Clinical: Week 7

Whoa. Where did the time go?! It’s 2021, and I just completed my 7th week of my clinical rotation. It was my first week in the IMCU, and I really enjoyed it. Unfortunately, all of the patients but one on the IMCU unit had COVID, so I didn’t have any patient interaction. However, I stayed plenty busy with screening patients, attending rounds with the IMCU lead doc and residents, and writing notes afterwards. I adore the dietitian I’m interning under, just like the previous two. She’s brilliant, both personally and professionally. She is a CNSC (Certified Nutrition Support Clinician), so she orders the parenteral nutrition when needed, which is often on the IMCU, unfortunately.

The week was pretty consistent with what I described above- screening patients, attending rounds, and writing notes, among other things. Those others things included reading up on enteral nutrition on vasopressors, nutrition support for the critically-ill (slowly advancing to goal in order to not overfeed patients), and attending a monthly RD meeting. The dietitian team is going to be trained on how to insert dobhoffs, so that’s exciting and badass of them!

I’m at a point in this rotation where things are just clicking. I feel proficient in the EMR system, my ADIME notes, and patient communication/education. I need to dabble more in enteral and parenteral nutrition calculations, but DAMN am I proud of myself for how far I’ve come in this short amount of time. Actually, I learned the following from my preceptor: She starts renal patients or those with kidney disease/injuries on Vital High Protein instead of Nepro because the potassium and phosphorus are very similar in each; however, Nepro overfeeds critically ill patients at the beginning stages of advancing to goal. She transitions them to Nepro after 10-20mls, or what’s appropriate for that particular patient’s energy requirements. 🤯 So strategic.

I know how to read most labs, recognize proper medication names and their role/interactions with nutrition, and how to engage with the doc and residents during rounds at this point. I’m actually really liking clinical, to the point where I would consider applying for a prn position. 🙂 Who would have thunk?!

This week, my preceptor is giving me the green light to represent the nutrition department in rounds, and then my last two weeks will be staff relief (covering floors as needed). I have my major project left, which I want to complete this week, and one last presentation to the kitchen staff (topics TBD). But I am goddamn doin it, and doin it pretty well! 2 weeks until my birthday, and 3 weeks until we leave for beautiful Big Sky, MT for 1 month. Let’s go! So much to look forward to.

What questions do you have? I don’t have terms and abbreviations for you this week because I’ve learned a lot of them already; however, here are some good pointers I learned from my preceptor!

  1. The 4, 3, 2 guideline of where potassium, phos, and mg should be. This is easier to remember.
  2. That opioid bowel dysfunction is a thing, causing severe constipation in many patients where a bowel regimen of 1 to up to 3 different laxatives are needed (Senna, Bisacodyl, Miralax, etc.)
  3. Levophed can prevent us from safely feeding patients based off the dosage. You can calculate this by taking the patient’s wt in kg and multiplying by 0.3. Whatever that number is, is the amount Levophed should be under in mcg.
  4. Propofol is a lipid-based sedative that contributes calories to the overall energy intake. Propofol in mls x 24hrs = total pls x 1.1 the = what kcal propofol is providing

Did this make sense and help? LMK! Have a great start to your week!

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