Things are changing! The hospital I’m interning at is undergoing some big changes while I’m there–lucky me! The first big change is that the dietitian offices are moving, and that happened this week. I also attended a distinguished speaker conference Thursday night, and my 5th blog for the Chicago Academy of Nutrition and Dietetics was posted on Thursday as well. To catch up with my previous clinical experience, check out:
DI: Week 18 – Clinicals and a Seminar
DI: Week 19 – All the Clinicals + Diabetes Education
DI: Week 20 – More Clinicals + Finally Official
DI: Week 21 – Clinicals + Site Visit + Another 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:
It was a busy day today, as per usual. I did a severe protein calorie malnutrition assessment, an inadequate oral intake, pressure ulcer, and 2 severe protein calorie malnutrition follow ups, 2 length of stay and 1 low BMI screens, and an uncontrolled diabetes diet education. The uncontrolled diabetes diet education was challenging for me because the patient had health insurance intermittently so was only able to get his diabetes meds sometimes. This meant that his diabetes would be fine, then uncontrolled, then fine again, then uncontrolled… I went over the diabetes diet with him again to hopefully help keep his blood sugars under control better. Consistently having access to his meds, though, would help a lot too. It’s cases like these that make me sad because this man could avoid the diabetes complications that result in him ending up in the hospital if he had consistent access to the medications that help him control his diabetes. Unfortunately, there isn’t anything I can do about that, and that’s what the social workers in the hospital work on. It’s just frustrating to know that my education can only take this man so far without access to diabetes medications. Luckily, my night class this week is virtual, so I was able to stay for my whole shift and didn’t have to rush through my charting. Instead, I have online kidney modules to complete.
Tuesday:
Today, I spent half of my day shadowing the outpatient dietitian and half doing my normal inpatient stuff. On the outpatient side, we had a patient with a new Celiac diagnosis, and a cancer patient. For inpatient, I did a high BMI education, pressure ulcer assessment, Crohn’s flare assessment, pressure ulcer follow up and a low BMI screen. Interestingly, two of my patients today, the Crohn’s flare and low BMI screen were teenagers (18, but still). In general, the majority of the patients at this hospital are middle-aged or older. Technically, we have a pediatric unit, but it’s small and is often used as overflow for some of the other units since we don’t have a lot of kids coming in. It’s funny because we rarely get consulted to the peds floor, but when we do, we’re generally seeing an overflow patient and not an actual kid. :P
Wednesday:
I came in early this morning to attend a cardiac rehab class. Once a week, one of the dietitians goes to the cardiac or pulmonary rehab class to answer participant’s questions. During these classes, the participants engage in supervised exercise. Some are recovering from a cardiac or pulmonary event, some just want to exercise in a safe environment where a nurse is close in case there’s a problem, and others are preparing for a transplant. I went to a pulmonary rehab class in Week 19. Unlike pulmonary rehab, cardiac rehab is generally a more talkative bunch. This is partly because we’re talking to them while they’re exercising, and obviously if you’re in pulmonary rehab, you probably have issues breathing which makes talking while exercising more challenging. Cardiac rehab patients also generally follow a cardiac diet and have questions about this. We got a lot of questions about salt and the different kinds of fat. It’s a fun change of pace from inpatient. I’m also responsible for giving feedback on their dietary records (this is optional for them to participate in).
For inpatient today: I did a high BMI education, a weight loss screen, a consistent carbohydrate education, 3 malnutrition follow ups, a TPN (receiving nutrition through a vein) follow up, and a pancreatic insufficiency follow up. I also had my first truly bizarre interaction with a patient–story time! My pancreatic insufficiency patient had just had his diet advanced and was now eating solid foods. I checked in with him to see how he was tolerating eating solid foods and how his appetite was doing. To my surprise, he immediately announced to me that he’s a “Type 4 diabetic”, doesn’t have a pancreas, and therefore won’t be able to digest the whole wheat pancakes he had for breakfast that he knew were whole wheat before eating but ate anyway. This surprised me because, according to his medical records, he’s actually a Type 2 diabetic and does, in fact, have a pancreas. I often talk with confused patients, but generally they’re older and have a medical diagnosis that explains their confusion. According to his nurse, this gentleman is just convinced that he doesn’t have a pancreas even though he definitely does. It was one of those moments where I was just smiling and nodding while this guy explained to me a bunch of things about his medical history that just weren’t true. And in case you’re wondering, he was fine from a nutrition standpoint despite the fact that he ate whole grain pancakes. :P
Wednesday just kept getting crazier, though, because part way through rounds my preceptor was informed about a training I was supposed to attend that neither she, nor I, knew about. We both found out about 10 minutes before this training started. Needless to say, an extra 2 hour training I didn’t know about until right before it started kind of threw a wrench in the rest of my day, but it’s just one of those things that you have to adapt to quickly. Luckily, I saw all of my patients before rounds, so after the training, I just had charting to do.
