8 weeks and counting...

Wowzas, it has been well over two months since my last post. I've completed both my community and food-service management rotations and am finishing up the remaining 8 weeks of my internship back in clinical :)

 In my community rotation, I worked with WIC, as well as ISU Extension. Both experiences were AWESOME. WIC is a really great program that helps out low-income families purchase healthy foods. The dietitians provide nutrition education to everyone before they receive their checks. ISU Extension is an organization through the college that provides education on various topics to people in the community, among other projects. I had a big community project where I visited with food pantry directors in the community to find out what food items participants don't know how to use or cook at home. With the information I gathered, I put together lesson plans for the ISU nutrition educator to use when participants come in for food. 

Food-service management isn't something I've ever had the desire to do and after spending five weeks in the food-service management rotation, my feelings still haven't changed. I was with Mercy Hospital food-service for one month and spent the remaining week with Sioux City school food-service. Some of the main things I did was taught a cross-contamination in-service for the dietary staff, conducted a survey to gather information from patients on food-service satisfaction as well as customer food-service satisfaction in the cafe, and planned a menu for an executive meeting and implemented it independently. 

Monday was my first day back in clinical and I've had a great week so far. The RD's are great and I really love the freedom I have in this rotation.

 Here's my 6 month schedule I posted on my wall. It's looking good!!

 

My desk at work

Our office - 5 of us

More to post later!

Week....?? Oh, it feels good to lose track!

Yikes! Another week has already gone by. AND the weather is divine! I can definitely handle 60 degree weather and the smell of earth. Course, Sioux City's earth has a bit more of the alcohol and urine stench than I prefer to take in, but even that is enough to make me smile. I actually do like this city ;-)


I'm focused on gastrointestinal (GI) diseases this week. I pretty much have a wing of the hospital to myself and then my preceptor checks my work at the end of the day. I love the freedom. My preceptor this week has a very specific way she likes things done, so she's harder to please than the other Dietitians. Regardless, I'm learning a lot and enjoying my time.


I've been able to observe quite a few different procedures this week. On Tuesday I watched a colonoscopy, which is an endoscopic examination of the colon and the distal part of the small bowel with a fiber optic camera on a flexible tube called an endoscope. The procedure is mainly used as a diagnostic tool for various intestinal/colon diseases. I also observed an EGD (esophagogastroduodenoscopy), which is a similar process to the colonoscopy, but is an examination of the lining of the esophagus, stomache, and upper duodenum with an endoscope placed down the throat. Most of the time, the patients are put to sleep, however, I witnessed both procedures be performed on a man who had insufficient lungs and could only handle so much anesthesia. It was actually hard to watch; and it actually turned out there was nothing wrong with him as far as the scopes could see. 


Yesterday I observed a small bowel function test. A woman had to drink barium sulfate, which is a contrast that visualizes the 
stomach and/or small bowel (which I'm told tastes terrible), and pictures were taken in 15 minute intervals showing the progression of barium through the bowels. This test is usually used to diagnose such things as Crohn's disease, cancer, polyps, and inflammation. 


Today I went to the wound care center at the hospital and they showed me the hyperbaric chambers. Certain diseases, such as diabetes or anemia do not allow blood cells to become supersaturated with oxygen at normal atmospheric pressure. By placing the patient in a hyperbaric chamber and administering pure oxygen, doctors can increase the amount of oxygen cells carried off through the bloodstream. Patients suffering from gas gangrene or flesh-eating bacterial infections can also benefit from the hyperbaric chamber's increased atmospheric pressure. Usually, the patient hangs out in the chamber for a couple of hours daily for a month or more so the procedure requires a level of commitment.

Lots to do yet tonight..

"A jug fills drop by drop"  - Buddha

When I first started blogging at the beginning of this internship, I thought for sure I'd be able to write every night. It's been 10 days since my last post and it seems like I just wrote. 

I haven't been cooking as much as I used to, however, supper tonight has inspired me to make time to cook more often. Stir fried mushrooms, onions, broccoli, cauliflower, and snap peas in spiced olive oil, stir fry sauce, and soy sauce....delicious!

Last week I had my diabetes rotation so I spent the majority of my time with diabetic inpatients and outpatients. I interviewed and counseled 3-4 patients per day and charted their Medical Nutrition Therapies and Nutrition Plans of Care. My biggest challenge was figuring out all of the different medications that can be taken by diabetics. Lots and lots. 

