This week I was at the hospital Mon-Thur and had another seminar on Friday. 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
DI: Week 20 – More Clinicals + Finally Official
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:
True to form, it was a busy day at the hospital! Today, I did an assessment for severe protein calorie malnutrition, two screens, five follow ups, and a high BMI education. One of my follow ups was with a woman who had staples in her stomach to restrict its size. This was done to help facilitate weight loss, however, she had some complications and ended up here to get the staples redone. She had lost a lot of weight (more than she should have), and developed a protein deficiency. Her case was complicated both on a calorie front and a protein front. We wanted to make sure to feed her adequate calories, especially since she experienced more extreme weight loss than she should have. However, she also has staples in her stomach restricting its size and therefore her ability to eat adequate calories. On top of that, we had to try and determine how much of this weight loss was due to the surgery (good weight loss) versus how much was due to the complications and lack of adequate calories (bad weight loss). On the protein front, she has stage III kidney disease, but also has an open wound that isn’t healing because she’s protein deficient. She needs more protein to heal the wound and combat the deficiency, however, her kidneys are failing and high amounts of protein put extra strain on them. Once again, it’s a fine balance between getting enough but not too much. Luckily, she’s been able to eat lots of small meals throughout the day and we added a protein/calorie supplement once a day to give her some extra protein (but not too much). After seeing all of my patients, I had to chart very quickly to get out on time so I could make it to my night class!
In class this week, we talked about nutrition support in a clinical setting. This includes things like enteral nutrition (tube feeds) and parenteral nutrition (giving nutrients directly through a vein). We also practiced case studies and calculating parenteral feeds.
Tuesday:
Today, I did another assessment for severe protein calorie malnutrition, two length of stay screens, two follow ups, and a new diabetes diet education. Once again, my diabetes education went extremely well and my patient was very engaged in our conversation. He asked a lot of great questions and seemed very motivated to get his diabetes under control. We talked about carbohydrate counting, foods that affect blood sugar, meal timing, etc. I’m actually enjoying diabetes educations more than I thought I would. I have had very engaged patients both times I gave diabetes educations though, so, to be fair, maybe I’m just liking them so much because of that. It’s really nice though to be able to talk to patients about nutrition who actually care about what you’re saying. Oftentimes, in a hospital setting, as I’ve mentioned previously, nutrition isn’t a big priority for patients. This is part of the reason why I gravitate more towards outpatient nutrition counseling or private practice–your patients are making an effort to see you and thus are more likely to care about nutrition. We’ll see though–there are definitely some aspects of clinicals that I’m loving.
Wednesday:
Happy Valentine’s Day! Surprisingly, we had a very light day today. I did a low BMI and length of stay screening, a tube feeding follow up, and an NPO follow up. NPO just means that someone isn’t eating/drinking. Once someone has been NPO for 5 days we have to follow up with them to determine if we will need to initiate nutrition support (tube feeding or feeding directly into a vein). I ruled out both of our screens for nutritional risk. Our low BMI patient’s weight was stable; she was just a small woman and was eating fine. The length of stay screen was a gentleman with an ankle injury who was eating just fine as well. For both of the patients we screened, we’ll follow up with them in a week, if they’re still in the hospital, to make sure everything is still going well from a nutritional standpoint.
Thursday:
Last day of clinicals for the week, and also an extremely busy day! Today, I did a renal follow up, TPN (nutrition delivered directly into the bloodstream through a vein) follow up, length of stay screen, severe protein calorie malnutrition assessment, high BMI/low Braden education/screen, new diabetes diet education, heart healthy diet education, and promotion for heart health month. I also had a site visit from the instructor for my supervised practice right before lunch. She’s visiting all of the intern’s hospitals over the next couple of weeks to check in and make sure everything is going okay. It was nice to actually meet her–since our “class” is supervised practice, we don’t see her on a week-to-week basis. During the lunch rush, I promoted heart health by distributing samples of a heart healthy salsa recipe and handed out recipe cards. This was a fun deviation from what I normally do at the hospital, although it did take an extra hour and a half out of my day. :P Once again, I was very lucky and had a wonderful new diabetes diet education. The patient I saw was also has hypertension and possible other heart issues, so my education touched on heart health as well as diabetes. After this education, I had a heart health education with another patient. We talked about healthy fats, limiting sodium, and trying to eat lots of fruits, veggies, and whole grains. This was a quicker education than the diabetes diet educations because we don’t have to go over carb counting and those kinds of things. Overall, it was a great (although busy) day!
Friday:
I had to leave nice and early to drive to Northern Illinois University for our monthly seminar series. The morning component was about eating disorders. A dietitian who specializes in eating disorders talked to us about considerations when working with a client with an eating disorder and when to refer. The key point I took away is that, if you don’t specialize in eating disorders, you must refer to someone who does when you see warning signs. Eating disorders are very complicated, and you can’t help someone if it’s out of your scope of practice. After her discussion, we had a panel of eating disorder survivors talk to us about their recovery stories. It’s very encouraging to hear these survivors’ stories, and how they healed their relationship with food.
In the afternoon, we had an interprofessional workshop with students from other healthcare disciplines (auditory, speech language pathology, physical therapy, counseling, nursing, pharmacy, etc.). I had a class in undergrad that was designed exactly like this workshop, so I knew what to expect. It’s fun to network with students from other healthcare disciplines though.
Friday night, Spencer came over and we went out to dinner at Benihana for a belated Valentine’s Day celebration. It was so nice to end my busy week with a nice dinner with one of my favorite people. After dinner, we watched “Chappie”. I can’t believe I haven’t seen this movie before! I was exhausted by the time we started watching, but stayed awake because it was so entertaining.
Weekend:
On Saturday, Spencer and I went to see “Black Panther” in theaters. I HIGHLY recommend this movie–it was so good! Definitely one of my favorite superhero movies. On Sunday, we went out for brunch at Billy’s Pancake House. I wasn’t really feeling crepes like I usually order, so I went with a Belgian waffle instead–delicious! The rest of the weekend, we ran some errands and just relaxed before Spencer left to drive back to Minnesota. Anyone else think the weekends go by way too fast?
Next week, I’ll be at the hospital every day! No night class this week (it’s virtual instead), but I do have a speaker conference Thursday night. Until then!
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