day three… i’m already tired.

this post may be short.

this waking up at 5:45 a.m. business is pretty harsh, but luckily the 7 a.m. check-in time will only last about two weeks. my current preceptor is usually the first to arrive, so i’ll be checking in early with her so we can get goin’ in the morning and get out in the early-ish afternoon.

so… today was my first “real” day on the job. my current preceptor is a peds dietitian who covers PMA (a general med unit), CICC (an intermediate care unit), the child cardiac unit, and a few others (i will definitely have her units memorized by the end of the two weeks with her).

lucky for me, she is awesome. super patient and a wonderful teacher. she teaches by example and then eventually challenges me remember what to do and where to go. she is also young and super energetic, which is really wonderful to work with.

our first patient this a.m. was a doozie: a 15 year old female with a “non-specific” eating disorder (meaning she is “on the spectrum” somewhere between anorexia, binging, purging, etc.). she weighed in at ~90 pounds, 61 inches (BMI < 18, by the way) and hadn’t eaten anything for two days.

UNC has an eating disorder (ED) unit / psychiatric unit, but my preceptor (i’m going to start typing “MP” instead of “my preceptor”) tried to explain that some patients don’t get sent to the unit if they don’t meet certain screening requirements. for example, this patient may not have been underweight enough to be considered for the ED unit. MP also explained that it has something to do with billing. i can’t quite remember what her explanation was, so i’ll ask again.

anyway, MP’s job here was simply to correct any dehydration, encourage the girl to order food from the menu, and give her a heads up that she will be receiving food supplements.

my second patient was a sweet, cute, darling little 11 month old infant, who has been plagued with congenital heart problems, breathing issues, and is now flat-out FTT (failure to thrive, or hasn’t gained weight properly). she is 11 months old and ~10 pounds. so sad, but such a sweet, strong little girl with a good dad.

our goals there were to educate the parent (mom is out of the picture) about correct infant formula preparation, check the girl’s calorie count for the day (how many kcals she had consumed/dad was keeping a list for us), and encourage him to feed her as many calories as possible. i’m sure we’ll check in on her again by the end of the week.

MP also spent a lot of time showing me from soup to nuts how to research a patient (reading past medical notes in the online charting system from RNs and MDs for example), formulate a diet plan/goals, how to speak with/visit a patient, and how to chart our services in the online medical record. i am SO FORTUNATE to be working with RDs who are on the forefront of electronic charting. everything is online, readily accessible, and easy to edit.

it seems like every dietitian charts her own way. MP uses PGIE (problem, goals, intervention, evaluation? is that right?) with some of the elements of the NCP (nutrition care process) thrown in (i.e. with PES statements — problem, etiology, signs/symptoms); while one of the other peds RDs i spoke with today uses ADIME (which i talked about earlier this week). it could be overwhelming if each RD wants me to learn how to chart like she does, but then again it would also be a great learning experience.

so… i actually typed way more than i thought i would/could tonight. it’s only 9:30 p.m. and i can feel my eyelids getting heavy. i’m also already thinking about my morning coffee…. mmmm….

more to come!