Pushing Fluids in Long Term Care
By Emily Glass
During my long term care rotation, one of the biggest concerns that repeatedly came up was resident not being hydrated. Through family visits, naps, activities and small appetites, many residents do not drink fluids throughout the day. I had the opportunity to do an activity on fluids with long tern care residents and assisted living residents. We discussed the importance of hydration and its role in our bodies, as well as, different tips on how to increase intake. We shared our favorite drinks and even got to taste some watermelon and strawberry infused water. The residents were happy to learn more about water and all agreed to try to drink a little bit more throughout the day!
Advanced Practice Rotation at Children’s National Medical Center
By Julia Werth
During my rotation at CNMC, I had the opportunity to work in the CANDO clinic alongside a developmental psychologist, neurologist, cardiologist, speech pathologist and my preceptor dietitian. We saw 4 children with congenital heart defects including a little boy who was born with fetal alcohol syndrome.
Use of Hormonal Therapy in Clinical Dietetics
Prior to completing my major case study, I was not familiar with the use of hormonal therapy for cancer patients. The patient I chose for my major case study had metastatic prostate cancer. He underwent hormonal therapy, more specifically, androgen deprivation therapy (ADT). Androgen deprivation therapy (ADT) is used to block the production of androgens as Prostate cancers need relatively high levels of androgens to grow. Treatment that blocks or decreases the production of androgen is recommended and implemented to inhibit tumor growth and metastasis. However, many prostate cancers eventually become “castration resistant”, which means the tumor can continue to grow even when androgen levels are low in the body. When patients become resistant to androgen suppression other forms of chemotherapy may be used in conjunction with continued ADT.
ADT is just one example of hormonal therapy for cancer treatment. I have included the infographic below to emphasize the most important information regarding hormonal therapy. Check it out below!
During the first few weeks of my clinical rotation, one of the projects I was given was to design a nutrition article for the monthly employee newsletter. I wrote a short article about the research surrounding the benefits of probiotics, and where they come from in our diet. I also included quick and easy recipe that utilizes some probiotic containing foods. Enjoy!
Wellness Wednesday Presentation
In my clinical rotation at Medstar Harbor Hosital I didn’t only have the opportunity to help my patients improve their health through nutrition, but also the staff! On Valentine’s Day I had the opportunity to present a Chiles themed Wellness Wednesday in the cafeteria to all staff. It was a hit and inspired many to choose our chiles themed menu items including baked fish with a crushed chili pepper topping and collard greens with chiles.
Management of COPD
Throughout my clinical rotation at Frederick Memorial Hospital, COPD exacerbation was one of the most common conditions requiring assessment from the Dietetics Department. Affecting over 30 million Americans today, patients with this condition are at higher risk of malnutrition and commonly present to the hospital with significant weight loss in a short period of time. Energy and protein needs are increased due to complications commonly associated with COPD, such as labored breathing, infection, and increased metabolism. Meeting these needs are essential for preventing further weight loss, supporting metabolic needs, and reducing further complications. Not only does this improve the health of the patient, but it also reduces hospital length of stay, prevents readmissions, and reduces overall costs to the hospital and the patient.
Refeeding syndrome is defined as the reintroduction of carbohydrate into the diet of starved patients. Usually, patients starting TPN have received minimum nutrition for a significant period and they should be monitored closely for electrolyte fluctuation and fluid overload to prevent refeeding syndrome consequences. These consequences include hypophosphatemia, hypokalemia, and hypomagnesemia. and these electrolytes should be corrected prior to initiating nutrition support. While I was at the Baltimore VA Medical Center working in the ICU, I had multiple patients who were at risk for refeeding syndrome and I became very familiar with monitoring and correcting abnormalities. Here is a diagram showing you how refeeding syndrome can occur in a patient:
Experience at The 2017 MSPEN Fall Event
I was fortunate to have the opportunity this September to attend The 2017 Maryland Society for Parenteral and Enteral Nutrition Fall Event. Registration was open to students, and it was a great opportunity for me to network with clinical dietitians in the area. I was also able to see the viewpoints of other professions in attendance-such as pharmacy and nursing- on presented topics. The first presentation focused on the prevalence of undernutrition in obese individuals, and what consequences can result following bariatric surgery. Following was a presentation exploring the need and safety of feeding while a patient is on pressors, as well as protein needs for patients during ECMO (extracorporeal membrane oxygenation). As an added bonus, there was a delicious catered vegetarian dinner and dessert bar!
