Happy February! Am I the only one who feels like January flew by? I’m officially halfway through my dietetic internship–crazy!! On one hand, I’m ready to finish and finally become a Registered Dietitian Nutritionist, and on the other I feel like I blinked and the past 5 months were over. This week was my first full week of my clinical rotation–no seminars or holidays. To catch up with my previous clinical experience, check out:
DI: Week 18 – Clinicals and a Seminar
In order to maintain patient confidentiality and privacy I’m being deliberately vague when blogging about where my rotation is and the patients I’m seeing. You can find a more detailed explanation of this in my Week 18 post.
Here’s what my week looked like:
Monday:
We had a very busy day! As I’ve mentioned previously, there are no dietitians on staff at the hospital over the weekend. This means that we have to see all of the patients admitted over the weekend on Monday. We also saw several patients for a BMI education. The policy of the hospital I’m at is that any patient who has a BMI >40 and has insurance that will reimburse for weight loss education has to be seen by the dietitian. This is actually pretty awkward because as I’m sure you can guess, hospitalized patients don’t feel good. They are often in pain, and their most pressing issue at hand generally isn’t losing weight. Since we do have to see them, however, we focus more on having a general conversation about healthy eating and how their weight has changed over time (if at all). This way, we’re doing our job while still being sensitive to the patient’s needs. I don’t think I feel fully comfortable with this yet, but my preceptors have been helpful in giving me strategies to approach this education in the right way. Personally, I just feel like this type of education is more appropriate for an outpatient setting or if requested by the patient.
In the afternoon, we saw a patient newly diagnosed with diabetes. She was primarily Spanish speaking, but luckily my preceptor for the day is proficient in Spanish. It was really cool to see this education take place. It was obvious to me that the patient felt much more comfortable and relaxed because my preceptor was able to communicate with her in the language she’s most comfortable with. There’s a lot of education involved with a new diabetes diagnosis, and it was clear that this woman was overwhelmed. Generally with these inpatient educations, the dietitian tries to educate on the most important things to start working on now, and then saves the rest of the details for the outpatient dietitian to continue with.
I also wrote my first independent note today! I’ve written patient notes before during my bariatrics rotation, but this is the first time I’ve written a clinical inpatient note. I wrote a nutrition assessment note for a patient we saw today who was experiencing severe protein-calorie malnutrition. In order for us to diagnose a patient with malnutrition, they have to meet at least two malnutrition criteria. The criteria include things like: significant weight loss (this is further defined into percentages over time), reduced caloric intake (also further specified), muscle mass wasting, fat wasting, and hand grip strength. The hospital I’m at doesn’t test hand grip strength, so we assess based on the other four criteria. The experience I’ve had charting at the bariatric clinic has really helped learn inpatient charting much more quickly.
Tuesday:
Today, I visited patients independently and charted on them. One of the patients I saw independently needed a screening for low BMI. Her weight was stable though, and her appetite was good, so she is not at nutritional risk at this time. My second patient had a low BMI and had lost a lot of weight over the last 6 months. She had virtually no appetite and hadn’t been eating well for almost 6 months. I identified muscle and fat wasting on her during our visit and was able to diagnose her with malnutrition. My preceptor had to verify that she was, in fact, malnourished since I’m not licensed and can’t actually make a nutrition diagnosis until I am. She agreed with everything I said, and complimented my charting which felt good. Other than that, today was pretty slow–we didn’t have very many patients to see.
Wednesday:
I diagnosed another patient with malnutrition today. She’s had swallowing issues for a few months now that have gotten progressively worse. Today, she wasn’t able to eat or drink anything without it immediately being regurgitated. This was a hard visit for me because there’s nothing I can do for her right now. She isn’t able to keep anything down, and the doctors haven’t figured out what’s wrong with her yet. They’re running more tests, so I’m hopeful that they’ll figure it out soon. We saw another patient with malnutrition today as well, who was much more…eccentric. According to her nurse, she’s been refusing a lot of medications and visits from providers. She was very nice to us, however, which was interesting. While we were talking to her though, she would randomly bring up something totally unrelated and then talk to us about food again. She also claimed that she couldn’t drink the Ensure at the hospital (she drinks it at home) because it had Nutrasweet in it (it doesn’t). We ended up getting a bottle from the kitchen and going through the ingredients label with her until she understood that it didn’t have any Nutrasweet. It’ll be interesting to see if she’s nice to us again when we follow up with her next week (if she’s still here). :P
In the afternoon, I was able to go with one of the dietitians to a pulmonary rehab class. The pulmonary/cardiac rehab center has a bunch of exercise machines and patients come to do supervised exercise. They have nurses to monitor them so they can safely exercise, and a couple times a month the dietitian comes to class in case they have any nutrition questions. We got a few questions, but overall the group was pretty quiet (some classes are apparently chattier than others). I should be able to attend one of the cardiac rehab classes as well which I’m excited about. It was just really cool to see another aspect of clinical dietetics.
Thursday:
In addition to doing a couple of follow ups independently, I did a diabetes diet education for a newly diagnosed patient. I taught him about which foods would affect his blood sugar, how to count carbs, and basic meal planning tips. He was very engaged and was able to teach-back everything I explained to him which was great. It was interesting to go from a follow up with a patient who wasn’t following the diabetic diet at all and had no interest in education to this gentleman who was very interested in learning more. It just feels amazing to be able to provide meaningful education to someone who’s genuinely interested in learning about it. I know that this man will be able to manage his new diabetes diagnosis better because of my education, and that feels incredible.
Friday:
Today, I did all of our patient visits independently. First, I did a couple of follow ups for patients who we diagnosed with severe protein calorie malnutrition previously. Then, after rounds, I did a heart failure and diabetic diet education. This education was challenging because the patient immediately got defensive about her diet despite the fact that I hadn’t said anything about her diet prior. It was hard because, based on what she was telling me she was eating, she had no clue which foods were high in sodium and carbs. I did my best to help teach her, but ultimately she just wasn’t ready to make changes to her diet, so I ended up referring her to the outpatient dietitian. I’ve realized that some patients are open to learning about nutrition while they’re hospitalized while others could care less. In those cases, you just do your job and respect that they aren’t ready for more at this time. After I finished seeing all of my patients and charting, I was off to meet Spencer at home! We celebrated my cousin’s birthday with all of my Illinois family with dinner and cake. After the party, Spencer and I watched “Meet the Robinsons” which surprisingly I hadn’t seen before. I still haven’t seen the whole thing because I fell asleep part way through (oops!). In my defense, I’ve had to get up early every morning to get to the hospital on time and it was already past my bedtime when we started the movie. :P
Weekend:
On Saturday, Spencer and I went to see “The Shape of Water” in theaters. I had heard a lot of good things about it from people, but really had mixed feelings about it. I liked the story, but there were some really strange parts in the movie that were a bit off-putting. Honestly, I’m not totally sure exactly how I feel about it still. If you’ve seen the movie, what are your thoughts? After the movie, Spencer taught me how to play the video game “Stardew Valley”. It’s such a cute game that I feel like I could get too caught up in. Luckily, I don’t have the game or even the device to play it, so I won’t need to worry about that, lol. On Sunday, we went out for breakfast and just relaxed before Spencer had to leave. I had some work to finish for the week which I was able to do Saturday night and Sunday afternoon.
Until next week!