At this point in my inpatient clinical rotation, I am 5.5 weeks in with about 14 days left to go! Despite my 3 hour total commute every day, this rotation has been my favorite so far (something I thought I would never say!).
IPC is both challenging and rewarding at the same time. Seeing a really complicated patient and trying to figure out the best nutrition advice is like being a detective. You need all of the pieces (patient’s medical history, hospital care, food intake, etc) before you give tips on how to eat healthier. Missing something like Chronic Kidney Disease (need lower protein) or not knowing if a patient is on dialysis (higher protein is needed), can really alter what you say.
This week, I had some really dumb moments, like thinking LOS >7 meant a loss of 7 pounds (it really means length of stay > 7 days), really crazy moments (Seeing an anorexic patient who is receiving chocolate ensure via her tube feeding, since that is all she says she can tolerate; oh and she is receiving only 200-300kcal a day from her TF because she won’t let us increase her rate), really interesting moments (finding a patient who had a Whipple procedure done, which is now my new case study), really great moments (working with a quadriplegic patient to figure out calorie needs with high protein for wound healing), really sad moments (seeing a young patient go on hospice care from cancer), and really gross moments (taste testing boost pudding with prosource for a patient on a fluid restriction needing a supplement). Just as a side note, never ever try prosource unless you are dared to do so.
You never know what you will see when you are in a hospital. You will always see patients with CHF or diabetes (dia-be-tus as some call it in the hospital) or who are obese (some with a BMI of 51). What is frustrating is going to see a patient, who is diabetic and morbidly obese, and speaking to them about their diet. I can’t even count how many times a diabetic patient will say they are following a diet and don’t need any education, yet they gained weight from their last visit and/or are in for an amputation due to uncontrolled diabetes. It’s times like that where you need to be able to walk away and know that someone will not be able to change unless they really want to do it.
One of the best things for me, is following a patient from being in critical care in the ICU to the floors. It is especially awesome to see a patient come off a ventilator and be able to eat and function normally. I had a few patients over the past few weeks where I thought they would not be turning out okay. To my surprise, I am now following a lot of the patients out of the ICU and to their way home.
This week was really stressful in that I finished my research paper (10 pages on the effects of probiotics on antibiotic associated diarrhea, IBD, and IBS), presented my case study to my internship directors (my last one!), and worked on 2 additional case studies. It is often tough trying to manage my time properly between my internship (8.5 hours/day), 3 hour commute, part-time job where I teach nutrition, social life, and homework. One of the biggest tips I can give to anyone juggling a lot is to schedule in when you will do things. And by schedule, I mean put your assignments and plans on a calendar with a due date. One of my goals for this past weekend was to finish my research paper and find a new case study. I did both, even though I really wanted to just curl up and relax. Now, I have one less thing to stress about as I am finishing my rotation.
As I wrote my research paper, I came across some really great ways that helped me to figure out how to get 26 research studies into my paper in the right place. Here is what I found to be the best strategy for me:
1. Once you find a topic, gather all the information you will think you will need (plus more). I was trying to figure out what else to add to my paper after I got to 8.5 pages and couldn’t think of what else to write.
2. Either print the studies you find, or download as PDFs.
3. Go through each study and highlight important information you would use in your paper.
4. Create an outline of your paper: Paragraph 1: introduction, 2: probiotics, 3: C diff. 4: C diff and probiotics, etc
5. Type or cut and paste the information from each research paper into the word document with your outline under the appropriate sections.
6. When you start your paper, look back at all of the research pasted under each topic point in your outline.
I found this way easier to organize my thoughts. It may have been a little time consuming, but it definitely made the research paper much easier for me to tackle.
Finally, this is my last week before I start my staff relief portion!