Whoa.

Oopsies, talk about being NPO. It's not that I forgot, of course, but instead I was on a holiday break! Therefore, there would be nothing DI related from December 17th - January 2nd. But, now that I'm back, I'm officially in my clinical rotations!

Today started off well and I was ready to go at 8am with my pre-rotation case studies and homework all set. I met with a preceptor and we went up onto the floor and did rounds with doctors, pharmacists, senior residents, and nurses. This was really neat to see how the multi-disciplinary team functions and how the RD's are involved. They gave their input for TPN vs. EN nutrition, how patients are feeling, how they are eating, etc. 

After a 3 hour session doing rounds, we visited some patients. Unfortunately the patients we saw were "frequent fliers," or patients who spend a lot of time in the hospital.

One patient had rhabdomyocarcinoma, or basically muscle cancer, and unfortunately they don't expect him to make it much longer. He has very bad ascites, or fluid accumulation in the abdomen (from a lack of liver and kidney function), and they drain up to 5 LITERS of fluid each day.

We also saw a cute little girl who has cancer, a patient who has a leaky G-tube (a tube that you feed yourself through your stomach), and a few patients who need TPN orders.

Along with this, I also had some practice writing TPN orders (like my previous post...not so fun!). But, it was nice to have practice and as I go along, I'll be able to whip through them. I also had my first day and practice into writing a nutrition assessment note. This means that I had to assess the patients height, weight, BMI, fluid intake, food intake, appetite, bowel movements, basically everything! Then, I had to practice writing a nutrition diagnosis, which is much different from a medical diagnosis.

First of all, dietitians can't make medical diagnoses. For example, if a patient comes in the hospital and they're not eating because of all the cancer medications they're on. Instead of making a diagnosis of cancer (since I can't do that), I would need to make a diagnosis of inadequate intake. It all basically revolves around standardized language, which I'll just have to get used to.

Then, I make the nutrition diagnosis. After that, I make intervention recommendations, such as a high calorie, high protein diet or carbohydrate consciousness. I make notes on the monitoring and evaluation, which is very important. This is where goals for the patient go, which might include to increase weight, decrease blood glucose levels, maintain weight, eating certain amounts at meals, etc.

What a lonnngggg day! But, awesome exposure and I'm excited for tomorrow. Now, it's time to read up a little and refresh about epilepsy. Bring on the ketogenic diets!

How many days?? 176.