Happy Monday! This week was week 4 of my clinical rotation. To catch up with what I’ve done in clinicals so far, check out:
DI: Week 18 – Clinicals and a Seminar
DI: Week 19 – All the Clinicals + Diabetes Education
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.
My week looked like this:
Monday:
Surprisingly, we didn’t have a lot of patients to see today. Usually, Mondays are crazy because there aren’t any dietitians on staff over the weekend and new patients come in all the time. I just had a couple of follow ups and a screen/assessment for a low Braden score. Braden scores indicate the risk that a patient has for developing a pressure ulcer. If they have a high risk, we are consulted to see them because pressure ulcers increase nutrient needs. Specifically, these patients generally need more protein. Technically, just because we get consulted for a screen doesn’t mean that the patient is actually at nutritional risk. If that’s the case, we just indicate that in our note and follow up in about a week if they’re still in the hospital. With low Braden scores, however, a lot of the patients aren’t eating well, so we usually end up writing a full nutrition assessment for them and monitoring them more closely.
I also got my badge today! It seems crazy that it took over 3 weeks to get one, but apparently this isn’t unusual for my hospital. I guess the last dietetic intern they had never even got a badge. Before I got a hospital badge, I was wearing my Loyola badge, however, just so that people could identify me. It’s nice to be all official now though, even if my badge is bright yellow to indicate that I’m still a student. :P
It took a lot longer to get to my night class tonight because it was snowing… It’s supposed to be pretty snowy all week which makes my commutes a lot longer. Luckily, I was only a couple of minutes late even though traffic was horrendous. We all did presentations on micronutrients and their implications for clinical practice. I presented on Vitamin K and how it interacts with Warfarin/Coumadin (a blood thinner). We got out early too which was amazing, even though it still took me almost twice as long to drive home…
Tuesday:
Today was a little crazy. The preceptor I was supposed to be with was recovering from the stomach flu, so I worked with the ICU dietitian today. I won’t actually be working in the ICU for a while yet, but it was cool to sit in on rounds and get introduced to it now. We also had to cover acute care/oncology, and I did an assessment for malnutrition and two screens. Like I’ve mentioned previously, we often get consulted to do screens on patients that report unintended weight loss. Sometimes though, like today, we go to talk to the patient, and they inform us that no, they actually haven’t experienced any unintentional weight loss. It’s good that we’re over-screening instead of under-screening, but at the same time, it’s a little annoying when mistakes like this happen. Today, it really wasn’t a huge deal because we didn’t have a lot of patients to see again, but on a busier day, these mistakes cut into the time we’re able to spend with patients who actually do need our help.
Wednesday:
We had a few more patients today than we have for the past couple of days. Today, I did 3 follow ups, 1 high BMI education, and an assessment for inadequate intake. This was the first time I’ve done a high BMI education by myself. I’m really not a big fan of these educations…
To recap from what I’ve mentioned in a previous post: we have to provide weight loss education to all patients with a BMI >40 who have health insurance that requires it. This is really awkward, and in my opinion, not very appropriate for an inpatient setting… I mean, when you’re in the hospital you have more important things to deal with than weight loss. And often, these patients are actually losing weight unintentionally because of their illness/injury (which isn’t good). I’ve shadowed a few of these educations that actually went very well, but they still just make me feel awkward.
This woman that I had to talk to about her BMI clearly wasn’t ready for this education. She also had the flu and pneumonia, so I certainly don’t blame her. The nice thing is that we have some leeway with how we approach this conversation. So instead of having to go in and say “you’re too big, lose weight”, I’m able to approach the conversation in a much more respectful and neutral way. For her, I just asked about how she’s been eating and if her weight has changed at all recently. Immediately, from the moment I entered the room, it was clear she didn’t want to talk about weight loss (she rolled her eyes when I introduced myself as a “dietetic intern”). So, I briefly talked about the “healthy plate” method and gave her the outpatient dietitian’s information if she has any questions after discharge. I didn’t think the conversation went well, but my preceptor said she thought I handled it nicely. I’m sure I’ll get used to this with time, but it’s definitely my least favorite part of clinicals so far.
Thursday:
We had a busier day today! Since it’s supposed to snow up to 10” between tonight and tomorrow morning, my preceptor decided to give me work I could do from home for tomorrow, so I won’t have to drive in. Since I won’t be coming in tomorrow, we did a lot of the visits we would’ve done tomorrow today. Today, I had the opportunity to do my first cancer symptoms education. When a patient is undergoing cancer treatments, they may experience a multitude of different symptoms that affect their ability to eat as much as they need (taste changes, nausea, early satiety, etc.). We had a patient today who is going to start cancer treatments soon. To get ahead, I provided him with this education now before his treatments start. This way, if he does experience these symptoms, he’ll know what to do right away instead of waiting until he’s able to see a dietitian again to get this education. In the afternoon, I was also able to participate in a webinar on nutrition and wound healing. It was interesting to hear about how protein needs change with wounds and how proper nutrition aids in healing.
Friday:
It snowed a lot last night! I’m very grateful that my preceptors let me work from home today because traffic conditions were very poor this morning when I would’ve had to leave. Today, I worked on stuff for National Nutrition Month. Each year, the hospital participates in National Nutrition Month with handouts, displays, and/or demonstrations. This year, we’re doing a whole grains theme, so I spent time researching which whole grains to promote, fun facts, and cooking tips for each. I’ll share more about National Nutrition Month once we get closer to March.
Weekend:
With all the snow, I didn’t really feel like going anywhere except grocery shopping. I also had schoolwork and things to do for clinicals, so I spent most of my weekend on my computer.
Next week, I’ll be at the hospital Mon-Thur and at a seminar on eating disorders and interprofessional skills on Friday. Until then!