PEACE!!

(7/17-7/30) MNT

Wrapping Up Site Visits

I have made it to my last and final week! It is so surreal that I have almost completed my dietetic internship. The last seven months have been nothing but challenging, fun, and insightful. To wrap up these last couple of weeks, I am at sites other than the hospital to become familiar with the vast opportunities for dietitians in healthcare. I was able to observe the dietitians at Frazier Rehab. The patients there are required to receive approximately three hours of therapy each day. Majority of the patients are recovering from a spinal cord injury, brain injury, or stroke. It was cool to see the physical and occupational therapists working 1-on-1 with patients to get stronger. I could see this as a potential population that I work with as a specialized dietitian. Before wanting to be a dietitian, I wanted to be a physical therapist so working in a rehab facility has my attention.

Another site I was able to visit was the NICU. The NICU is the intensive care unit for sick or preterm babies. The NICU is very different from adult ICU’s with different terminology, treatments and focal points, and lots of math. I forced myself into taste testing a variety of infant formulas… definitely not what I expected; I can’t even explain it… just go try it for yourself. Anyways, I learned that the NICU is not for me, but it was sweet to be around babies for two days.

My very last site of my entire internship (feels crazy to say) was the Brown Cancer Center. At this center, I observed oncology medical nutrition therapy and even saw the wig room. It is important that oncology dietitians are able to work around the patients treatment schedule. They have to take into consideration that the patient may feel ill and have a poor appetite due to treatment. They deal with a lot of tube feeds at the oncology center because so many patients need the supplemental nutrition to better stabilize their weights and have better recovery and cure of their cancer.

Case Study

To wrap up my internship, I had the opportunity to end with a big assignment and presentation, a case study. The assignment involves choosing a case (patient), studying the diagnosis/disease of that patient, providing appropriate interventions based on the literature you found, and monitoring the outcomes of the interventions. For my case study, I chose a young male who went into hypermetabolism after surviving four cardiac arrests due to an overdose. The reason I chose this case was not only because I saw this patient code (cardiac arrest) in the ICU during rounds, but I also got to place an enteral feeding tube on him as well. The main topic of the case study was feeding the ICU patient. For patients in the ICU that are hypermetabolic and hemodynamically unstable, you should hold TF until their pressure support is weaned off or stable and at a low rate. Feeding a patient on increasing pressors can lead to ischemic bowel due to the lack of blood flow to the GI tract (Preiser, et al., 2021). After this big assignment was all said and done, I obtained CRDN 3.1: Perform MNT by utilizing the Nutrition Care Process.

Thank You to All

Throughout this experience, I have gained more knowledge, more confidence, and more discipline than I could have imagined. I cannot say thank you enough to those who have supported me, guided me, and taught me during this experience. I am now applying for jobs and interviewing with more confidence than ever. I can see myself working as an entry-level dietitian and succeeding. The influence my preceptors have had on my current and future self will take me far in the world of dietetics. Precepting has such great value, it is hard to put into words the amazing, hardworking, and helpful preceptors I have learned from along the way. There is no way I would be able to walk into a patient’s room and provide MNT without the experience of the dietetic internship. I hope to one day be half the preceptor that mine were and further the success of dietetics. Again, I cannot put into words how thankful I am for everyone involved in my journey the last seven months, and I will forever be grateful. For now, PEACE!!

Written by Brianna Starr, UK Dietetic Intern

References

Preiser, J. C., Arabi, Y. M., Berger, M. M., Casaer, M., McClave, S., Montejo-González, J. C., Peake, S., Reintam Blaser, A., Van den Berghe, G., van Zanten, A., Wernerman, J., & Wischmeyer, P. (2021). A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice. Critical care (London, England), 25(1), 424. https://doi.org/10.1186/s13054-021-03847-4