This week, I completed my first full week of my inpatient clinical rotation. I’ve found myself really liking being in the hospital. Each day is so different. One of the best things about being in clinical is there is always a variety of diseases, diets, and interesting medical histories.
Every day when I came in, I would research the new patients (needing initial assessments) and follow-ups for the day. I sifted through EMRs on the computer to find the patient’s height, weight, BMI, medications, allergies, I&Os, diet orders, and lab values. Using the information I researched, I would calculate the patient’s energy, protein, and fluid needs. When the RD came in, we would go out on the floor and do patient rounds. After the first few days, I was charting on all of the patients we saw (with supervision).
There were some really interesting patients this week. One lady had her stomach removed a few years ago and her intestine stretched to create a pouch. I ended up calculating her tube feeding recommendation. She was one of the many tube feeding recommendations I calculated this week (and 1 TPN). Another patient I saw, had a PEJ tube and a G-tube for drainage due to cancer. The patient ended up excreting almost 3 liters of fluid and was severely hypovolemic and had hyponatremia.
I also saw 2 swallowing evaluations this week. I was in the radiology room with the patient and technicians. They would give the patient a small amount of food (applesauce, cottage cheese, etc) with barium in it. They would then have a screen where you saw the food enter the patient’s mouth and esophagus. Both patients I saw had food get stuck in the esophagus, due to poor swallowing abilities. One patient ended up back on NPO and the other was advanced to pureed. Just as a side note, I had to taste test a pureed diet for an assignment. One item I tasted was pureed chicken. It tasted like gross chicken mashed potatoes. I would definitely not suggest trying that if you don’t have to.
One of the hardest things in clinical was seeing patients with a laundry list of diseases and medications. A lot of the issues were diet related. I saw a few patients with amputations due to uncontrolled diabetes and bedridden patients due to their morbid obesity. The craziest part was that they were still adamant on not changing their diet to a healthier one. It was rewarding to talk to a patient that was interested in what you had to say. One of the patients I got to educate had a cardiac diet. We talked about how he could lower his sodium intake at home and the importance of small changes to make a habit stick.
I really found it to be helpful to have a clipboard and small binder with equations (calculating protein, calories, ideal body weight, and fluid needs), lab values (and what they mean for disease states), and tube feeding information. You could also use an IPad if your facility allows you to. I also brought a small notebook on rounds with me so I could jot down information about the patient and tips for performing a nutrition assessment. It definitely gets easier the more you do it.
Next week, I will be with another RD that does the ICU rounds. I’m really excited to participate in interdisciplinary meetings on patients.