDNT) Reference Manual.  Although there are changes to standardized language or terminology for each step of Nutrition Care Process outlined in the 4th edition, the changes in Step 2: Nutrition Diagnosis are most noteworthy.  This is especially true since standardized language must be used for Nutrition Diagnoses.  The changes are as follows:

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Celebrate Women’s Health Week !

May 13th, 2013

By: Cyndi Guveiyian RD, LD

Women's health pic

National Women’s Health Week is May 12-18, 2013!  This weeklong health observance coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health brings together communities, businesses, government, health organizations, and other groups in an effort to promote women’s health and its importance.

Women often serve as caregivers for their families, putting the needs of their spouses, children, and parents before their own. Too often, a woman’s health and well-being become secondary. Does this sound familiar? It’s time to take action and put the focus on a very important person…YOU!

The U.S. Department of Health and Human Services’ Office on Women’s Health recommends following five steps to improve your physical and mental health and lower the risk of certain diseases:

  • Visit a health care professional to receive regular checkups and preventive screenings (e.g., mammograms, Pap Test, annual physical, etc.)
  • Get active.  There are 1440 minutes in a day.  Dedicate 30 minutes of those to exercise!
  • Eat healthy by consuming a wide variety of foods from all food groups each day.  A healthy eating plan is one that emphasizes fruits, vegetables, whole grains, and lower fat milk and milk groups; includes lean meats, poultry, fish, beans, eggs, and nuts; is low in fat, salt (sodium), and added sugars.
  • Pay attention to mental health, including getting enough sleep and managing stress.
  • Avoid unhealthy behaviors, such as smoking, not wearing a seatbelt or bicycle helmet, and texting while driving.


As a community, we have a responsibility to support the important women we know and do everything we can to help them take steps for longer, healthier, happier lives.  Most importantly, we owe it to ourselves as women to put ourselves first on occasion.  We work hard each day to keep all the balls in motion and synchronized in perfect harmony.  We deserve to be around to see the fruit of our labor!  What will you do to promote women’s health?  Share your comments.


Resources (accessed 5.13.13) (accessed 5.13.13)

Lifestyle Changes for Those with Pre-Diabetes

March 21st, 2013

By: Brenda Gerdeman DTR

Diabetes is the 7th leading cause of death in the United States. Did you know that 8.3% of the U.S. population or 25.8 million people have diabetes? It is also alarming that approximately 7.0 million or 27% of those individuals are undiagnosed. In Ohio, 10.1% of the adult population has been diagnosed with diabetes whereas another 3.0% of Ohioans are undiagnosed. So what can be done to help?

There is a “warning” condition called Pre-Diabetes that can occur before the onset of Type II Diabetes Mellitus. According to the American Diabetes Association, Pre-Diabetes can be diagnosed when fasted blood glucose levels range from 100-125 mg/dL, glycosylated hemoglobin (HgA1C) levels range between 5.7%-6.4%, or an abnormal oral glucose tolerance test (not commonly tested). When blood glucose control falls within these ranges, it is a strong indicator that lifestyle changes should occur to reduce your risk of developing Type II Diabetes

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February: Heart Awareness Month

February 4th, 2013

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