Clinicals: Week 3

3 weeks down. 7 weeks to go! This week’s triumphs revolved around still improving with Swedish’s EMR system, further educating myself on refeeding syndrome and nutrition therapy for enteral and parenteral nutrition, and staying calm amid the increase in COVID cases and hospitalizations. I also plan on sharing my inspiration to learn a new language (or at least advance to conversational Spanish), some clinical attire I recommend (with the links to these items), and I’ll wrap up with more terms and abbreviations I picked up this week.

Okay, so EMR systems and charting can be extensive. I learned the basics pretty quickly in the first 2 weeks, but advancing to detailed charting is a little trickier. It takes time, patience, and proper navigation. What I mean by this is that you have to know where to look to retrieve pertinent information to determine the best clinical course of action for that patient. There are probably 15-20 main tabs to choose from, but then those tabs branch into past history and sub-tabs. 🤪 It’s a lot, but the advice I have for you is to be as attentive as possible when being trained. Remain patient, and simply do the best you can when trying to tackle this for the first several times. Give yourself grace. You’re learning, after all, and you won’t know how to execute charting perfectly at first.

As many of you know, knowledge is power. This is especially true in the nutrition and dietetics field. Studies are constantly being published, and this means we need to keep up with the latest evidence-based research. I’m lucky enough to have preceptors that supply me with applicable studies. If you’re interested, here are the ones I read this week.

Nutrition Therapy & Critical Illness: Practical Guidelines for the ICU

ERAS (Enhanced Recovery After Surgery): A Review

I also read 3 articles on enteral nutrition (EN) and watched an inservice webinar on parenteral nutrition (PN), which was very interesting (especially with adaptations for COVID patients). You see, COVID patients usually require BiPap, a pressurized oxygen mask used to force the delivery of oxygen into the lungs. With this positive pressure, comes an increased risk for aspiration. Therefore, EN might not be feasible or recommended when a COVID pt requires continuous Bipap. In addition, COVID pmts have a lower threshold for PN due to increased risk of infection. This puts medical professionals in a tough spot. Intermittent Bipap with EN is the goal, should PO (oral) intake not be an option. Remember, we always want our patients to eat orally first if possible, then continue to use the gut with EN if that’s not possible. TPN is the last resort, but it’s necessary in some patients.

Speaking of COVID, we (hospital staff) were aware that it would probably take about 2 weeks to see the aftermath of Thanksgiving get togethers. The load at the beginning of the week seemed pretty consistent with how it’s been the last 2 weeks, but Wed-Fri started increasing day by day. By Friday, the ICU floor was at capacity and we received an email that other floors would see an overflow of patients and COVID+ cases. This was evident in the workload the dietitian had that even bleed to us interns. The team was stressed, but not nearly as stressed as what we witnessed not he floors among the nurses and doctors all suited up in full-on PPE wear (gowns, gloves, double masks *surgical + N95*, and face shields). The energy was palpable. I teared up once on Thursday and once on Friday.

I’m not sharing this for you to pity me. I’m sharing to be transparent that this is exactly what’s going on in hospitals right now. it’s real, just as they report it and you hear on the news and from medical personnel. I watched Grey’s Anatomy on Thursday. It was the 1st episode of this most recent season about COVID. It depicted EXACTLY how it’s like in the hospital right now, so if you want a visual, watch that episode. I say this not to scare you either. I’m actually not scared, just sad. I’m sad for patients fighting for and losing their lives. I’m sad they have to do this alone. I’m sad for the family members that can’t be with them. I’m sad for the medical staff that are so stressed and overwhelmed but remain dedicated to saving lives and doing the best they can. I hope this wave ends soon.

On a lighter note, I witnessed my preceptor speak conversational Spanish to several patients. This re-inspired me to pick up Spanish as my second language. I would love to utilize this skill in both my professional and personal life, as I find it important to be able to communicate in various ways with others. I got to use the translation service too to communicate with a Japanese patient. That was fun! I received important information from him that I would have otherwise not known to improve his intake for MNT and recovery.

Okay! So I purchased these stretchy yoga-like (but not quite) pants that look like business pants. OMG they are SO comfortable! I’ll link both pair below. Very affordable too.

The grey, patterned pants above can be found here.

And then I purchased black ones with pockets, found here.

I’ve been alternating shoes, between booties, my Sperry boots, and these Sketcher’s glitter sneaks. Love them all, but the last two are the most comfortable for being on your feet.

Last but not least, here are the terms and abbreviations I learned this week that may be helpful for you to learn or add to your vocabulary in preparation for clinicals.

Terminology

  • stoma: opening in the abdomen
  • ileus: the inability for the intestine to contract (can lead to obstruction)
  • midline PN is peripheral, not a central PICC (confusing, right?)
  • trophic feed: progressive, incremental increases to ease into feeding and maintenance to avoid referring and overfeeding while achieving tolerance and goal

Abbreviations

  • SBO: small bowel obstruction
  • PE: pulmonary embolism
  • TTP: thrombotic thrombocytopenia purport
  • HFpEF: heart failure with preserved ejection fraction
  • TIA: transient ischaemic attack
  • DVT: deep vein thrombosis
  • PCI: percutaneous coronary intervention
  • CP: community pneumonia
  • NST: nutrition support team
  • SVT: supraventricular tachycardia
  • BNP: brain natriuretic peptide
  • PICS: post-intensive care syndrome
  • IMN: immunonutrition
  • OA: osteoarthritis
  • OSA: obstructive sleep apnea

Did this help? Let me know! Hopefully I can play catch up with my Feed Me Happy and Fuel Her Up content soon. I have a plan for 2021. 🙂 Stay tuned!

1 Comment

  1. I took 4 years of French and never use it. The two semesters of Spanish, though, I use on a regular basis. I only know enough to get by to work with my patients. I use the translator phone for everything else. As far as COVID is concerned, as a physical therapist I see mostly post-COVID patients or those considered PUI’s in rehab. 90 minutes is a long time to spend in full PPE for those exposed patients! If post-COVID patients were intubated for a long time, they often have swallowing issues that persist, so continue to need a modified diet due to the risk of aspirating. I watched that same episode of Grey’s and wrote about it, too! Will likely post next week. I hope the show helps convince more people to take COVID seriously. Thanks for sharing your thoughts and experiences!

    Like

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