I'm almost through my 4th week of my IPC rotation! Last week, I rotated with the RD in the ICU. This week, I rotated with the RD on the general patient floors. I'm not sure which one I like better at this point.
The ICU rounds are really intense! We (myself and the RD) rotate patient rooms with nurses, pharmacists, the intensivist, and a speech therapist. It is really interesting to talk so in depth about a patient. The intense part is when they start talking about medications, interactions, and using big medical jargon. I definitely take a lot of notes! The one thing about ICU, is you don't get to interact with patients much. You look at a ton of labs and do ventilation calculations (calculating energy requirements for a patient on a ventilator, taking into account the medications they are on). You also write a lot of TF or TPN recommendations, but that's about it.
When I rotate on the patient floors, I get to do a lot more educations (Coumadin, CHO-controlled diet, Renal diet, etc). You really get to chat with the patient about their home eating and the diet they are on. You might recommend/initiate a supplement and you track what the patient eats as well. Some patients are way more talkative and inviting than others. Also, don't judge anyone by their age. I met a patient today, who was in her 90s, still living on her own and cooking all her meals. She was lively and in relatively good health. Later today, I went on a home care visit and met a lady in her early 60s. She was using a walker, had uncontrolled diabetes (BG levels in the 500-600s), and was achy and in pain. She was an "interesting" visit, to say the least. Some of my favorite quotes from her were, "I only buy pork chops to chew on the bone," "Why do I even have to eat protein?" and my favorite, "I may eat some spar-a-grass tonight (aka asparagus)."
Some of my other favorite moments/quotes of the week were:
1. "My weight has been stable at home, but high. But that is because I eat a lot. I eat cake cookies, candy. I know I shouldn't but I do anyway." (Patient had: T2DM, CHF, Obesity, Renal failure etc)
2. "Your name sounds like a nice soft kitty." (From an 80 year old patient to me. What she meant, I don't know).
3. Patient: "You won't believe me when I say why I am here. The KKK are after me and my neighborhood and I can't believe it is not covered on the news yet." (enough said).
4. Meeting a 3 year old patient in PEDs with a PEG tube in. He was so cute and sweet! He was born premature, but looked as normal as could be now. He was my first PEDS patient thus far :)
So far, I really like the rotation. It is very busy! I come in and do research on patients (medical/food and nutrition history, diet orders, etc). I calculate TF and calorie/protein/fluid requirements on a daily basis. I do all of the nutrition assessments when I rotate with the RD and I have been doing most of the patient educations. I feel like I am getting to know some things like the back of my hand. I really like the fast paced nature of the hospital. It is always different and there are always, always interesting patients to see :)
Thursday, January 23, 2014
Friday, January 10, 2014
First Week of my Inpatient Clinical Rotation
This week, I completed my first full week of my inpatient clinical rotation. I've found myself really liking being in the hospital. Each day is so different. One of the best things about being in clinical is there is always a variety of diseases, diets, and interesting medical histories.
Every day when I came in, I would research the new patients (needing initial assessments) and follow-ups for the day. I sifted through EMRs on the computer to find the patient's height, weight, BMI, medications, allergies, I&Os, diet orders, and lab values. Using the information I researched, I would calculate the patient's energy, protein, and fluid needs. When the RD came in, we would go out on the floor and do patient rounds. After the first few days, I was charting on all of the patients we saw (with supervision).
There were some really interesting patients this week. One lady had her stomach removed a few years ago and her intestine stretched to create a pouch. I ended up calculating her tube feeding recommendation. She was one of the many tube feeding recommendations I calculated this week (and 1 TPN). Another patient I saw, had a PEJ tube and a G-tube for drainage due to cancer. The patient ended up excreting almost 3 liters of fluid and was severely hypovolemic and had hyponatremia.
I also saw 2 swallowing evaluations this week. I was in the radiology room with the patient and technicians. They would give the patient a small amount of food (applesauce, cottage cheese, etc) with barium in it. They would then have a screen where you saw the food enter the patient's mouth and esophagus. Both patients I saw had food get stuck in the esophagus, due to poor swallowing abilities. One patient ended up back on NPO and the other was advanced to pureed. Just as a side note, I had to taste test a pureed diet for an assignment. One item I tasted was pureed chicken. It tasted like gross chicken mashed potatoes. I would definitely not suggest trying that if you don't have to.
