This week I officially started my ICU (intensive care unit) rotation at the hospital. Because the hospital I’m interning at is pretty small the ICU is equally little with 12 beds. This means that some days I only had one or two patients to see in the ICU. On these days, I picked up a couple patients from different units as well to help the other dietitians out. To catch up with my previous clinical experiences, 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
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:
Somewhat ironically, my first day in each new unit I’ve been in has been extremely slow. My first day in the ICU was no exception. Today, the ICU was also only half full so I just had two patients to see. I picked up a few patients from general medicine to help fill my day, but overall it was an uneventful day. One thing that was really nice though is where I was able to park today. This may seem silly, but since our office is in a trailer now our parking situation is a little weird. We have a small parking lot right next to the trailer, but that lot generally fills really early since other hospital personnel and patients park there too. This means that I’ve been having to park a few buildings over and walking to the trailer. The walk really isn’t that bad, but when it’s really cold out, windy, and/or snowing it definitely isn’t a fun time. Today was the first day since moving into the trailer that I was actually able to park in the lot right next to it. Sometimes, it’s the little things that make your day better. :P
At our night class we had a guest speaker give a presentation on diabetes. Then we split into groups and completed a case study.
Tuesday:
It was a full house in the ICU today! I also covered the intermediate care floor (step down from ICU) since the dietitian who usually covers that floor was doing outpatient appointments today. I had a couple of diabetes diet educations and a couple of low BMI assessments–remember when I said we get waves of certain patients? For one of my diabetes diet educations it was challenging because the patient also has short-term memory loss and mild dementia. She was actually diagnosed with diabetes a month ago, but forgot about it so the hospital thought they were the ones who diagnosed it for the first time until they were able to get in touch with her primary care physician. Since she has issues remembering things I just covered the basics of the diabetic diet: foods that affect blood sugar, eating consistently, etc. I also heavily used the plate method which is just a picture of a plate where half is vegetables, a quarter is protein and a quarter is grains. If nothing else, hopefully having that picture will help her out. I’ve had patients before with memory issues, but I’ve never had to do a diet education for them before.
Wednesday:
Yet another mild day in the ICU. All the ICU beds are full, however, most of the patients in the ICU right now are actually intermediate care patients. The floor is set up so that half of is officially intermediate care and the other half is ICU. However, since it’s silly to transfer a patient just down the hall when they’re downgraded to intermediate care, patients remain in the same room until they’re able to be transferred to the general medicine floor. As far as division of responsibility for the dietitians, however, we have one dietitian who covers the intermediate care side, and another one who covers the entire ICU side regardless if the patient is officially an ICU patient or not. The only times this gets confusing are during ICU rounds because we don’t discuss the intermediate care patients. Since all the patients in the ICU unit are on my patient list regardless if they’re officially an ICU patient or not I don’t actually know that a patient is intermediate care or not unless we skip over them in rounds. It’s a little weird doing things this way, but it helps the dietitian team because we’re covering all the same rooms everyday as opposed to the intermediate care dietitian having to come to the ICU side to see some patients some days depending on their official status.
Thursday:
Today, I covered both the ICU and intermediate care. Another relatively slow day compared to the gen med/surgery realm. I also spent some time putting the finishing touches on my in-service assignment. One of the assignments for my supervised practice this semester is to develop a lesson plan and educate a group of people at the hospital (other dietitians, food service staff, nurses, etc.) about a nutrition related topic. I developed a lesson about low stomach acid (hypochlorhydria) for the other dietitians. It’s an up and coming topic, so there isn’t a lot of evidence based information out there. It did give me an opportunity to shed some light on something patients have been talking about though.
Friday:
I had four patients to see in the ICU today, so it was still a pretty light day. I also had a few patients who I had to chart on that I couldn’t actually talk to. This is something that happens pretty often in the ICU. Patients come in and for whatever reason are unable to provide an accurate weight/diet history. In these cases, I have to get most of my information about their nutrition status from their chart. This isn’t always the easiest thing to do, but based on the circumstances it’s necessary. If a patient has family who stops in periodically I try to visit the patient when family is there. This happened yesterday where I had to see a patient with dementia. She couldn’t provide me with a weight or diet history, so I had to rely more on the information in her chart. I scheduled a follow up with her for today since I knew her family was supposed to come see her. Luckily, they visited today so I got a better idea of her weight and diet history from them.
In the afternoon, I presented my in-service on low stomach acid to the dietitian team. They were very interested in the topic, and thought I presented it well. It’s something that patients have been bringing up more and more as time goes on (so I’ve been told), so this was a nice way for the dietitians to get a crash course in what’s out there on this topic.
Weekend:
Spencer came to visit and we went to see the river dyeing in Chicago! Every year for Saint Patrick’s Day they dye the Chicago River green. Since I’m actually living in the area now, I figured we’d better see it! It was really fun to see, there were tons of people all decked out in green!
Next week I’ll be at the hospital Mon-Thur, and at a research symposium on Friday. Until then!