This week is my pulmonary rotation, which focuses on patients with COPD, respiratory distress, pneumonia, etc.. It's my 3rd week on the floor and I've started working independently. I'm assigned patients daily and do whatever I need to make sure they're getting proper nutrition. I begin by reviewing their charts thoroughly focusing on diagnosis, medical history, medications, current lab values, social history, surgeries, consults, current nutrition intake. 

Usually, the next step is to interview the patient to see if they are getting enough nutrition as well as inquire about needed nutrition education/counseling. It's not uncommon to find that patient's aren't eating well due to poor appetite in which case I would need to make sure they are getting sent nutritional supplements that they like and will tolerate. Many times they have a new diagnosis and aren't sure what they should or shouldn't be eating, in which case I would gather educational materials pertinent to their condition and educate them. However, it's very common for people to be knowledgeable in the area of proper nutrition, but are not compliant. These patients are a challenge to work with because it doesn't matter how much I educate them, they just aren't receptive or motivated enough to change. 

Patients with conditions that prevent them from eating may require tube feedings so they don't go too long without nutrition. Tube feedings, called enteral nutrition, can be given through a nasogastric tube for short term or a PEG tube which requires a surgical insertion into the stomache. It might be that they are unable to swallow, on a ventilator, post surgery, etc. Usually by day 4 without eating, a tube feeding is ordered, if not sooner. This is when my calculator and I get to bond. There are several different feeding formulas to use depending on patient's particular condition/state/diagnosis. I need to make sure that whatever feeding they are receiving is meeting their estimated calorie, protein, & fluid needs.

I gave a presentation to some sophomore kids a couple of days ago with one of the Dietitians. I put together a presentation called "Nutrition Fact or Myth" which is self-explanatory :) The kids seemed to have fun with it and it got them talking so it was a fun time. 

I suppose, I need to get some work done and go to bed. My throat is itchy and I have that feeling of sickness coming on so I need to get to bed early tonight. This waking up at 5:50 am is starting to catch up with me. 

Night!

“To achieve the impossible; it is precisely the unthinkable that must be thought.” Tom Robbins

I appreciate weekends more than ever.

The boyfriend and I are sitting at Panera Bread after getting booted from a cute little coffee shop, Coffeeworks, which closes at 3pm. All of my favorite places in this city are only open for a few hours on the weekends or not open at all. Anyway, I'm drinking plain old coffee and Myron ordered this. Always has to one up me.

I feel like there's so much to write that I'm not really sure where to begin. I haven't been able to post all week due to the unreliability of "borrowing" the neighbors unsecured internet connection. Some days it works great, and some days I can't connect at all. I suppose it's about time to fork over some cash to the internet company and purchase my own connection. I just wish we could all be friends and share like we did when we were kids. Why can't we outsmart the internet providers by networking with  neighbors, share passwords, whatever works, and all spend a lot less than we need to each month to get online. Myron would like to add that the world will not be able to function without city wide WiFi soon, and we'll all be able to get online for free. He's probably right, however, it would be nice if that would occur right now while I'm working full time without pay and not when I'm making bank. Right..


So enough with that spiel, onto my cardiac nutrition therapy experience. There was definitely a lot to learn this past week. It included my first time interviewing and counseling patients and charting independently. Last week I shadowed each of the dietitians and was able to observe each of their their own unique styles of counseling. They all make it look easy as pie. It's definitely one of those things though, that you get better at with practice. The very first time I spoke with a patient, I got very nervous. Probably because they just had a life or death moment in the form of heart failure, and here I was telling them how they  needed to change their lifestyle to lower their risk for a subsequent episode. Of course they hung to every word I said. That moment was very powerful, and at the same time had me questioning everything I was saying. Am I making sense to them, are they understanding what I'm saying, am I even giving them good advice, do they understand the impact their choices have on their health, etc. And then I learned that there are many patients who "duck" when they see the dietitian coming. When I notice this, I announce "Hi, it's the diet police!", which usually lightens the mood.




One of the questions I had to answer in a Professional Reflection to my instructor at ISU was, "What made you feel competent this week?". That I had to laugh at because I realized that that is about as good as it's going to get at this point in the internship. I perceived the question as, "What didn't make you feel dumb this week?". The good news is, I actually had an answer to that question. The thing that stuck out to the most to me was noticing a folic acid deficiency in a man who was anemic. He was being supplemented with iron due to the anemia, but was not receiving a folic acid supplement, which is also another deficiency that leads to anemia. My preceptor had me talk to the patients nurse, who talked to the patients doctor, and the man got his folic acid. It's those moments that put a little pep in my step and leave people wondering, "Why is that intern walking funny?". 




