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!

Mercy Day #1

Alright, little behind with my postings. Last Friday was of course my last day in Ames for orientation and it went great. We listened to speakers from both the Dairy Council and Beef Industry. They gave us samples of their products and I decided I'm not a fan of Lactaid or Dairy Ease. The lactose is already broken down so for people who lack the enzyme to metabolize lactose, it's wonderful. One thing I thought a little odd was that the speaker from the beef industry had us sampling frozen beef dinners. I understand that some people just lack the time, desire, or skill to cook, but I can't see myself ever recommending TV dinners to clients, especially pot roast. 

That afternoon an RD from HyVee came to discuss just what it is that dietitians do at HyVee. She also explained the NuVal system, which, if you don't know what it is, you should check it out. Typically, every item in HyVee has a NuVal score right next to the price of the item. The score ranges from 0-100 with 100 being the best rating. It just makes it easier to compare items that there are a lot of...say cereal, crackers, spaghetti sauces, etc..

Today I officially started at Mercy Hospital here in Sioux City. The majority of the day I was in orientation with other new employees. At the end of the day I found the Dietitian's office and met all four of the RD's I'll be working with. One of the ladies, Kim, gave me a tour of the hospital. I have to say, it was entirely overwhelming. That hospital is a lot bigger than I thought it was. Not only that, but there are four different buildings connected with skyway's, but once you walk to the next building, you suddenly find yourself 3 or 4 floors lower or higher than the previous building. The floors are just all over the place, it's hard to keep track of where you are. 

My preceptor, Nancy, seems very nice and helpful. I sat with her for about an hour to discuss the layout of a typical day. Tomorrow I'll be on the computer learning the two different programs used by the dietitians. As for now, I'm exhausted. Time for bed! G'night.

It is not our differences that divide us. It is our inability to recognize, accept, and celebrate those differences.

- Audre Lorde

Day #4

Today was a really good day. 

We spent all morning working on case studies and calculations. Thank god the coffee pot kept getting refilled. I seemed to be chugging it like it was water and I'd been walking through the desert all week. Except it was coffee and I'm an intern who just got out of bed and was forced to rack my brain. Calculations went well though...seems to all be coming back to me pretty quickly. Case studies are a little more difficult; there's just so much to look up from medications, food-medication interactions, side effects, labs, abbreviations, diagnoses, calorie contents. And then trying to put it all together in one very complex puzzle. It's a lot of work, but it can actually be a lot of fun. And once I start working with charts, I'm hoping my brain can absorb everything. I know it will be overwhelming for awhile though. 

Here's some footage from our morning..

                                    Working hard

                            Missing my pocket protector.

                   Some of the ladies in my group

For lunch today we had vegetarian spinach wraps. I meant to take a picture to show you the size of this monster that I ate ALL of, but I always forget to take pictures of my food. Probably because all I can think to do is eat. I love wraps, especially when they are green.

We then hopped on the bus to the computer lab. We were told by the administrators of the iPod Touches to put together a little power-point of pictures taken throughout the week with our i Pods and present today. I agreed to present my groups power-point because I feel I need to get better at public speaking. CRAZY right?! I've never volunteered to speak in front of a big group. What's even crazier is that I actually had fun doing it. I had no idea what I was going to say and just "wung it". And it was pretty liberating! 

We took some online quizzes for HIPAA, and discrimination policies. Also, a new intern pre-test, which we were all pretty freaked out about. And we all found out that we still have things to learn...which I think was the point behind it. Anyway, we got out a half hour early today, which was obviously very exciting.

I then had to find the student health center on this gargantuan campus of ISU.  Why? Because even though I had the chicken pox when I was a little person, Mercy hospital still feels the need to test my blood to prove immunity. So I had what's called a titre. Now, my history behind giving blood is nonexistent due to the fact that my veins are what they call "difficult". I've given up on donating and when I tried giving blood last semester for a research project they poked me about five times before they gave up trying to draw my blood. So when I walked into this room and saw this needle connected to a very large empty tube, I panicked a bit and warned this STUDENT that was going to take my blood that I had "difficult veins". She just kinda chuckled, jabbed the needle in my arm, and I couldn't believe how fast she had that tube filled. And I could barely feel it. Relief.

Whitney, my roommate for the week, and I decided to eat supper at Panera Bread since it's a WiFi hotspot and we wanted to play with our iPod Touches. I got the usual, mediterranean sandwich with black bean soup and a coffee. Also something picture worthy that I inhaled before the thought came to mind. 

One more day of orientation and then home!!

"Some people are always grumbling because roses have thorns; I am thankful that thorns have roses". Alphonse Karr

Day #3

Halfway through orientation week...yay!

Today went by so fast, it was wonderful. First, a representative from "Nestle" came in to talk about all of the different supplements and feedings they have, which are often prescribed to inpatients and some outpatients depending on their needs. The speaker was telling us it's a really good idea to get to know all of our pharmaceutical reps well in case they could help us out with questions or figuring out what type of product to use on a particular patient. When I worked at the hospital as a dietary aide, there were always representatives in the entryway with  whatever new products they had. They were always sexy (and dressed that way too) and some of the docs woulds sip their coffee and flirt with them all morning. I guess they were just following that rule too.

