Dietetic Internship Week 30: Nutrition Care III (ICU)

This past week, I really made an effort to assess patients’ status, speak up during rounds and communicate more with the team, and ask questions when I was unsure. I’m happy to say that I passed this rotation.

I was able to identify when patients were unable to maintain their blood pressure, and reacted to the situation appropriately by slowing tube feed rates or maintaining a slow rate rather than increasing to the goal rate. Similarly, when their blood pressure control was improving, I identified these situations and suggested to increase their tube feeds to goal rate.

I also made a conscious effort to speak up more during rounds. I wrote down notes to remind myself about electrolyte replacements or other topics I wanted to discuss with the team, and spoke to the doctor when it was appropriate to do so. ICU rounds are great because  almost everyone involved in the care of the patient is there, so it’s easy to communicate and discuss among the team. Not all of my suggestions were implemented, for example, I was wondering whether we wanted to provide vitamin D & calcium supplements to a patient receiving a 5-day course of steroid therapy. The response was “no”, because the medication was short-term. A part of me knew that might be the case, but I’m glad that I asked.

Finally, I consciously tried to ask questions when I was unsure. I found this to be helpful especially when there were “gray areas” where I was unsure of how to weigh the pros vs. cons of two decisions. Talking over these scenarios with someone more experienced was helpful in learning what information is important to prioritize when coming up with patient care plans.

Moving forward, I’ll be starting relief at Burnaby. I know that the exposure to patients that I had during the ICU gave me more experiences I can draw upon to make better decisions for patients. I will continue to communicate the patient’s nutritional needs to other healthcare staff, and consult with my preceptor when I’m faced with a situation with which I don’t feel comfortable.

I can’t believe internship is almost over. I’ll be working on my cover letter and resume and starting to apply for work opportunities. Life feels a bit uncertain right now, and I’m doing my best to navigate the darkness that is the future.

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