Clinicals: Week 6

Happy holidays and New Year, friends! ๐ŸŽ† I hope you had a lovely couple of weeks and some down time to reset. Since I am interning at the hospital, I chose to stay home with my husband and two dogs to keep my family safe. Although we had COVID back in March, it has not been confirmed that COVID antibodies last long-term (or for what duration), and being on COVID floors makes me uneasy (not for me, but passing it on to others). My 92 year old at-risk grandma lives below my parents, so it’s not worth chancing to me. While I am open to approaching 2021 with hope (my chosen word of the year), I am cautiously optimistic and holding reservations with COVID still in swing. I’m planning 2-3 months out and taking life one day at a time, which is sometimes all we can do. Okay, that was a little intro- onto my clinical recap! ๐Ÿ‘‡๐Ÿผ

Week 6 of my clinical rotation was just what I needed, an over-the-hill turning point! On Monday I completed my first patient notes with NO CORRECTIONS!!!! AHHHHH!!! ๐Ÿ‘๐Ÿผ This was such a big deal and win for me since I’m such a type-A perfectionist (not always a good thing), and every correction and edit I received felt like a punch to the gut lol. However, as I mentioned in my previous post, this is part of the learning process and time of growth for us future dietitians. It just also felt good to bask in the glory of my error-free note haha.

Then on Tuesday, I wrote my first tube feed order with no corrections needed! Man, I was on a roll and floating on cloud 9 (at least in the office). Like I said, COVID is still in full swing, and I’m reading too many H&P (History & Physical) notes detailing depression, suicidal ideations, and other mental illnesses exacerbated by COVID and isolation. It’s sad, and I’m so impressed with the medical personnel who see this on a daily basis. I can’t imagine, since I’m just reading about it. The other difficult component is speaking with family members pleading to help their loved one when you’re calling to retrieve wt, ht, and nutrition Hx info. This part challenges your communication skills and evokes empathy and compassion (other crucial components of patient care).

Aside from those two wins of writing correct patient notes and a tube feed Rx, I learned that thiamine is used as MNT intervention for alcoholism, refeeding syndrome, and sepsis in the critically ill. I now order this for any patient who presents with any of those since thiamine is depleted, and subsequently impairs glucose metabolism, which can cause elevated POC glucose levels.

I have come across many patients with trouble swallowing too, so I’ve had practice and open communication with contacting the SLP (speech language pathologist) on staff. My preceptor told me a story of when she was an intern. Her patient reported mild trouble swallowing. The doctor said it was fine, but she ordered the speech consult anyways. The SLP found said patient had cancer in their voice box. Had she not had the bravery to listen to her clinical judgement, the patient might not have been diagnosed as early as they were with cancer. That story spoke to me, so I thought I’d share. The moral of the story is that you should focus on providing your patients with the best care possible. If you suspect something within your scope of practice, follow up, refer out, or place an order. It can’t hurt, only help.

I’m not sure if I mentioned this, but I’ve been shadowing the RD who covers the GI floors and COVID wing. We don’t go on the primary COVID floors, but they’ve overflowed to other floors. On the GI floors, I’ve seen many patients with SBOs (small bowel obstructions), ileuses (lack of movement in the intestines), ischemia (tissue and cell death), etc. Very interesting! If these patient’s issues do not resolve and their bowel isn’t working fully, TPN is initiated 5-7 later. I will be learning more about parenteral nutrition on the IMCU over the next two weeks.

I was surprised that I only had to work half days on Thursday and Friday for NYE and NYD- so exciting and nice! I really have loved and appreciate my experience at Swedish Hospital, made possible by the incredible dietitian team there.

4 weeks left- 2 on the IMCU and 2 as staff relief on floors assigned to me- OMG, so so close! ๐Ÿ˜†

Terms I learned

  • Ogilvie Syndrome: dilation of the colon, which causes a pseudo-obstruction

Abbreviations I learned

  • ESBL: “Extended Spectrum Beta-Lactamases” are chemicals or enzymes secreted by harmful bacteria that make them more resistant to antibiotics
  • MRDO: “Multi-Drug Resistant Organisms” are bacteria themselves resistant to antiobiotics
  • KUB: a kidney, ureter, and bladder (KUB) X-ray
  • MAP: mean arterial pressure
  • HCV: Hepatitis C
  • PCT: procalcitonin (marker for sepsis, and COVID)

Happy to discuss this post further and hear you thoughts. 4 weeks and counting! Happy New Year again, and best wishes in 2021.

1 Comment

  1. Speech therapists are such an important part of the team! Iโ€™m excited to hear about all that you are learning. Iโ€™ve worked with several COVID-positive patients in acute care and post-Covid patients in inpatient rehab as a PT. It sounds like youโ€™ve got a great CI who is reinforcing a holistic view toward patient care. Looking forward to hearing more!


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