Dietetic Internship Week 5: Nutrition Care I

I did a 30 minute run and walk interval workout this evening. I feel lactic acid pooling in my thighs and my glutes. Even my face feels tired. But in other news, I finished my first placement in the Nutrition Care I module today, and with that, I’m 10% done internship!

I saw 4 patients: 2 alone and 2 with my partner. One patient only spoke Mandarin, and she was quite grateful to be able to communicate with someone. She also complimented the hospital on the level of service, saying how nice it was that people frequently came by to check up on her.

I also had the pleasure of starting to wean a patient from tube feeds. Her swallow has been getting better and the speech-language pathologist allowed her to have a full fluid diet. The full fluid diet is actually somewhat substantial. Lunch and dinner includes: juice, milk, soup, pudding, and provides ~350 kcal each. Breakfast is a bit lighter at ~290 kcal. My preceptor asks what our next steps would be with this patient, and I said “we can add Ensure to improve her oral intakes?” Of course, that was an option. But the more important thing would be to decrease the tube feeds so she’s not receiving both a tray and a formula that meets her estimated energy requirements. After calculating how much she was getting from the tray, and adding one bottle of Ensure per meal, I was surprised to find that she already exceeded her estimated requirements. I spoke with my preceptor, who reassured me that it’s fine in this situation because she will likely decrease her oral intakes accordingly.

At the end of this placement, I’ve identified a few areas I want to work on:

  • Speaking with patients who have dementia, hard of hearing, or do not speak English well: practice using simple phrases and asking direct questions.
  • Getting better at gathering information from different sources.
  • Become more flexible: patients’ conditions change throughout the day, being ready to respond to these changes in a timely manner.
  • Improving critical thinking skills: being able to put different pieces together to paint a coherent picture of a patient’s condition, and coming up with an appropriate intervention based on the information gathered (this one’s kinda big, and I’ll definitely need to work on this throughout my Nutrition Care modules).

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