Thursday:
This morning, the dietitian’s offices moved into a trailer. Yes, you read that correctly, we’re now in a trailer. :P This is a temporary move, though the offices will be in the trailer for the rest of my clinical rotation. After a year, they’ll move into their permanent, “new”, offices, but for now we’re all hanging out in a trailer. We aren’t the only ones whose offices moved; we’re in the trailer with social work, case management, spiritual care, etc. The trailer has a lot of small, individual offices for the management of each department. The rest of us are in a large room full of desks. It’ll be interesting to get used to since each of the dietitians previously had their own office. I share with whichever dietitian I’m working with that day. Now, I have my own desk which is an upgrade for me, but it’ll be strange working with dozens of people in the same room.
Despite being uprooted this morning, we still had plenty of patients to see! I did a high BMI education, an inadequate oral intake assessment, a length of stay screen, a tube feeding follow up, an uncontrolled diabetes diet education, a weight loss assessment, a follow up for the Crohn’s patient I saw earlier this week, a failure to thrive assessment, and a gastric sleeve follow up. This is the first time I’ve done a weight loss education with a patient that wanted to talk to me! And I’ll admit, these educations are fun when the patient actually wants to talk to you and make changes. I have a strong interest in weight management with people who actually want to make a change. I just don’t feel that it’s my place to tell somebody that they have to change everything about their life. That’s their choice, and I’m here to help if they want. Now that I’ve had a positive experience with a weight loss education, I feel a lot better about it overall. I also had the opportunity to talk to a bariatric surgery patient (admitted for a different reason) which was awesome since I had experience working directly with bariatric patients last semester (Weeks 2, 3 and 4). We were supposed to talk to him about weight loss as well because his BMI is just over 40. Since he’s a bariatric patient, however, he’s doing everything to lose weight and regularly follows up with a bariatric dietitian. I just had to check in with him to see how things were going. I wrote in his chart that he’s already doing things for weight loss and doesn’t need further education from us. He was a very nice man who’s had a lot of success since his surgery. This was exciting since not everyone experiences success with it (like most things).
After leaving the hospital, I had to drive to campus for a distinguished speaker conference. We had three speakers talk to us about our role as health professionals in reducing health disparities and promoting equity. The speakers were amazing, and it was cool to hear about all the things different organizations (including Loyola) are doing to promote health equity. This made my day very long since I didn’t get home until almost 10pm, but I still think extra things like this enhance my education and I’m grateful for these opportunities.
The Chicago Academy of Nutrition and Dietetics (CAND) published my 5th blog post today! You can find it here. I wrote about fruit juice and kids, which you might remember I also wrote about when I interned at the food pantry last semester.
Friday:
After such a long day yesterday, it was hard to get out of bed, but I had patients to see! I also had to drive to a new parking lot today since our offices are now in a trailer. Today, I did 3 malnutrition assessments, a tube feeding assessment, a high BMI education, a trigeminal nerve follow up, and an inadequate oral intake assessment. In the past, I’ve only done follow ups with patients with tube feeding to see how they’re tolerating it. This was the first time I actually wrote out a tube feeding prescription for a patient. He had previously been on tube feedings at home, but the hospital doesn’t carry the same formula he was using. I had to find a comparable formula, and calculate how much he would need to meet his nutritional needs. Our workflow was a little off today since our office isn’t in the same building as our patients anymore. It takes longer to travel between the office and our patients, which makes things more complicated. Previously, if a patient wasn’t available while we were on the floor, or if we had a patient added onto our task list later in the day we could easily run back up to the floor from the office to see them. Now, we’re in a separate building so it takes a while to travel in between. This means we have to be more cautious with how we’re spending our time. We also have to plan to make as few trips as possible between the office and the floor since it takes a lot more time. I’m sure we’ll adapt, but it’s an adjustment for sure.
Weekend:
Whew! It was a long week–can you tell? I caught up on some much needed sleep over the weekend, and chunked away at my never ending to-do list. I’m excited to get to the point in my life where I can work full-time without simultaneously being a student.
Next week, I’ll be at the hospital all week and will actually have in-person night class again. Until then!