I have ALL THE FEELS 7 weeks into my clinical semester – excited, challenged, frustrated, **EXHAUSTED, and rewarded.

One of my goals during the internship is to share my journey with y’all and demystify what REALLY goes on during the dietetic internship from an intern’s perspective — i want to add a positive voice in a candid, non sugarcoated way.

I went into the semester with an open mind & have enjoyed clinicals a lot more than I expected & I attribute that to the diverse specialties at LUMC (keeps me engaged, interested, & challenged), patient preceptors (T GOD!!), & tapping into my curiosity. IMO, curiosity & having the humility to ask questions is the best way to build your knowledge & expertise.

In my next blog post, I’ll take a deeper dive into the positives and negatives from interning at a hospital with diverse specialties, but first, I want to share what exactly I’ve been learning and doing in these rotations!

♡ GEN MED

• Tackled my fears of seeing patients alone
• Hammered down my ADIME note ~*lingo
• Gave my first (heart healthy  education

♡ NEURO

• First time calculating tube feed in practice (A LOT !!) #IRL –I gotta say, it’s so rewarding to apply what you’ve been studying for years to help pts. 
• Learned more about dysphagia, diet advancement, and the importance of multidisciplinary referrals & interventions (HUGE s/o to all speech language pathologists)
• Reviewed a journal with the RDNs about keto diet to control seizures in children with epilepsy (usually when they don’t respond to meds)
  • The clinical dietitians at Loyola meet for journal club to stay on the pulse of cutting-edge research that’s within our scope of practice
  • FCKING fascinating & magical studies emerging around this topic
    

♡ LIVER TRANSPLANT

• Saw my first post liver transplant ICU patient
• Listened to a liver transplant evaluation & education
• Learned more about jaundice (a yellow cast to your eyes and skin; sign of high bilirubin levels)
• Got experience in both inpatient and outpatient
• Sat in on the liver transplant board meeting where the entire liver transplant team (surgeon, social workers, dietitians, psychologists, nurse practitioners, residents, dietetic interns, and more) discuss whether an individual is a good candidate for liver transplant

♡ CYSTIC FIBROSIS & LUNG TRANSPLANT

• Provided tube feed recs for post liver transplant pts in the ICU
  • DON’T FORGET TO FACTOR IN THE PROPOFOL!!
• Inpatient and outpatient patients with CF
• FAVE ROTATION SO FAR: I really enjoyed working with this patient population because you follow these patients for life and develop a relationship with them! <3
• Presented a Trikafta study to the Loyola RDs and discussed how this new drug will affect our nutrition interventions for patients with CF
  • WTF IS TRIKAFTA: the brand name for the hot new drug in CF world,  “Elexacaftor/ivacaftor/tezacaftor.”  This drug was approved for medical use last year and we all love how much dietitians LOVE new study!
    • This drug is used for the treatment of CF in patients aged 12 years and older who have at least one F508del mutation in the cystic fibrosis transmembrane conductance regulator (CFTR) gene
  • I saw patients who have started taking Trikafta and I was astonished with the results. I’m excited and eager to see where the research goes – there is a clinical trial undergoing right now for patients <12 years old

♡ ONCOLOGY & HEMATOLOGY

• Saw up to 6 patients this week! (week 6)
• I saw oncology patients and patients who were receiving bone marrow transplants
• Regardless of what floor you’re working, it’s imperative that you diagnose malnutrition in patients appropriately. One of the reasons being for reimbursement. According to JAND, across the health system, reimbursement from malnutrition diagnoses as a major comorbidity or complication increased by  3-fold ($153,339 to $448,223), while as a comorbidity or complication increased by 2-fold ($79,393,599 to $136,265,632).
  • The patient population on this floor are often malnourished due to their inability to meet nutrition needs orally because of cancer treatment side effects (mucositis, nausea, vomiting, decreased appetite) and this is the rotation that really hammered in my head how important it is to appropriately diagnose and document malnutrition.
• TUMOR LYSIS SYNDROME (TLS): is a condition that occurs when a large number of cancer cells die within a short period, releasing their contents (uric acid, potassium, phosphorous) into the blood and these contents rise faster than the kidneys can remove them. This causes TLS. The excess phosphorus can “sop up” the calcium and decrease calcium in the blood.
  • There are preventative measures healthcare practitioners take to prevent this from happening, like IV fluids and medications. Sometimes, doctors change the diet order to a renal diet (lot potassium, low phosphorus, and low protein.)
  • I had to challenge a doctor for the first time to liberalize a patient’s diet order because although the patient was at risk for TLS, it wasn’t yet clinically appropriate to restrict a patient who was already malnourished and not eating.

♡ BURN

• I feel extremely lucky to have had the opportunity to rotate in the burn unit at Loyola. Loyola Medicine is regarded as a regional and national leader in burn and trauma and treats 700 patients annually. It is 1 of the 3 burn units in Illinois
• What I learned:
  • EBB PHASE: immediately following a burn injury, the patient enters this phase for ~72 hours. In this phase, the patient experiences hyperglycemia and hypo-metabolism
  • FLOW PHASE: this occurs 3-5 days after the injury and the patient becomes hypermetabolic, AKA, they have SIGNIFICANT increased nutrition needs. The hypermetabolism can last for 1-2 years post injury
• For patients with >20% total body surface area burns, a tube feed is almost always necessary (unless clinical judgement notes contraindications) because it’s rare that an individual can meet nutrition needs orally.
  • My preceptor here taught me that we use TUBE FEEDS to keep them alive (to meet their increased nutrition needs) and ORAL INTAKE for pleasure

♡ TBD:

• KIDNEY DIALYSIS (OUTPATIENT)
• SURGICAL AND MEDICAL ICU
• HEART TRANSPLANT
• KIDNEY TRANSPLANT
• STAFF RELIEF… 😳

*CUE THE DUN DUN DUNNNN*

AND THAT’S THE MNT-EA 🍵☝🏼

xx hails