My Clinical Rotations: Spring
Pediatrics
Doernbecher Children's Hospital: Portland, OR
2 Weeks
I spent two weeks at Doernbecher Children's Hospital where I gained experience providing specialized medical nutrition therapy to pediatric patients with congenital and/or acquired diseases of infancy and childhood. Disease states that I worked with most frequently included: diabetes, eating disorders, cystic fibrosis, and failure to thrive children. I utilized the nutrition care process of assessment, diagnosis, intervention, and monitoring and evaluation in the care of every patient. I was exposed to both inpatient and outpatient clinics at Doernbecher. This rotation was eye opening, and validated my interest in clinical pediatric nutrition as a potential career path.
I found my Case Study during this rotation (17 year old Male - Anorexia Nervosa): Powerpoint Presentation
2 Weeks
I spent two weeks at Doernbecher Children's Hospital where I gained experience providing specialized medical nutrition therapy to pediatric patients with congenital and/or acquired diseases of infancy and childhood. Disease states that I worked with most frequently included: diabetes, eating disorders, cystic fibrosis, and failure to thrive children. I utilized the nutrition care process of assessment, diagnosis, intervention, and monitoring and evaluation in the care of every patient. I was exposed to both inpatient and outpatient clinics at Doernbecher. This rotation was eye opening, and validated my interest in clinical pediatric nutrition as a potential career path.
I found my Case Study during this rotation (17 year old Male - Anorexia Nervosa): Powerpoint Presentation
Critical Care
Oregon Health and Science University: Porltand, OR
2 Weeks
I worked on the Intensive Care Unit with a Critical Care Dietitian, caring for patients through the use of TPN (Total Parenteral Nutrition). I learned how to assess a critically ill patient, how to determine whether they were an appropriate candidate for TPN, and how to recommend the use of TPN. I learned how to write TPN prescriptions based on a calculated dosing weight, and energy and protein needs. Based on lab values, I was able to determine how to adjust electrolytes, and determined appropriate vitamin and mineral amounts in the TPN. Patients placed on TPN will most likely be on it for several days, so I followed each patient on TPN daily, monitoring for electrolyte/ acid-base laboratory values daily. I worked with pharmacy daily, and was able to witness the creation of TPN in the actual laboratory room. This rotation was fascinating and taught me how to utilize nutrition care through the use of TPN.
2 Weeks
I worked on the Intensive Care Unit with a Critical Care Dietitian, caring for patients through the use of TPN (Total Parenteral Nutrition). I learned how to assess a critically ill patient, how to determine whether they were an appropriate candidate for TPN, and how to recommend the use of TPN. I learned how to write TPN prescriptions based on a calculated dosing weight, and energy and protein needs. Based on lab values, I was able to determine how to adjust electrolytes, and determined appropriate vitamin and mineral amounts in the TPN. Patients placed on TPN will most likely be on it for several days, so I followed each patient on TPN daily, monitoring for electrolyte/ acid-base laboratory values daily. I worked with pharmacy daily, and was able to witness the creation of TPN in the actual laboratory room. This rotation was fascinating and taught me how to utilize nutrition care through the use of TPN.
Geriatrics
Providence Benedictine Nusing Center: Mt. Angel, OR
2 Weeks
This rotation provided me with hands on nutrition care experience in the long-term care facility setting. I learned how to assess elderly patients, learned how to best assess needs, and what interventions are most appropriate with these patients. I learned the paper charting system at Benedictine, and conducted initial assessments daily. I followed patients who needed more specialized nutrition care; these patients were those who had experienced significant weight loss, had pressure ulcers, or who were on tube feedings. I provided education to patients when indicated (low sodium, high protein, carbohydrate counting, etc.). I researched new studies on nutrition needs in the elderly and applied this to practice. I also wrote several pieces of education material for residents within the care facility. An example is listed below:
Education Material: Step Up Your Fruits and Veggies
2 Weeks
This rotation provided me with hands on nutrition care experience in the long-term care facility setting. I learned how to assess elderly patients, learned how to best assess needs, and what interventions are most appropriate with these patients. I learned the paper charting system at Benedictine, and conducted initial assessments daily. I followed patients who needed more specialized nutrition care; these patients were those who had experienced significant weight loss, had pressure ulcers, or who were on tube feedings. I provided education to patients when indicated (low sodium, high protein, carbohydrate counting, etc.). I researched new studies on nutrition needs in the elderly and applied this to practice. I also wrote several pieces of education material for residents within the care facility. An example is listed below:
Education Material: Step Up Your Fruits and Veggies
Staff Experience
Oregon Health and Science University: Portland, OR
2 Weeks
I returned back to my Medicine and Surgery floors from my Med/Surg Rotation in February. I worked with the same patient populations, and was much more independent on these floors. I did initial assessments, received consults for all patients on 14A and 7C, followed patients that were assessed as nutritionally at risk, and attended rounds on my own daily. I wrote notes on about 7 - 10 patients daily, and provided nutrition intervention recommendations. I provided education to patients when indicated (post-bariatric, post-nissen, low sodium/heart healthy, diabetes, renal, etc.). I felt very competent at the end of this rotation, and though I still have a lot to learn, feel as though I could step into an entry-level RD position on a Medicine/Surgery Floor.
