Clinicals: Week 1

I started my clinical rotation at Swedish Hospital for my dietetic internship last week. It’s my last of 4 rotations, and it was the one I was looking forward to the LEAST. Why? Well, healthcare workers are normally under a lot of pressure, but they are stressed more than ever due to the COVID pandemic and in the midst of a second surge. I was so nervous to enter a medical facility, especially a hospital, and I was unsure of what to expect and what my preceptors (mentors) expected from me as an intern. I asked myself… “Was I ready? Am I competent? Would I be safe from exposure to COVID?”. My mind was reeling the week leading up to my first day. Then, my first day arrived, and a wave a calm and excitement washed over me. Somehow I knew I was ready.

Me on my first day of clinicals.

On my first day, my preceptor met me in the waiting room. I was brought to the dietitian’s office and soon after, I got a tour of the hospital. As we were walking through the units and floors, I realized these bright red signs on the doors with photos of masks and other PPE wear. I was told that these were for droplet pts (patients who are high risk) and/or COVID patients. “Wait, WHAT?!” I thought to myself. “I’m on a floor with COVID patients?”. I was stunned because my impression was that COVID patients were quarantined to their own wing within the hospital. I was then told that they are staying on floors that correlate with the level of care they need and require (i.e. CCU vs ICU). Makes sense, but it was still a surprise because I wasn’t aware that I’d be working in close proximity to the virus. This immediately made me reevaluate seeing my family and friends for the next 10 weeks, the duration of my rotation. I had a discussion with both close friends and family members of whom I regularly see. I told them that I didn’t feel comfortable seeing them for their own protection and safety and that we’ll have to stay in touch virtually for now. They understood, thankfully.

Put COVID aside, I started learning Swedish Hospital’s EMR (Electronic Medical Record) system, Meditech. Yaaaa….so I was VERY overwhelmed navigating this portal to say the least. The medical jargon, abbreviations, and correct entries were a bit much. Plus, there are about 15+ areas I need to know to pull information from. It’s a tedious system to get to know intimately, but it’ll just take time, practice and patience (my new mantra). I really wish my DPD courses integrated medical terminology, nutrition-related medications, and prepared me more for charting. I understand that learning hands on and in the field is best, but there is something to be said about feeling prepared with an introduction to this knowledge. Luckily, my preceptor is amazing and patient. She had me observe her screen patients several times before I attempted to do so. She created a scavenger hunt to help me navigate Meditech, and she even had me conduct a mock NFPE on her to see what I felt like prior to performing one on an actual patient.

My first NFPE was the highlight of my week. It was on a woman with Down’s syndrome. We struggled to gather information during her assessment due to minimal verbal communication, but we successfully carried out the NFPE. During it, she extended her hand to me. I instinctually clasped mine in hers. We held hands for a bit before I moved down to her legs. My heart cannot tell you how sweet and memorable that moment was for me. It embodied the need and desire for human contact for our patients, especially in a time of distress.

I did another NFPE later in the week on an elderly man. He kept urging my preceptor and I to take care of ourselves so we wouldn’t end up like him. He said he wished he knew how to take care of himself earlier in life so he wouldn’t be like this man. That was tough to hear and respond to while then trying to ask about his frickin bowel movements…These are things we don’t talk about in our classes. Someone is in pain, whether mentally, emotionally, and/or physically, and we must relay our empathy while still carrying out our job in a concise time frame. This comes with good mentorship and practice. Luckily, I have both right now.

Besides screening, assessing, conducting NFPEs and writing notes, I listened in on two inservice webinars. One was on COVID Nutrition Interventions re critically-ill patients. This was super interesting! I’m going to do follow-up research then write another post on this to extend my COVID nutrition tips/sources. The other was on a food insecurity initiative Swedish Hospital is rolling out. Many of you reading this are probably aware that I started a food pantry at Dominican’s campus last year, so you know I’m super passionate about minimizing hunger. I was asked to create a flyer insert of tips on how to utilize foods being distributed to patients who discharge. That was fun!

All in all, my first week was overwhelming and a learning curve, but I am looking forward to staying open-minded and positive over these next 9 weeks. I know that I’m going to learn so much from the incredible and experienced dietitian team, so I plan on absorbing as much information as I possibly can.

For my future dietitian friends, I thought I’d share some medical terminology and abbreviations I wasn’t familiar with that may help you for your clinical rotation and practice. I also suggest researching nutrition-related medications to be familiar with these names. The hospital you intern at should also have a food drug booklet to reference should you need it (which you will).

Terminology

  • Dyspnea- shortness of breath
  • Vasopressors- medication used to raise blood volume and pressure when BP is low
  • Laminectomy- removal of the lamina (part of the vertebrae)
  • Oophorectomy- removal of the ovaries
  • Cachexia- muscle wasting that can include fat loss

Abbreviations

  • PMH: Past Medical History
  • PTA: Prior to Admission
  • A&O: Alert & Oriented
  • N/V: Nausea/Vomiting
  • C/S: Chewing/Swallowing
  • C/D: Constipation/Diarrhea
  • RVR: Rapid Ventricular Response
  • HL: Hyperlipidemia
  • AMS: Altered Mental State
  • CKD: Chronic Kidney Disease
  • ARF: Acute Renal Failure
  • Times to administer a supplement/day:
  • QD: 1/day
  • BID: 2/day
  • TID: 3/day
  • QID: 4/day
  • IC: Indirect Calorimetry
  • PI: Pressure Injury
  • DKA: Diabetic Ketoacidosis
  • CABG: Coronary Artery Bypass Surgery

There are more terms and abbreviations, but I’ll have to do a better job of remembering and jotting them all down. Did this help? If so, let me know if the comments below or shoot me a DM on Instagram! I plan on writing a reflection and summary of each week during my clinical rotation. I think it’ll simultaneously help me process and review while hopefully relaying ym experience and pertinent information that can help you along your journey.

Have a great weekend!

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