Another week down, and only 2 and a half weeks to go in my clinical rotation. OMG. This week I spent a few more days at the dialysis clinic in addition to a couple days at the hospital. Although I don’t have any interest in working with dialysis, I still feel like the opportunity was extremely beneficial and I’m certainly taking away a lot of useful information.
Monday, November 9, 2015: I started off the week at the hospital and stayed late to observe and work the tray line in the kitchen! The RD I’m with is also the Clinical Nutrition Manager at the hospital, so she wears many hats (and hairnets), as she bounces between seeing patients and also overseeing some of the work that goes on in the kitchen. We helped set up trays for dinner (at 4:30 in the afternoon!) and distributed them to patient rooms. Being at a smaller hospital, it didn’t take too long, so we were done by 5:15!
There are two main entrees offered at each meal time for a patient to choose, however if neither seem appealing, they also have an “always available” menu to pick and choose from that has items like hamburger, grilled chicken, grilled chicken salad, soup, etc… We tend to cater to a patients wishes as much as possible, which I think is another benefit of being at a smaller hospital. Patients are assigned a “diet order” upon admission based on any comorbidities or conditions they have. For instance, someone with a history of hypertension, heart disease or heart failure will probably be on the “Heart Healthy” diet order, which limits added fat and salt.
Tuesday, November 10, 2015: I was at the dialysis clinic today, and pretty much just did a lot of paperwork and reports to help get the RD caught up and prepared for rounds this week.
We hardly ever look at albumin values in regards to nutrition status in hospital patients since it can be sensitive to things such as infection and inflammation, however albumin is one of the main lab values monitored and followed in dialysis patients. For people with chronic kidney disease that aren’t on dialysis, they are recommended to limit their protein intake, however patients that are on dialysis actually lose a lot of protein through dialysis and thus require more protein than the usual person. A low albumin can be indicative of low protein intake in dialysis patients, which could lead to a greater risk of illness and malnutrition.
Anyway, I say all of that because one of the reports I had to type up was on changes in albumin values for patients on PD (peritoneal dialysis). It was certainly interesting to see how a patients values could fluctuate from month to month, either slowly increasing/decreasing, dropping suddenly, or roughly staying the same.
We also looked at fluid weight gain in patients. With decrease in kidney function comes more fluid retention, leading to weight gain…from fluid. This excess fluid weight gain can lead to high blood pressure and even congestive heart failure. This report looked at each patients average percent increase of their “target weight” (their dry weight with no excess fluid and well-controlled blood pressure) from fluids in between treatments. It helps the RD distinguish which patients need more education or may be struggling with balancing their fluid intake.
Wednesday, November 11, 2015: Today was a bit of a blur…I’m not sure why, though. I put together an information bulletin board and read through some modules to better familiarize myself with the whole process of peritoneal dialysis. There are two main types of dialysis: hemodialysis and peritoneal dialysis. PD patients are able to dialyze from home instead of coming in to the clinic 3 times a week, however they must dialyze every single day, and sometimes multiple times a day.
Thursday, November 12, 2015: Today was the day that the nephrologist came to the clinic to do his monthly rounds with the patients on PD. I got to sit in with the RD as she talked with each patient and reviewed their labs and any questions or concerns they had. Today was my last day at the dialysis clinic, and while it was a great opportunity, I’m super ready to get back to the hospital and see my own patients again. A girl can only sit around and observe for so long!!
I definitely feel very well educated on food sources of potassium and phosphorus after this rotation!! I even had a flash back to my anatomy and physiology course in undergrad (with Dr. Said for all you UGA peeps) where I still remember learning about the parathyroid gland and PTH. If you’re like, “wait, why is she mentioning that….?”, it’s because high PTH levels can lead to adverse effects (like brittle bones) that can worsen a kidney disease patient’s outcome. Oh, and high PTH usually results from high phosphorus levels that can be found in those with kidney disease.
Okay, okay, okay sorry I’m throwing out all these random long-winded informational paragraphs that are probably boring 98% of y’all to tears, these little rants are just a way to get my thoughts out and review some of what I experienced. Maybe y’all are learning something too? Maybe something that can win you points at your next Trivia Tuesday? You never know….
ALSO today, my first blog post over at Holley Grainger Nutrition went live!!! I’m excited to be interning and working with her over the next few months, and eager to see how my own networking and nutrition communication skill can improve š Hopefully I can bring y’all some tasty recipes, like this ancient grain stuffed squash one!
Friday, November 13, 2015: Today was such a great day! Not only was I back at the hospital, but One Direction’s new album came out AND my friends came to visit me!!!! It was a typical day at the hospital, so nothing new to report back.
Eek, sorry this recap is SO delayed!!!! I thought I had posted it, but there it was, just sitting in my drafts like an abandoned little puppy. Forgive me!