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