Dietetic Internship: Week 10 - Clara Norfleet

Week 10 of my internship (week 5 of my clinical rotations), and I’m still chugging along. This week I was able to conduct my first one on one cardiac rehab outpatient appointment! I’m continuing to see patients on my own, and feel like I’m getting better at my interactions in terms of knowing what to discuss and cover with patients based on their condition. Much like in the past working with WIC clients, I have likewise found myself developing sort of a “script” for my patient interactions in the hospital, in that each condition warrants certain information to be obtained. We obviously work to ensure they are on a diet that is adequate for their estimated nutrient needs and that they are eating enough of it to meet their needs given their current condition, but it goes beyond just how they’re eating. Past medical history, unintentional weight loss or loss of appetite, current medications, bowel movements (oh #shit), intake and output and presence/absence of edema are just a few of the additional items we look at for each patient that gets an RD consult. My brain is on overdrive by the end of the day (and I’m only in a 30-bed hospital!), but I can already feel myself getting into more of a comfortable groove as the weeks pass…praise the Lord.

Anyway, sorry I rambled. Here’s the day by day breakdown, if you are into that sorta thing:

Monday, September 21, 2015: nothing too remarkable or crazy happened today. I saw 3 acute-care patients and 2 in our skilled nursing facility/rehab wing. Pretty straight forward, doing a few follow-ups from last week, as well as a couple new screenings and assessments. I also sat in on an outpatient appointment for a patient that was referred from their primary care provider for obesity.

easy dinner: leftover baked chicken, steamed green beans, mashed caulifower with sauteed onions and mushrooms

Tuesday, September 22, 2015: Every month (I think…) there is a type of “lunch and learn” opportunity, where a surgeon will present 2-3 case studies on patients they had recently. Today’s topic focused on bladder and prostate cancer. A lot of words were thrown around that I had no clue the meaning or relevancy of, but it was still a great opportunity to hear more sides of care. Other than that, I saw 3 patients in the morning, then did some research during the afternoon while my preceptor worked on some paper work. Oh! I also found out today that the physical therapist at the hospital graduated from UGA too! I never thought I would be so grateful to go to such a large university, but it really does provide such a fun connection to other alum, especially when you are in a new and unfamiliar environment. Oddly enough, it’s is almost a source of comfort — like a little slice of home

after being in a hospital for 9 hours, i needed some freeeeesh air

Wednesday, September 23, 2015: Today was the day that I got to conduct my first one on one cardiac rehab appointment! These are done at least once with each patient that is enrolled in the cardiac rehab program, and serve as a time to touch base individually and address any questions or concerns the patient may have. Appointments are typically 25ish minutes long, and mainly focus on goal-setting. Ideally, any type of goal can be set, but we typically focus on lowering cholesterol levels (well, raising HDL), encouraging weight loss and physical activity, and adopting a more heart healthy diet. Motivational interviewing is a big component of addressing these goals, so I felt in my ELEMENT. No, I’m totally kidding. My interviewing skills may have gotten a liiiiittle rusty after a 4 month hiatus, but I still felt pretty comfortable (like, 92.3%) in leading conversation and letting the patient talk through it as well. It’s difficult to work with patients that have low or no motivation or desire to change…I mean sometimes that conversation can turn to some preeetty awkward silences, but that’s when you just have to just “roll with resistance” as Dr. Fischer always taught us in undergrad 😉

breakfast topped with the pumpkin banana bread i posted earlier this week :) — breakfast topped with the pumpkin banana bread i posted earlier this week 🙂

Thursday, September 24, 2015: Oh, today was pretty fun! I spent a good amount of time talking to one patient and found out that she not only studied nutrition in undergrad, but at UGA as well! She was a pleasure to work with, and set the tone for the rest of the day. I also ended up meeting another Clara, which is the equivalent of finding a $100 bill on the middle of a busy sidewalk. Other than those two encounters, today was about the same as any other day.

Friday, September 25, 2015: This has felt like the LONGEST week EVER, and I’m not sure why. I’ve been enjoying the days, but I won’t lie in saying that I was so thankful today was Friday. It didn’t help that today was packed full of follow-ups, new admits, and outpatient appointments. I ended up seeing 7 patients on my own, and that doesn’t include the outpatient appointment that I also sat in on. I’ve really enjoyed working with the patients in the rehab/skilled nursing facility wing, because we usually get multiple visits with them, as they typically stay for a couple weeks. It’s awesome to see their improvements day to day or week to week, not just nutritionally but also physically, as most of them are there after having some type of hip/knee surgery, or heart failure.

I didn’t end up getting off until 5, so I had a little time to relax before heading out to meet a few other interns at Funkatorium for a flight of beer and food. I’ve been here a handful of times, and it is by far my favorite brewery in Asheville! I recommend it to anyone, especially if you like sours.

curry hummus....yes. just yes. — curry hummus….yes. just yes.

Saturday, September 26, 2015: Not much on the dietetics front today, but I did get in a nice (and fast!!) 8 mile run at the park juuuust before it started to pour. Perfect timing! Leaves are starting to carpet the ground and I could not be more excited if I tried. I spent the remainder of the day running some errands around town before getting home to make some dinner and snuggle up on the couch for an early night.

my favorite way to start saturdays: a big bowl of oatmeal, with every possible topping in my kitchen

Sunday, September 27, 2015: My half birthday, if anyone cared to know 😉 I met up with another intern (and friend) Katie for breakfast at Biscuit Head before heading to church. I have heard so many great things about Biscuit Head, but had yet to make my way there. After finally getting there today, I can testify that it is one of the best breakfasts that I have ever had. I had their “half breakfast”, which is just a homemade biscuit, 2 eggs and your choice of 1 side, and to be such a simple plate, it packed some unreal taste. We got there pretty early (around 8:30) and a line was already forming, so you know it’s good food! The West Asheville location was super cozy too. It reminded me a lot like Mama’s Boy in Athens 🙂

Anyway, after church I headed out to High Five Coffee, where I am currently typing up all of this to actually post it ON SCHEDULE!! I’ve also got to update my weekly tracking log of all patient encounters I have, as well as a competency log, tracking all the activities I’ve performed or observed for the week. A lot of logging and charting and backtracking….

afternoon snacking featuring the tastiest local hummus!! checkout rootsfood.com to see if its sold near you — PROMISE you won’t regret it

Hope everyone had a wonderful week and weekend! Thanks for reading along 🙂

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