This week I was at the hospital Mon-Thurs before travelling to Wisconsin Thursday night to spend Easter weekend with Spencer’s family. I finished my ICU rotation and started staff relief! At this point I’m functioning as a Registered Dietitian Nutritionist with a few limitations. For example, I still can’t change diet orders and need someone to sign off on my notes because I’m not licensed as an RDN. 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
DI: Week 22 – Clinicals + Moving Into a Trailer
DI: Week 23 – Clinicals + Finding a New Normal
DI: Week 24 – Clinicals, a Seminar, and Big Changes
DI: Week 25 – Starting in the ICU
DI: Week 26 – Second Week in the ICU
Here’s what my week looked like:
Monday:
Last day in the ICU, and it was another slow one. I only had three patients to see today, and one was a tube feeding follow up. Follow ups for tube feedings are generally pretty quick unless something is wrong and the patient isn’t tolerating the feeding. This patient was at his goal rate and tolerating it just fine, so all we have to do is write a note and check his lab values. I diagnosed my other two patients with malnutrition and then got to spend the rest of the afternoon charting and gathering information for my case study. One of our big projects this semester for supervised practice is to write up a case study on one of our patients. This is a slow process because I have to pull information (like lab values, weights, medications, etc.) from the electronic medical record to use in my case study. You can’t really just print out the whole record (for practicality and patient confidentiality reasons), so it’s time consuming to go through and copy information over. Luckily, I had some time this afternoon before leaving early for my night class.
Tonight, we gave group presentations on different body composition measuring devices. My group gave a presentation on ultrasound and how its used to measure body composition. Then, we had a guest speaker give a presentation on body composition as a whole.
Tuesday:
First day of staff relief! Technically, we only need to complete 5 days of staff relief to meet our competencies. However, many of us are starting staff relief early. This is kind of nice because then we get more practice at it. I’ve pretty much been doing staff relief for the most part for weeks now, the main difference today was that one of the dietitians gave me her work cellphone so I would be contacted if needed by other providers instead of her. We don’t get called that often though, so it’s more of a “just-in-case” thing. I’m doing my staff relief in Gen Med/Surge which spans two floors of the hospital and 48 beds. Despite the hospital being at capacity, I only had 6 patients to see out of the 48 admitted to the floors I’m covering. All in all, my first day of staff relief went very well.
Wednesday:
Today was another surprisingly light day, though I actually had a few more interesting patients. One of the follow ups I completed today was with a younger man who has oral cancer. His face is swollen from the cancer and treatments, so he has difficulty opening his jaw. He can pretty much only drink liquids and isn’t really able to chew any solid foods. He’s been drinking 5-6 Ensures a day to make sure that he’s meeting all his nutritional needs, so that’s what we’re giving him at the hospital. It’s not ideal, obviously, but it’s what has to happen until he’s able to eat solid foods again. I also saw a patient who was here when I first started at the hospital. She’s malnourished and has stomach staples restricting the size of her stomach which makes it difficult for her to eat. I saw her at the hospital when I first started, and now she’s back. She’s still malnourished, and her eating is even worse than it was a couple of months ago. She doesn’t want to eat anything, but has non healing wounds and other health conditions that won’t improve until she’s eating enough. At this point, the gastroenterologist is on consult to see if we need to start a tube feeding since she just isn’t able to eat anything. I picked up a patient from rounds today too. Both Gen Med and Gen Surge have rounds that I attend every day to get a better idea of what’s happening with the patients. During rounds today, a nurse mentioned that her patient just received a diabetes diagnosis and was discharging today so I added her to my patient list. We try really hard to see all patients newly diagnosed with diabetes to educate them on the diabetic diet. This patient was Spanish speaking, but she had family in the room who were able to translate and we have diabetic diet handouts in Spanish that I was able to give her. It feels good when I can catch a patient before they’re discharged to educate them.
Thursday:
Today, I did my first hyperemesis gravidarum (really bad morning sickness) education. She was in the CDU which is a unit near the Emergency Room for patients who aren’t expected to be in the hospital longer than 36 hours. We don’t usually see patients in the Emergency Room or the CDU. Generally, patients are admitted to other floors or discharged before we see them. I’ve never been to the CDU until today, so it was a bit of an adventure just to find my patient in the first place. She’s 14 weeks pregnant and hasn’t been able to eat very much for the past month due to extreme nausea and vomiting. She’s getting an anti-nausea medication now which is helping a lot. I also gave her nutrition education for strategies to still eat with hyperemesis gravidarum. After I finished at the hospital I drove to Wisconsin to spend the weekend with Spencer and his family!
Weekend:
I spent the weekend with Spencer and his family in Wisconsin. Since it’s nearing the end of the semester I spent a good chunk of my weekend working on assignments and projects. We had Easter lunch together with some of Spencer’s Minnesota family which was a lot of fun. Overall though, my weekend was pretty much spent in front of my computer working on assignments. The end of semesters is always so fun. :P
Next week, I’ll be continuing my staff relief at the hospital. I also have an RD Exam Review Workshop all day Friday and Saturday–I can’t believe we’re already nearing this time! Until then!