I flowed from the ICU to the medical wards at Burnaby Hospital for my last relief placement. Although the patients’ reasons for admission were similar to those in the medical units at Royal Columbian Hospital, I felt a different vibe– perhaps that’s just the difference between a community hospital and a tertiary site. I had lots of opportunities to assess patients, as well as design and implement nutrition care plans during this rotation. A few of my valuable lessons learned:
- Prioritize patients who area admitted with hyperkalemia, this is an acute nutrition-related issue that needs to be addressed quickly.
- A low K level doesn’t necessarily indicate refeeding syndrome, consider other sources of K losses, for instance, vomiting or diarrhea.
- Patients with face mask for O2 delivery are at high risk for aspiration. When they eat, they need to take off their face mask, take a bite, put face mask back on, chew, and swallow. All this is happening while the mask is forcing oxygen into their nose and mouth. Check with nursing for signs of aspiration, refer patient to SLP for a swallow assessment. Consider also that patients may not be on a face mask for very long.
- Talking with doctors: ask follow up questions as necessary to clarify nutrition care plan, especially when it relates to fluid status in a patient who is receiving tube feeds.
- Talking with family members or patients: use language that sets out dietary guidelines and my recommendations clearly, and be confident in the knowledge of myself and other healthcare professionals.
So with this, I ended the clinical placements of my dietetic internship. I’m so happy and proud that I passed this rotation. Above all, I’m hopeful that my patient care practices will improve based on my experiences during internship. It’s been a long journey with lots of unexpected twists and turns, and it’s not quite over yet. But I feel like I’ve cleared a major landmark, and that’s worth celebrating.