As I am also completing my clinical rotation in the internship, I have learned that I am drawn most to the upper gastrointestinal tract. Because of this, it was a great experience for me to have additional exposure to further my learning on bariatric surgery. I was lucky enough to sit next to the speaker at the event, and could ask her questions following her presentation. The University of Maryland Dietetic Internship pushes you to be a self-learner, but it was refreshing to sit back and learn from an expert on their subject.
As a student, it is important for me to explore the opportunities available in the field of dietetics. Taking the initiative to participate in activities outside of my rotation sites allows me to pursue finding exactly what I am passionate about. Attending such a conference was initially intimidating; I didn’t know what would be expected of me as an audience member, or if I would be able to follow along with the subject matter. To my delight, the atmosphere was very relaxed, and I couldn’t have been happier that I decided to go.
Practicing Effectively As a Clinical Intern
October 22, 2017
Only practice can prepare you to become a clinical intern and practice involves self-evaluation, which can be a truly positive or negative experience. Sometimes, it is easy to forget that self-evaluation should not be solely negative reflections on oneself. As an undergrad, I read a book called The Four Agreements by Don Miguel Ruiz. Essentially, the book dissects four therapeutic rules of life and the author describes the book as, “a practical guide to personal freedom.” In this post, I want to apply “the four agreements” to the clinical rotation, in hopes of reminding others, as well as myself, how to refine the skill of being new at something.
The first agreement in the book is to, “be impeccable with your word.” This means to speak with integrity and in a way that is in the direction of positivity towards yourself and others. I would like to apply this in the realm of learning in the clinical environment by thinking of it as respecting yourself in your thoughts and out loud. For example, instead of telling yourself, “I’m really bad at interviewing patients,” one might say, “I haven’t refined that skill yet.”
The second agreement is, “don’t take anything personally.” Carrying out tasks in an unfamiliar environment may entail being corrected. By not taking a correction personally, one can spend more time working to improve their ability to learn and less time feeling a sense of failure. Sometimes being corrected can be embarrassing, or make someone want to give up all together. When this happens, it is important to remember that a correction not meant to hurt one’s feelings, but is meant to aid in the achievement a common goal: the intern’s learning.
The third agreement is, “don’t make assumptions.” The author asks readers to practice clear communication by having courage to, “ask questions and to express what you really want.” By avoiding assumptions in the clinical setting an intern can prevent miscommunication between their preceptors, patients, the healthcare team, and oneself. Through this, the intern may also improve their ability to receive the information as well. For example, being that the clinical environment is fast paced, I often have to take a moment to metabolize my thoughts before asking a question in order to develop a way to efficiently transmit my message. On the receiving end, I try to declutter my thoughts of assumptions so that I may be more heightened to listening to the speaker and less to my own notions.
The fourth and last agreement is, “always do your best.” Someone’s “best” changes in every circumstance; one’s “best” when they are healthy is different from when they are sick, and one’s “best” in a unfamiliar task is different from when a task is familiar. Therefore, always putting forth the appropriate time and effort for a given situation can help ensure that regret and negative self-judgment can be avoided. For example, I often have to remind myself that my weak spots will not change over night and that I will do the best I can do, with the ability that I have, in hopes of making those weak spots stronger.
In summary, while the old saying is that practice makes perfect, the above agreements provide the reminder that we cannot truly learn when our minds are clouded by self-judgement, self-doubt, and void of self-care. If the experience is not positive and full of self-appreciation, then why are we doing it in the first place?