Clinical Rotation

16 weeks of my clinical rotation were spent at this site, which included an ICU, various hospital units, and a separate long-term acute care hospital. I was exposed to many different settings such as oncology, diabetes, renal, nutrition support, cardiac, and long-term care. I conducted numerous nutrition and malnutrition assessments (including the nutrition-focused physical exam), reviewed patent charts for pertinent medical and nutrition history, and charted on the patients seen with appropriate nutrition recommendations. During patient assessments I would build rapport, collect additional details about their medical and nutrition history, and give the appropriate intervention when indicated. I conducted both in-person and phone visits (for COVID-19 patients). I provided nutrition education for patients with conditions such as diabetes mellitus (Types 1 and 2), congestive heart failure, pancreatitis, and bariatric surgery history. I have ample experience providing oral nutrition supplements and leaving nutrition support recommendations for both enteral and parenteral nutrition. I also have experience working with the interdisciplinary team, such as attending ICU rounds, communicating with nurses about patients, and briefly shadowing speech and language pathologists conducting a fiberoptic endoscopic evaluation of swallowing (FEES) and a videofluoroscopic swallow study (VFSS).

My DaVita renal rotation was extremely insightful and personally impactful. I worked through numerous renal modules throughout the week, deepening my knowledge of renal physiology, the various types of dialysis, renal laboratory values, renal medications, and motivational interviewing. I was able to sit in on several nutrition assessments and counseling sessions that took place during dialysis and became more aware of the dietary restrictions placed on renal patients. I also attended interdisciplinary Plan of Care rounds that took place during outpatient appointments. The dietitian and I assessed patients' parathyroid hormone laboratory values, taking into account the corrected calcium and phosphorous values. Part of my time in the facility was also spent creating a bulletin board highlighting renal-friendly Thanksgiving foods.

I had an interesting and informative week with the diabetes education dietitians! I was able to sit in on several counseling sessions (initial assessments and follow-up visits) and helped with providing education and demonstrating portion sizes of a variety of foods using food models. I also developed a diabetes meal plan and gained a deeper understanding of diabetes medications, carbohydrate counting, the Diabetes Plate Method, managing hypoglycemia and hyperglycemia, and the coding and billing process used in the outpatient education setting.

I was able to spend time in a variety of settings during my oncology rotation, such as the chemotherapy infusion center and radiation oncology unit. I learned different strategies to help patients who are experiencing a variety of chemotherapy and radiation side effects, such as loss of appetite, nausea, vomiting, diarrhea, constipation, metallic taste, and loss of taste. Maintaining adequate nutritional intake to prevent unintentional weight loss is critical throughout cancer treatment, and I was able to observe the dietitians provide additional support via provision of recipes or meal ideas, oral nutrition supplements, or nutrition support when needed.

My pediatric rotation was spent with a dietitian who specializes in pulmonary and cystic fibrosis and another who specializes in oncology. During the first half of my rotation I spent time in the outpatient cystic fibrosis clinic, learning about pancreatic enzyme replacement therapy, common gastrointestinal complications, and common micronutrient supplementation provided to cystic fibrosis patients. I also observed inpatient hospital dietitian visits with infants having feeding difficulties experiencing a variety of gastrointestinal symptoms and was able to learn about the various pediatric formulas recommended for this unique population.

During the oncology portion of my rotation I attended interdisciplinary rounds each morning and learned about the variety of patient situations, prognoses, and nutrition treatment plans (including nutrition support). I also spent time working with the dietitian on creating a custom TPN for an oncology patient, ensuring it would properly meet their nutrient needs while minimizing the risk of refeeding syndrome.