week three…

another great week under my belt. three down, nine to go!

last week i rotated to a new pediatric dietitian, who covers gastrointestinal (G.I.), pulmonary, neurology, and hemotology/oncology (blood disorders/cancer) pediatric services.

by the end of the week, my preceptor (MP) was giving me my own patients, which i was able to see from start to finish!

what this means: MP gets “assigned” patients based on what services she covers. so, for example, when an MD orders a “nutrition consult” in one of MP’s services (i.e. a kid is admitted with a GI, pulmo, neuro, or heme/onc problem and has a nutritional need), she researches the pt (past medical history, current medicines, reason for hospitalization, reason for nutrition consult), visits the patient, makes adjustment to the patient’s diet (or tube feed or TPN feed) as needed, and writes a note in the pt’s chart using the nutrition care process (NCP).

the NCP is the A-DIME process i spoke about before. the NCP is the method of charting that includes an (A) assessment, (D) nutrition diagnosis, (I) nutrition intervention (what you plan to do for the patient), and (ME) plans for monitoring and evaluating the patient.

so, again, after a week of learning how to assess the needs of MP’s patients, by friday, i was able to see two of my own patients from start to finish! granted, i had MANY questions for MP to answer along the way. MP also accompanied me into patients’ rooms during my visits, and she gave a final edit to all of my chart notes, but… it felt pretty wonderful to start to be independent.

some notable cases: i provided an initial assessment of a 19 yo male with cystic fibrosis (CF). FYI: CF is a heritable disease characterized by abnormal secretions (by the pancreas, lungs, GI tract, etc). this leads to abnormal digestion, decreased lung function (among other systemic problems), which can lead to increased nutrient needs (it takes a LOT of energy/calories to breathe when your lungs are filled with thick mucus, and it’s nearly impossible to digest lipids, protein, and carbohydrates when your pancreas isn’t producing enough enzymes).

thus, the medical nutrition therapy (MNT) for CF patients is a high-protein, high-fat diet with supplemental enzymes and fat-soluble vitamins. anything we can do to increase intake, absorption, and subsequent weight gain is a good thing.

a second case: a heartbreaking 7 yo girl with acute lymphocyte leukemia (ALL), or a type of blood cancer. the nutrition consult was to help the patient find foods that taste good while she undergoes chemotherapies. (FYI: chemotherapy can lead to dysguesia, or a change in taste, and sometimes aguesia, the absence of taste, and it can also suppress appetite).

the best part: this little girl wanted to talk to me. i love it when the kids will talk while the parents patiently listen. the girl’s problem seemed to be a mixture of dysguesia (meat didn’t taste good to her; chocolate chip cookies did!) and simply a dislike for the hospital food.

since she had been steadily losing weight, i educated her on tips for combating dysguesia and appetite changes, i encouraged her to focus on ordering/eating the foods that she knew tasted good, and i added supplements (calorically-dense chocolate milkshakes, puddings, etc.) to her daily meals.

i’ll be checking up on both patients next week to see if the supplements/tips have helped their weight and appetite.

i also got my first bit of experience calculating TPN this week. TPN (total parenteral nutrition) is formula/nutrition delivered through the veins and requires careful planning and calculation.

more to come!