One of the hardest things in clinical was seeing patients with a laundry list of diseases and medications. A lot of the issues were diet related. I saw a few patients with amputations due to uncontrolled diabetes and bedridden patients due to their morbid obesity. The craziest part was that they were still adamant on not changing their diet to a healthier one. It was rewarding to talk to a patient that was interested in what you had to say. One of the patients I got to educate had a cardiac diet. We talked about how he could lower his sodium intake at home and the importance of small changes to make a habit stick.
I really found it to be helpful to have a clipboard and small binder with equations (calculating protein, calories, ideal body weight, and fluid needs), lab values (and what they mean for disease states), and tube feeding information. You could also use an IPad if your facility allows you to. I also brought a small notebook on rounds with me so I could jot down information about the patient and tips for performing a nutrition assessment. It definitely gets easier the more you do it.
Next week, I will be with another RD that does the ICU rounds. I'm really excited to participate in interdisciplinary meetings on patients.
Every day when I came in, I would research the new patients (needing initial assessments) and follow-ups for the day. I sifted through EMRs on the computer to find the patient's height, weight, BMI, medications, allergies, I&Os, diet orders, and lab values. Using the information I researched, I would calculate the patient's energy, protein, and fluid needs. When the RD came in, we would go out on the floor and do patient rounds. After the first few days, I was charting on all of the patients we saw (with supervision).
There were some really interesting patients this week. One lady had her stomach removed a few years ago and her intestine stretched to create a pouch. I ended up calculating her tube feeding recommendation. She was one of the many tube feeding recommendations I calculated this week (and 1 TPN). Another patient I saw, had a PEJ tube and a G-tube for drainage due to cancer. The patient ended up excreting almost 3 liters of fluid and was severely hypovolemic and had hyponatremia.
I also saw 2 swallowing evaluations this week. I was in the radiology room with the patient and technicians. They would give the patient a small amount of food (applesauce, cottage cheese, etc) with barium in it. They would then have a screen where you saw the food enter the patient's mouth and esophagus. Both patients I saw had food get stuck in the esophagus, due to poor swallowing abilities. One patient ended up back on NPO and the other was advanced to pureed. Just as a side note, I had to taste test a pureed diet for an assignment. One item I tasted was pureed chicken. It tasted like gross chicken mashed potatoes. I would definitely not suggest trying that if you don't have to.
One of the hardest things in clinical was seeing patients with a laundry list of diseases and medications. A lot of the issues were diet related. I saw a few patients with amputations due to uncontrolled diabetes and bedridden patients due to their morbid obesity. The craziest part was that they were still adamant on not changing their diet to a healthier one. It was rewarding to talk to a patient that was interested in what you had to say. One of the patients I got to educate had a cardiac diet. We talked about how he could lower his sodium intake at home and the importance of small changes to make a habit stick.
I really found it to be helpful to have a clipboard and small binder with equations (calculating protein, calories, ideal body weight, and fluid needs), lab values (and what they mean for disease states), and tube feeding information. You could also use an IPad if your facility allows you to. I also brought a small notebook on rounds with me so I could jot down information about the patient and tips for performing a nutrition assessment. It definitely gets easier the more you do it.
Next week, I will be with another RD that does the ICU rounds. I'm really excited to participate in interdisciplinary meetings on patients.
Friday, January 3, 2014
The Start of My Inpatient Clinical Rotation
As of today, I am 18 weeks into my dietetic internship! Just to recap, I completed food service management with school nutrition education and community (at WIC). I am currently in my inpatient rotation in a 200-bed hospital.
I have only been at my clinical facility for 2 days now, but, I really like it. I'm pretty surprised too. I used to work as a Food and Nutrition Aide at a hospital and I hated it! Most of the patients didn't care what you had to say. They just wanted to "go home and eat their bacon" (a quote I heard fairly often of cardiac diet patients). It is different being with the RD and seen as more of a professional.