The next speaker, Kathy Pertzborn, RD, LD from Children's Hospital in Des Moine spoke next about pediatric nutrition. This woman was amazing. She talked about how parents freak out when their kids won't eat what was made for supper and so they  make them something else so their kid won't "go hungry". She quotes author Ellyn Satter's book "Parents are responsible for the what, when and where of feeding. children are responsible for the how much and whether of eating". So parents are the ones who choose what to eat for supper (hopefully something nutritious!), and what time the meal is served. If children say "no way", that is a choice they are making. Soon they will learn that they cannot control the situation and will have to eat what is in front of them or nothing at all. And if they don't eat simply because they are not hungry, that is completely fine. Why should we be forcing our kids to eat when they aren't hungry, especially when obesity among children is already on the rise. THEY WILL NOT STARVE. Simply tell them that supper will only be offered at this time. Still offer a night snack, (also chosen by the parent) which should be offered every evening anyway.

We had another buffet style lunch that included the most amazing vegetarian lasagna I've ever had, bread stick, green beans, side salad, and iced tea. Right afterwards, there was a panel discussion with 3 former interns and 2 RD preceptors. We asked a ton of questions and got some really useful information from how to  manage time to how to deal with "grouches" on the job. One of the interns actually planned a wedding and got married by the time she was done with her internship. Another one had two teenagers to take care of. Personally, I think those women are very inspiring. A couple of days ago we were told we couldn't even have a very part time job during this the internship because "it is certain you will fail".

For the last few hours we worked on case studies and worksheets focusing on how to use the Nutrition Care Process. It's something we did a lot of in undergrad so I'm pretty comfortable with it. I get to spend all of tonight working on another one to go over tomorrow.

Here's a picture from my new fancy little iPod Touch.

Two more days of orientation, then home!

"Our ultimate freedom is the right and power to decide how anybody or anything outside ourselves will affect us." ~Stephen R. Covey~

Day #2

Early morning...up at 5:40 a.m. so my roommate and I could leave by 6:40 to catch the campus bus. There's no place to park at the computer lab where we had to be all morning. We went through a tutorial on how to use the new "Blackboard Learn" class module. Once we log in, we can view everything that needs to get done in the next 6 months. We will have to send information to our instructors at ISU daily/weekly/monthly, just depending on what it is. There are evaluations, worksheets, case studies, reflections, journals, assessments, presentations, and discussions. Unfortunately I didn't get my morning coffee which made it a bit of struggle to get through everything.

The highlight of the day came next in the form of our very own iPod touch's to be used throughout the internship. ISU purchased them as part of a grant and we're one of the first groups to try them out and give feedback and what apps we like and if they help our learning experience. So far, it's only distracted me from learning anything other than how to search for unnecessary (but fun!) apps. Personally I recommend the free allrecipes.com application if you like to cook. 

The entire afternoon was spent working on the Nutrition Care Process, which is like the bible for dietitians. ADIME = Assessment, Diagnosis, Intervention, Monitoring, and Evaluation.  Those 5 words make an entire textbook. That's probably all that needs to be said about that.

 

It had been snowing all day and my car was covered with ice and snow after class. A friendly old man had just finished scraping his car and came over and as asked if I would like help with mine. He said he just wanted us to be safe and that someday he might need help from somebody so he's doing what he can do to help others now. Hard to not smile at that.

My fever has gone away, but my arm is throbbing from the tetanus shot more than ever. It's a good thing that immunization is required only once every ten years. The way I've been feeling lately after these shots makes me want to take my chances. 

So exhausted. Bedtime!

"A pessimist sees the difficulty in every opportunity; an optimist sees the opportunity in every difficulty."    Churchill.

Day #1

Okay, first day of the week long internship orientation is officially over and done with! I don't remember the last time I felt jitters like I did this morning getting ready to go...oh my goodness. Alas, I made it there with a few minutes to spare, found my spot which was labeled with my name tag, and was "ready to rock n' roll" (phrase heard often throughout the day:)

Of course, we did the "go around" where we introduced ourselves... and found out that the group of interns this semester is the most diverse Iowa State University's ever had. There were people from all over the country.  Many of them are participating in a distance program where they can actually find their own preceptors where they live and not have to be stationed in Iowa.  I, however, will be located in Sioux City, IA working mainly at Mercy Hospital, but also at Siouxland District Health Department, ISU Extension, a private practice (I get to choose!) , Sioux City schools, and Siouxland Dialysis Center. 

There really isn't too much to report today. I basically just had to sign my name a whole bunch. I started off signing really pretty and fluent, and by the time I reached the last few pages I couldn't quite tell it was a name anymore. 

We had a buffet style lunch that was catered by the school; broccoli cheese soup on top of a baked potato. Also a side salad and a brownie. Yum! 

The rest of the day consisted of a speaker Dr. Denise Vrchota presenting "Communication Skills for the Dietetic Professional". It was basically the same info that you would learn in college speech or seminar class, but it's nice to review. Every once in a while I need to be reminded that my posture needs to be worked on so I appear confident and to stop with the "ummmms" while presenting in front of a group. Does it ever get easier?!? It just isn't natural for me to stand with shoulders back and nose up in the air, and while one person is telling me to do so despite my lack of comfort, another person says to just be comfortable and act like yourself and that's when you make a good impression.

Overall, it was a successful first day! I now need to get to bed because I've been running a little bit of a fever that I blame on the Flu or tetanus shot that I received last week.

Goodnight my friends, you'll read more tomorrow!

Always chase your dreams instead of running from your fears.

Author Unknown