This week I continued my clinical rotation and attended a seminar.
Please note: you may have noticed in last week’s post and you’ll probably notice in this one that I’m being extremely vague about where my clinical rotation is and the patients I’m seeing. This is deliberate. In an effort to protect patient’s identity and personal information I’m not sharing the specific hospital that I’m at. Close friends, family members, and other Loyola interns do, however, know which hospital I’m interning in, and therefore, to ensure that all of my patient’s confidentiality is maintained, any descriptions of patients and their medical conditions that I blog about are deliberately vague and generic. This is also why I won’t be including any pictures of the hospital on my blog, or directly naming my preceptors and others that I’m working with. If things are confusingly vague please let me know, otherwise I hope everyone understands why I’m detailing appointments with patients in this way. It’s a fine balance between trying to explain what I’m doing while still ensuring that everyone’s privacy is protected. I appreciate it. :)
Here’s what my week looked like:
Monday:
My preceptor and I did chart review first thing this morning to find out more about the patients we’re seeing. We review their past medical history, weights, labs, medications, wound care consults, diet order, food intake while in the hospital, etc. to get a better picture of the potential nutritional risk this patient could be experiencing.
After chart review, we visited a patient who has a short bowel obstruction. Because of this, she wasn’t eating, so we visited her to get a better idea of her nutritional risk. After asking questions about her appetite and body weight and performing a physical exam on muscle and fat stores to identify any potential wasting, we determined that she wasn’t at nutritional risk at this time.
Then, we went to rounds with the nurses and case managers. Rounds are helpful because the nurses inform everyone of changes that have not yet been updated in the medical record. They also let us know if a patient will be discharged that day, so that we know whether or not we’ll have to see them for a length of stay screen. Basically, we have to see patients at least once every 7 days they’re in the hospital. If they aren’t at nutritional risk, however, and are discharged on day 7 it isn’t necessary for us to see them. This allows us to then spend more time focusing on patients who need nutritional intervention instead.
Once rounds were over, we visited the rest of our patients. We followed up with a few patients who had already been seen earlier in the week. Then, we did an assessment, and another screen for a patient with a pressure ulcer. Interestingly, one of the patients we saw only spoke Russian. We used a language line interpreter to speak to her which is something I’ve never done before. It’s challenging because you’re speaking through another person, but very important so that we can help the patient effectively.
Tuesday:
This morning, my preceptor had me determine which patients we needed to see for the day independently. After I marked all of the patients I thought we needed to see, we compared lists. We saw one patient in oncology, one in telemetry, and a few in acute care. Overall, the hospital is pretty small so some days there aren’t a lot of patients that we need to see. We also had an appointment at the outpatient oncology unit which was interesting because I hadn’t been there before. We talked with a patient while she received her chemo infusions about the importance of eating a high calorie and high protein diet. She has been losing a fair amount of weight and is experiencing taste changes as a result of the cancer treatment. At this point, we stressed the importance of just getting food in regardless of whether it was super healthy. Obviously, we still want her to eat a healthy diet, but it’s more important that she’s getting the calories in overall.
After our outpatient visit, we attended rounds. It’s interesting being in rounds because I learn more information about the patients we have to see, which is good. At the same time, however, a lot of the information the nurses share isn’t relevant to nutrition. This makes it challenging because I’m the kind of person that thinks I have to know everything in order to do my job well. In reality, I need to focus on what is actually nutritionally relevant. That’s the point of specializations (it’s just a hard habit to break).
We saw the rest of our patients after rounds. It’s always interesting the type of people you meet in the hospital. We spoke to one gentleman today about the importance of calories and protein since he had a wound and was experiencing some muscle/fat wasting and he responded with “To hell with calories and protein!”. :P I always have to remind myself when things like this happen not to take things personally. People don’t feel well when they’re hospitalized, and this can obviously affect their mood considerably. Even healthy people can have bad days as well, so I’ve quickly learned to just have a positive attitude and accept that not all patients will be receptive to nutrition advice/education.
Wednesday:
Today was a little hectic since my scheduled preceptor’s son was sick and she stayed home with him. Instead, I worked with the telemetry/outpatient dietitian. We had to cover all of her patients and the patients my original preceptor would’ve had as well. First, we screened several patients to assess whether or not they needed additional nutrition intervention. We also did some diabetes education with a woman who was struggling to control her blood sugars. In the afternoon, we talked with a woman admitted for diverticulitis. She has Celiac disease that she was managing well, but was very unsure of what to eat to manage her diverticulosis. We educated her on fiber consumption and the importance of giving her GI tract time to rest when she experienced flare ups (diverticulitis).
Thursday:
The hospital I’m interning at is going to be making a lot of big changes over the next couple months. One of these changes is switching the program they use for electronic charting. Since I’ll be here when that change happens, I attended a 5-hour training on how to use the new system. Luckily, they’re switching to a system that I’ve briefly used during my bariatric rotation.
After our training and a late lunch, we only had a couple of patients to see. At the beginning of the week, everyone was very careful to try and see patients before today since the training took up such a large amount of time. One of the patients we saw has kidney failure and diabetes, so we educated him on a consistent carbohydrate renal diet. He also just started dialysis which changes his protein requirements. Luckily, he knew a fair amount already and had been making some dietary changes which made our job much easier.
Friday:
Today was our first seminar series of the semester at Rush University in Chicago. For the first part of the seminar, we learned about interviewing strategies and tips to find our first job. The process of becoming a Registered Dietitian Nutritionist (RDN) is very different than finding a job right out of college because we have this internship after we graduate. The afternoon session was about nutrition communications. We learned about strategies for communicating nutrition messages to the public over social media and blogging. Nutrition communications is becoming more and more essential for RDNs to learn. It’s also something I’m planning on pursuing in the future. I just definitely wasn’t excited to drive in Chicago rush hour to get home. :P
Weekend:
I had a pretty relaxed weekend, and checked a few things off my never ending to-do list. During the week, I only have time to complete things for my rotation and class, which leaves the weekend for everything else. I also watched a pretty great webinar by Libby Rothschild and the Nutrition Entrepreneurs Dietetic Practice Group about using Instagram as a nutrition professional (you can find it here). I’ll definitely be using these strategies when I finish my internship and have an RDN Instagram account! My less academic/professional entertainment was watching “Definitely, Maybe”. It’s one of those feel-good romances that I just can’t help but watch every few years. :P
Next week will be my first full week of clinicals–until then!
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