Our Lady of Bellefonte Hospital: Medical Nutrition Therapy, Week 2-4

This last Friday, as I was filling out my time sheet, I had to stop for a second and ask one of the other dietitians if this was actually the end of my fourth week of my internship. I actually had to stop as I was filling it out to check with them and make sure I wasn’t being an idiot. These first four weeks have absolutely flown by.

During the first two weeks, I was basically shadowing along with the other dietitians and helping out with the charting notes. But these last two weeks I have been like a baby bird leaping from the nest – I was starting to go into rooms by myself, asking questions, and gathering information all on my own. I’m perfectly fine talking to people, but this interview-style of talking to people is new for me. I have to make sure I ask the appropriate questions for this particular patient. Not only do you have to ask the appropriate question, you have to make sure you speak loud enough and listen very intently or else you can miss something important for your notes. I also got to perform my first nutrition-focused physical exam.

DHN NFPE pic.jpg

One competency I did well on was designing, implementing, and evaluating a presentation to a target audience (CRDN 3.4). I was lucky enough to give two different presentations on incorporating a high-fiber diet and why getting enough fiber is important. The class was for the cardiac rehab patients. This was new for me as well; all the presentations I’ve given up to this point have been for a younger audience. I found myself having to be careful about my word selection to make sure I used words and phrases that appealed to their level of nutritional understanding. The response I received from my audience was positive overall, so this felt great.

During my fourth week, I was with the behavioral unit the entire time with one of the other dietitians. As I said in my last blog post, this is where the patients with psychiatric disorders usually end up. In short, these patients can be quite unpredictable and you have to treat them a little differently than patients within the other hospital units. Specifically, with how you negotiate with them. This was a competency I want to improve upon (CRDN 2.8) because I can do fine when I have to talk to patients who are predictable. But when working in behavioral, you need a certain toolkit of skills that are most appropriate when dealing with these types of patients.

To elaborate further and demonstrate something new that I learned, I’ll use a certain patient who had an opioid addiction as an example. I learned that opioid use can be linked with constipation. According to Schwarzer et al., “It is mainly caused by linkage of the opioid to the peripheral mu-receptors in the bowel and may increase as a result of certain concomitant circumstances, such as poor intake of fluids or electrolyte disorder.” This was important to know because the patient was also abusing laxatives, possibly bulimic, and severely malnourished. Clearly a very complex case and I think gaining more experience will allow me to handle these situations and this competency better in the future.

After these first four weeks, I am immensely more prepared than when I first entered into this rotation. I am learning at an extremely rapid pace and I have loved working with the other dietitians. Most importantly, I feel like I am making a difference and starting to contribute to the health of the patients. I can’t wait for the weeks ahead. 


References:

1. Schwarzer, A., Nauck, F. & Klaschik, E. Schmerz. Strong opioids and constipation. (2005) 19: 214. https://doi.org/10.1007/s00482-004-0325-3