Our Lady of Bellefonte Hospital: Medical Nutrition Therapy, Week 9-10

It blows my mind that I am currently typing my final blog post as my first rotation comes to an end. It feels like yesterday I was just trying to navigate through the massive snow storm on my first day to find out where the dietitian’s office was even located. Then, today was my first day at my new rotation.

Talking with the patients, assessing their needs, and actually seeing your care help the patients was extremely gratifying. Being in the hospital is almost never fun for these patients. Often, they’re sick, hurt, impatient, scared, and just want to feel better so they can go home. Knowing this, when you see that you’ve made a positive impact on their lives, it can mean a lot to both of you. It’s how I felt after helping this one patient who was obese and was having bowel issues – she just couldn’t keep any food down, but she finally had her surgery. However, she was afraid to eat whole foods again due to the fear of not being able to tolerate them. She expressed her issues with me and I wasn’t 100% sure on how I should approach the situation. So, I told her I would go discuss with the other dietitians and come right back up to her room. After discussing, I returned back to the room with a full low FODMAP that she may be able to tolerate and she was so filled with joy. Seeing someone being relieved of their worry because of you is one of a kind. I feel like this is a competency I did well on because I had to go the extra mile to figure out what was best for this patient - CRDN 2.7 Apply leadership skills to achieve desired outcomes.

After I took this patient their handout for the low FODMAP diet, I wanted to review up on some of the available literature on the effectiveness of this treatment. To my luck, I found a recent meta-analysis from 2016 that included 6 RCT’s and 16 non-randomized interventions on the effects of a FODMAP diet on IBS, IBD, and other gastrointestinal symptoms. This analysis concluded that there was a significant decrease in IBS symptom severity scores, significant improvements in the IBS quality of life scores, and FODMAP diets significantly reduce symptom severity for abdominal pain and overall symptoms. Overall, the analysis supported the efficacy of FODMAP diets in the treatment of gastrointestinal symptoms (Marsh, et al., 2016).

Another activity I got to partake in in the last two weeks was the use of a calorie count consult from the MD. It was actually for a homeless patient who was recently admitted into the hospital and diagnosed with severe protein calorie malnutrition. I had to work with the PCT for 3 days to get an accurate calorie and protein count of how much he was taking in each day. Then, I had to compare his average calorie and protein intake to what his estimated needs were. Since he was taking in slightly less than we wanted, we had to add a supplement to each meal to bump up his intake.

Finally, the last activity that really stood out to me was my presentation of my case study to the  other dietians in the office. I had a fun time creating and presenting this patient I had been following for such a long period of time. The other dietitians offered awesome feedback to what I should keep and what I should consider including for next time. Their main points were focused on the assessment of the patient and the overall understanding of his case of the disease state, so I think a competency I could work on would be CRDN 1.6 Incorporate critical-thinking skills in overall practice. I would say the coolest (but also sad) part of the entire case study is what happened on my very last day of my internship. This patient was initially admitted in January and then discharged towards the end of the month. Well, I return to work on my final day and look down at my list of patients for the day and it just so happens the guy I did my case study on was readmitted into the hospital due to relapsing. It was a very real moment for me and also sad just because I know he had high hopes last time he was discharged, but his struggle continues. 

  Great 10 weeks. :)

Great 10 weeks. :)


References:

1. Marsh, A., Eslick, E.M. & Eslick, G.D. (2016). Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis. Eur J Nutr. 55: 897. https://doi.org/10.1007/s00394-015-0922-1.