Tag Archives: critical care dietitian

Changing it Up

Wow, so it has been a while since I last updated about my dietetic internship. I have a good reason though! My preceptor put me on staff relief last week. This is earlier than normal and I am honored that they entrusted me with those duties! Not to mention it was the critical care unit! Needless to say it was quite busy between going on rounds, visiting patients, writing tube feedings, and working on my clinical homework and major case study. The ICU is no joke and I have to say it was a bit stressful at times (mainly the first day I was doing staff relief and I felt a tad overwhelmed) but I quickly adapted to the responsibilities and even spoke up during rounds, where the nurses and doctors go from room to room and discuss each patient. I don’t think they really knew who I was, just some random person in a lab coat following them around, until I piped up about a certain patient’s tube feeding being changed that day. They were all sort of shocked (and appreciative) and it made me feel really good to contribute!

This week, I am finally switching it up and changing hospitals for a couple weeks. Yes, I am still in the clinical rotation in my dietetic internship, but I am going to a different place to see a different perspective. I will let you know which hospital it is once they give me the OK to post it in social media. I am excited and a little nervous- I have grown so used to the hospital where I have spent the past 8 weeks. However, I will return to my original hospital in 2 weeks to do 2 weeks of full-on staff relief. Until then, this new hospital will give me another view of how a hospital can be run, because to an extent each hospital can be pretty different. I will definitely update by the end of the week to update on how it’s going there!

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Tube-ular!

This week has been very busy.  My focus has shifted more to critically ill patients and those needing enteral feedings, which are formula feedings through the nose or through a tube connecting to the stomach/small intestine.  I’ve had to pick out which formula to use, their daily needs for calories and protein, and how much they need to be given per hour.  Its using a few algebra skills as well as clinical judgement.

One lady I wrote an order for has a jejunostomy tube, which is a tube that connects from the skin to the jejunum, a part of the small bowel.  She is on enteral feedings at home, and uses a particular formula that is pumped into her during the night.  However, she is post-op from surgery, which automatically  increases her nutrition needs- mainly protein!  Extra protein will help her body to heal better.  I went in to speak to her about starting her tube feeding and she was worried about switching formula; sometimes with different formula compositions, some side effects such as diarrhea could occur.  I assured her that we would be following her very closely to make sure she was tolerating it ok, and that her body needed the high-protein formula.  She and her husband were glad I took the time to speak to them, and I was too!

A lot of the other enteral feedings I ordered were for people who were unable to speak to me- and visiting with patients is one of my favorite parts of dietetics- so I was glad to have this interaction.

Having the ability to order tube feedings is pretty awesome, if I do say so myself.  It’s nice to have a definite impact on a patient’s plan of care.  With interviews and recommendations, you never know if the patient is really going to be impacted by what you say or if the doctors are actually going to listen to you.  Tube feedings are another story- once the doctor gives the word, it’s all up to me!

The Reality of It

I, for one, have never had to stay in the hospital more than maybe a night in the emergency room. No one close to me has had to be hospitalized for a lengthy amount of time that I have been old enough to remember. (Both things i am extremely grateful for!) Therefore, working at the hospital does give me a big dose of reality- that there are REALLY sick people out there. People who led healthy lives that suddenly are dying of cancer. People who will end up with diabetes and renal failure. Others with devastating strokes.

Today I spent some time on patients in the Critical Care Unit, the  ICU if you will. That’s where the sickest of the sick end up. I had to recommend tube feedings to two patients. One of the patients was probably going to end up in a long term care facility, never being the same after a terrible cerebrovascular event. The other was being considered for hospice, which of course means that he is getting ready to die. Today I left with a different perspective. Instead of happily bopping into patients rooms and teaching them how to order off the menu, recommending supplement shakes, or teaching about nutrition with whatever new disease they acquired, I had to sit at the computer and think about the severity of their conditions. It didn’t help to run into a family that was crying for another patient further down in the ICU.

It kind of makes you appreciate life, you know?

My mom, a former ICU nurse, made a comment a week or two ago about how patients love students in the hospital. Probably because we’re not used to being in this environment, we almost care too much! One of my patients dying or being close to dying affects me quite a bit. I know in time it will impact me in a lesser way, but it’s definitely something that takes getting used to.

I don’t mean to complain; I know doctors deal with this stuff all the time. But it’s almost reinforcing my original plan to get into public health- prevention!