I spent two weeks working with the nutrition support dietitians at Texas Health Dallas. Nutrition support is tube feeding (TPN-total parenteral nutrition-nutrition through the veins) or (EN-enteral nutrition-nutrition through a tube that goes from the mouth or nose to the small intestine or from a PEG which is a hole in the gut to the outside of the body on the abdomen). It was pretty intense and I learned a lot! I wore a white lab coat and looked like a smart doctor walking around the hospital. A nutrition support dietitian works with many health care professionals during the care of a nutrition support patient such as physicians, physician assistants, pharmacists, nurses, and other dietitians.
My first day I was given two new patients in need of nutrition support. I had to figure out what was going on with them, what their calorie needs were, which formula to use, and how much formula to give them. I didn't know where to start. I'll just keep this short and say that after my first day, I felt like I learned nothing in my four years of college and thus far in my internship. When it was time to go over the patients' notes with the dietitian, I thought I had it all figured out. Nope. The dietitian was asking me all sorts of questions like why is it bad to have high blood potassium and why is it bad to have low blood phosphorus and what is ALS, among other abbreviations. I didn't know and she didn't give me the answer, my assignment was to look it up and let her know the next day. It was frustrating. The worst part was really getting to know all the medications. Some patients are on 20-30 different meds. I had to keep looking up meds over and over again, I feel like I'm learning a foreign language. Its important for the dietitian to know drug-nutrient interactions and side effects that meds can cause because they can affect eating habits or digestion such as nausea, vomiting, diarrhea, indigestion, constipation, or abdominal pain. I got to take part in ICU rounds because I had a few patients in there on the vent. I had to laugh when I saw a younger doctor dozing off behind his computer during rounds. At least he woke up in time to talk about his patients. After the first few days, I felt more comfortable and was pretty independent. Each day I would get one or two new patients and follow-up on the ones from a couple days ago. It was nice to get to know my patients and keep up with what was going on with them. I knew I was becoming a dietitian when I blurted out in the office, "He pooped!" I was so happy that one of my patients pooped! I was getting worried because he hadn't in over a week.
Some challenges I had were figuring out calorie needs and a nutrition plan for obese patients and dealing with patients that I knew were not going to live much longer. Several of them were on the ventilator because they went into respiratory failure and some just underwent major surgeries like the Whipple and triple bypass surgery.
I got to watch a nurse on the nutrition support team place a Dobhoff tube (feeding tube from the nose to the ligament of treitz--in the small intestine). That was kind of gross. I can't imagine having a tube thread through me. I also saw the nurse place a PICC line. A PICC is a peripherally inserted central catheter. It is used to deliver IV fluids, long term antibiotics, or TPN. A line is inserted through a vein in the arm and threaded through the heart and into the vena cava.
Overall, I really enjoyed this rotation because I learned so much and it made sense. However, I'm not so sure I would like it as a career, at least until I become more familiar with all medical conditions, medications, and terminology.
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