Another 2 weeks down and it flies by just as fast as the others have. It’s honestly hard to believe that I only have 2 weeks remaining until I am finished with this clinical rotation and begin my community rotation. I’m still learning at an extremely rapid pace and finally starting to refine my skills in a clinical setting.
I am still rotating each week with a different dietitian and this week I was with the oncology department and the behavioral unit. There were three main activities that stuck out to me: getting to sit in on some outpatient counseling, giving a nutrition seminar to the behavioral patients, and getting to fill in for some of the other dietitians who were gone this past week.
One of my biggest interests as a dietitian is to help counsel people in a one-on-one setting and this week I got to do exactly that. Well, I didn’t do the majority of the counseling, but I got to observe and add in my two cents when appropriate. I have had some experience counseling people in the past, but this time was completely different because of the type of person who came in for help. This person was not motivated at all to make a change – didn’t like any fruits or vegetables, had a myriad of diseases, and was over 300 lbs – so it was interesting to see how the dietitian I was shadowing handled it. We were able to set a few goals for them, but it would be surprising if they actually followed through with any of them. It showed me that a core competency I want to work on is [CRDN 3.6 Use effective education and counseling skills to facilitate behavior change.]
There were also some of the dietitians who were sick or out of town this week, so it was a new experience for me to help out and take on some of the work load for their patients. This ranged from anybody who had a broken foot in the orthopedic unit to a patient who was in ICU that had overdosed on a new drug called Flakka and was on the ventilator. Because of being fairly successful at this, I think a competency I did well on was [CRDN 2.4 Function as a member of an interprofessional team.]. We also decided to have a little empathy for our patients and all the dietitians decided to try the Ensure and Glucerna shakes that we gave our patients. Some tasted better than others. :)
I also got to work with a different group of individuals in the behavioral unit (detox and acute). These are people who struggle with alcoholism, behavioral disorders, and/or substance abuse. I was able to conduct a nutritional seminar for these patients, for those who were interested in coming. To my surprise, they had some solid questions for me and most of them were actually eager to learn something. The environment was much more laid back than my normal classes I put on for the cardiac and pulmonary rehab classes. It was basically a question and answer the entire time and completely informal. I had a blast talking to them and I think they really enjoyed my help.
It was after I got done talking to some of those individuals with alcoholism when I came across one of them who was at risk for refeeding syndrome. Refeeding syndrome is a syndrome consisting of metabolic disturbances that occur as a result of reinstitution of nutrition to patients who are starved, severely malnourished or metabolically stressed due to severe illness. I had learned about refeeding syndrome in class, but I wanted to dig a little deeper. I found some great information from Stanga et al. (2008) that determine the following as main points: always be aware of the circumstances in which the syndrome is likely to develop; refeed slowly and build up the macronutrient content of the feed over several days; monitor the patient frequently; anticipate the additional requirements, particularly of phosphate, potassium, magnesium and thiamine; and minimize salt intake, unless the patient is salt depleted.
Next up is the final home stretch at my last rotation. I am pumped to see what lies ahead.
1. Nutrition in clinical practice—the refeeding syndrome: illustrative cases and guidelines for prevention and treatment. Z Stanga, A Brunner, et al. European Journal of Clinical Nutrition volume 62, pages 687–694 (2008)