My first day, I mostly had orientation to the facility. I was introduced to all the hospitals procedures and protocols. I spent a lot of time learning their EMR system with all the patient information. My preceptor gave me a booklet with equations (for calculating calories and protein for certain BMIs) and tube feeding protocols. This is literally my go-to book for the rotation. If you don't receive something like this, ask your facility what procedures they use to calculate calorie and protein needs. You can make your own sort of "cheat sheet."
My second day was where most of the action occurred. I learned how to complete a nutrition profile for new patients that needed nutrition consults. This involved researching the patient past medical history, current medications, diagnoses, lab values, BMI, anthropometrics, and calculating requirements for calories, protein, and fluid. I was able to shadow the RD for the second half of the day. I got to see a range of medical diagnoses in such a short time; congestive heart failure, acute renal failure, hypertension, dementia, hyperlipidemia, hypothyroidism, and more! I even got to chart on 2 of the patients :)
When I first started, I was afraid that I wouldn't know what to say to patients. The more I learned about diets in clinical, the less I felt I knew! After the first few days, I began to feel more comfortable. You find out everything you need to know about the patient prior to going in to do an assessment. The assessments are usually short (<30minutes). Also, my facility (and probably many others), have access to the nutrition care manual, which lists every disease, lab values, educational handouts, and more. So, if you don't know something, you definitely have the tools to find out.
Just some tips I have for the first few days of inpatient clinical:
-Ask as many questions as you can about nutrition assessments and patient procedure. I think it really helps to hear it explained different ways by different RDs.
-Practice finding nutrition information on patients. The one RD had me on a nutrition profile hunt my first day. I would get a patient and find out their BMI, calorie needs, medications, etc. It helped me to navigate through their system and to research different medications.
-Follow the RDs on their rounds; even if they don't outright ask you, ask them!
-If the facility has access to the nutrition care manual, peruse through it. It is such a great resource (it is expensive to buy).
-This website was useful too: http://www.uptodate.com/home
Hopefully, I will be seeing patients on my own in the next few weeks! :)
I have only been at my clinical facility for 2 days now, but, I really like it. I'm pretty surprised too. I used to work as a Food and Nutrition Aide at a hospital and I hated it! Most of the patients didn't care what you had to say. They just wanted to "go home and eat their bacon" (a quote I heard fairly often of cardiac diet patients). It is different being with the RD and seen as more of a professional.
My first day, I mostly had orientation to the facility. I was introduced to all the hospitals procedures and protocols. I spent a lot of time learning their EMR system with all the patient information. My preceptor gave me a booklet with equations (for calculating calories and protein for certain BMIs) and tube feeding protocols. This is literally my go-to book for the rotation. If you don't receive something like this, ask your facility what procedures they use to calculate calorie and protein needs. You can make your own sort of "cheat sheet."
My second day was where most of the action occurred. I learned how to complete a nutrition profile for new patients that needed nutrition consults. This involved researching the patient past medical history, current medications, diagnoses, lab values, BMI, anthropometrics, and calculating requirements for calories, protein, and fluid. I was able to shadow the RD for the second half of the day. I got to see a range of medical diagnoses in such a short time; congestive heart failure, acute renal failure, hypertension, dementia, hyperlipidemia, hypothyroidism, and more! I even got to chart on 2 of the patients :)
When I first started, I was afraid that I wouldn't know what to say to patients. The more I learned about diets in clinical, the less I felt I knew! After the first few days, I began to feel more comfortable. You find out everything you need to know about the patient prior to going in to do an assessment. The assessments are usually short (<30minutes). Also, my facility (and probably many others), have access to the nutrition care manual, which lists every disease, lab values, educational handouts, and more. So, if you don't know something, you definitely have the tools to find out.
Just some tips I have for the first few days of inpatient clinical:
-Ask as many questions as you can about nutrition assessments and patient procedure. I think it really helps to hear it explained different ways by different RDs.
-Practice finding nutrition information on patients. The one RD had me on a nutrition profile hunt my first day. I would get a patient and find out their BMI, calorie needs, medications, etc. It helped me to navigate through their system and to research different medications.
-Follow the RDs on their rounds; even if they don't outright ask you, ask them!
-If the facility has access to the nutrition care manual, peruse through it. It is such a great resource (it is expensive to buy).
-This website was useful too: http://www.uptodate.com/home
Hopefully, I will be seeing patients on my own in the next few weeks! :)
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