Making My Way Through MNT

(6/5-6/18) MNT

RD’s Give Physical Exams?

I cannot believe weeks 3 & 4 have come to an end; I am already almost halfway through MNT! My confidence and knowledge have come a long way since the beginning, but I am just getting started. I completed my first few Nutrition Focused Physical Exams, on both an alert patient that was vomiting… and an intubated patient. Yes, as RD’s we are required to do physical exams. But don’t fret! They are not super invasive, and the patient does not have to remove their gown. However, this is probably the thing that has pushed me most out of my comfort zone so far just because I was not used to touching patients, and like I said… one of them was vomiting. However, I was able to complete CRDN 3.2 in doing so.

Meds, Meds, & More Meds

I am trying to give myself grace throughout this whole process because it is a lot of information thrown out at once. The internship is meant to be challenging in preparation for an entry-level RD position. Personally, the most challenging thing so far is memorizing medications. Because there are so many medications regularly used in the hospital setting and they are big, hard to pronounce words, I struggle to recognize them and their indication. I am continuing to work on this and luckily the EMR has an option to read into the details of the medication.

The ICU

I have gotten more experience with the ICU. The ICU can be a challenging part of the internship and even the job as a clinical dietitian. There a lot of terminology, medications, and critical things happening that require interdisciplinary involvement. I was able to speak up in interdisciplinary meetings and participate in a group setting to support patient improvement. One important thing to look for while assessing patients in the ICU is vasopressors. Is the patient on any medications that are going to affect the blood flow to the GI tract? Vasopressors such as epinephrine, dobutamine, and vasopressin reduce the blood flow to the GI tract, contraindicating early nutritional support. Until these vasopressors are stable or declining, a patient should not receive early nutrition. If a hemodynamically unstable patient was to receive nutrition, it could lead to bowel ischemia or dead bowel. This is why it is important as an RD working with ICU patients to first assess medications before feeding (Simo Es Covello et al., 2020).

Clinical Advice

One piece of advice I learned early on in clinical is to make an effort for patient interaction. Some clinical dietitians sit at their computer majority of the day and may see a few patients in person if needed. My preceptor is huge on RD’s being seen, known, and understood. Our profession tends to get overlooked, and rarely leaving the office unless really necessary is not a way to change this. Go see all the patients you can that day even if it is just to check in on them and ask about their intakes. Use each patient interaction as a way to get the individual to smile. I am sure the last place they want to be is in the hospital. Go, have a conversation, and learn about your patient so you can give the best intervention possible. While you’re at it, throw some education at them. What are we doing if we aren’t educating about nutrition and we’re just asking how much they eat and poop? What nutritional advice is going to fit that individual best to improve signs & symptoms, labs, current illness, etc.? These are important things to consider before walking into a patient room.

Written by Brianna Starr, UK Dietetic Intern

References

Simo Es Covello, L. H., Gava-Brandolis, M. G., Castro, M. G., Dos Santos Netos, M. F., Manzanares, W., & Toledo, D. O. (2020). Vasopressors and nutrition therapy: Safe dose for the outset of enteral nutrition? Critical Care Research and Practice, 2020, 1095693. https://doi.org/10.1155/2020/1095693