I attended something called "Grand Rounds", something that many hospitals have routinely. It's a presentation given over lunch by a medical professional on their latest research. I went to one on "Limb Salvage" by a doc from Chicago. He's traveling the country trying to spread the word on new advances in wound care. The presentation was a bit over my head, but from what I gathered, he believes that serious wounds should be treated, not amputated. And there are new forms of treatment he believes all hospitals should be implementing.  




Since it was my cardiac rotation last week, I was able to observe a couple of cardiac catheterization procedures. It is a procedure used to check out how well the blood is flowing to the heart as well as how well the heart is pumping. A catheter is inserted into the patients femoral artery in the groin area and travels all the way up to the heart. It seemed odd to me that they only used local anaesthetic. I would probably have a panic attack knowing that a  wire is in my heart. The procedure only took about 15 minutes and the patients went home the next morning. 




Alright, it's getting late and I still have lots of reading to do for Diabetes rotation next week..

"Imagine a world in which medicine was oriented towards healing rather than disease where doctors believed in the natural healing capacity of human beings and emphasized prevention over treatment. In such a world doctors and patients would be partners working towards the same end."

Andrew Weil, MD

Cardiac Unit Day 1

Today I was given my own patients, which meant I had to research their charts, speak with them directly, and come up with some sort of intervention regarding nutrition. Maybe they weren't eating enough, or they had difficulty swallowing due to dysphagia. Whatever the problem was, I had to address it in the chart note. My favorite part about this career is that I have the perfect balance between patient care and research. Probably 1/3rd of my day would be working directly with patients while the rest of the day consists of researching their charts trying to figure out what could be going on with their health. I love working with people so I would never want to do away with that, but it is nice to spend a little time on my own as well throughout the day researching, charting, etc.
I actually have a lot of work to do tonight so I'm going to make this post short and sweet. Miniature snickers.

Mercy Day #3

I learned something very important today. It's a shame I didn't learn it on day #1. There is an actual coffee shop at the hospital. I've been getting the crappy cafeteria coffee since I started. So this news is very very exciting for me. I haven't tried it yet. I actually passed it on the way to the employee parking lot, and today was the first day I had to park in it. The lot is 2 buildings and a block away from the building I work in, so it's just easiest to go into that first building and use the sky ways to get to the dietitian's office. Anyway, good good deal.

 I was with LeAnne today who focuses mainly on the cardiac unit. She talked to quite a few patients on the importance of a heart healthy diet. It's interesting how some people are very interested and proactive when it comes to eating better for their health. Others are very bitter and see nutrition education as something to be ignored. When in actuality, their poor nutritional choices are probably a big reason for them being there in the first place. It's very difficult to emphasize the impacts of nutrition relative to heart disease without looking like we are pointing a finger. Also, how do you go about changing the eating habits of someone who's been eating the same things for decades?? These are the biggest challenges I face so far with this group.

Ooooh boyfriend just showed up and surprised me! Catch up lata!

Mercy Day #2

Even though it was my second day at the hospital, it felt more like my first since I mainly sat through orientation with other employees yesterday. Today was the first day I wore the white lab coat, pager, and name badge. (Enough to fool someone into thinking I'm an actual professional :)

One of the RD's, Steph, taught me how to review patient information as well as how to chart on a patient using the software they have at the hospital. Once I play around with it on my own, I'm sure I'll catch on pretty quickly.  She also let me borrow her "nutrition bible" that she made up during her internship and has added to since she started practicing 9 years ago.  I was so giddy when she told me I could make copies of whatever I wanted and pointed me in the direction of the copier. 

I sat in on a patient discharge meeting in the ICU. It involved a respiratory therapist, nurse, social worker, and dietitian. It seems crazy to me how much information everyone memorizes on the patients. They were rattling off lab values, medications,  diets, etc.,  without ever having to look at their clipboards. Very cool.

I listened in on Steph talk to inpatients who were isolated due to disease. As long as you're not going to be very close to the patient and not touching them, it's not required to put on the personal protective equipment (PPE) such as the face mask, hat, gloves, gown. 

So that was my day. I'm now sipping decaf green tea, listening to Frank Sinatra on pandora, and am going to start putting together my reference binder. What I really need to do is get started with using the gym here...still haven't done that. It's just so warm and cozy in this apartment.

Ciao!