Patient I followed for several days: Follow Up/Monitoring Note Example (Patient Previously on TPN)
2 Weeks
I returned back to my Medicine and Surgery floors from my Med/Surg Rotation in February. I worked with the same patient populations, and was much more independent on these floors. I did initial assessments, received consults for all patients on 14A and 7C, followed patients that were assessed as nutritionally at risk, and attended rounds on my own daily. I wrote notes on about 7 - 10 patients daily, and provided nutrition intervention recommendations. I provided education to patients when indicated (post-bariatric, post-nissen, low sodium/heart healthy, diabetes, renal, etc.). I felt very competent at the end of this rotation, and though I still have a lot to learn, feel as though I could step into an entry-level RD position on a Medicine/Surgery Floor.
Patient I followed for several days: Follow Up/Monitoring Note Example (Patient Previously on TPN)
Emphasis
Doernbecher Children's Hospital: Portland, OR
2 Weeks
I returned to Doernbecher Children's Hospital for more experience in Pediatric Nutrition. I gained more experience working with children-specific disease states which require intensive nutrition care (cystic fibrosis, eating disorders, diabetes). I became more independent in this rotation, and saw children/families on my own. I provided nutrition education when indicated, and provided nutrition interventions following evidence based guidelines.
On my first day of rotation, a patient arrived to DCH with cellulitis of the left leg. He was a 17 year old male, who was morbidly obese - he weighed 575 lbs. He also had Diabetes Mellitus Type 2, Hypertension, and Congestive Heart Failure. This patient was in the hospital for the entire length of my rotation. He was placed on a sodium restricted diet (2 gm per day) and a calorie restricted diet (2800 - 3000 kcal/day). I was given the task of completing daily menus for this patient. I visited him everyday, talked with him about preferences, and provided him with low sodium diet education numerous times. This task proved very challenging, but gave me great insight into the difficulty of living with these chronic diseases as a young, teenage child.
Example of One Day Menu: Under 2000 mg Na and 2800 - 3000 kcal
2 Weeks
I returned to Doernbecher Children's Hospital for more experience in Pediatric Nutrition. I gained more experience working with children-specific disease states which require intensive nutrition care (cystic fibrosis, eating disorders, diabetes). I became more independent in this rotation, and saw children/families on my own. I provided nutrition education when indicated, and provided nutrition interventions following evidence based guidelines.
On my first day of rotation, a patient arrived to DCH with cellulitis of the left leg. He was a 17 year old male, who was morbidly obese - he weighed 575 lbs. He also had Diabetes Mellitus Type 2, Hypertension, and Congestive Heart Failure. This patient was in the hospital for the entire length of my rotation. He was placed on a sodium restricted diet (2 gm per day) and a calorie restricted diet (2800 - 3000 kcal/day). I was given the task of completing daily menus for this patient. I visited him everyday, talked with him about preferences, and provided him with low sodium diet education numerous times. This task proved very challenging, but gave me great insight into the difficulty of living with these chronic diseases as a young, teenage child.
Example of One Day Menu: Under 2000 mg Na and 2800 - 3000 kcal
Management
Oregon Health and Science University: Portland, OR
2 Weeks
I returned to OHSU to work with Steven Hiatt, Food and Nutrition Manager. I worked on several projects for him including assessing the productivity of programs, cafes, food venues, etc. I got to sit in on meetings involving employee development, new food safety standards, and the creation of new position descriptions. I also helped Heidi Burnett, Food Service Manager at OHSU, with the annual Comprehensive Room Service Review. I evaluated the productividty, customer satisfaction, and room for improvement of this two year old program at OHSU.
Project #1: Farmer's Market Observations (Assess the Makret to determine how cafes can change to better compete)
Project #2: Nucleus Cafe Observations (This cafe is going under changes starting 07/01/11, suggestions were needed for improvement)
Project #3: Nurses Review of Roomservice (Top 10 observations which were explained in the surveys I compiled)
2 Weeks
I returned to OHSU to work with Steven Hiatt, Food and Nutrition Manager. I worked on several projects for him including assessing the productivity of programs, cafes, food venues, etc. I got to sit in on meetings involving employee development, new food safety standards, and the creation of new position descriptions. I also helped Heidi Burnett, Food Service Manager at OHSU, with the annual Comprehensive Room Service Review. I evaluated the productividty, customer satisfaction, and room for improvement of this two year old program at OHSU.
Project #1: Farmer's Market Observations (Assess the Makret to determine how cafes can change to better compete)
Project #2: Nucleus Cafe Observations (This cafe is going under changes starting 07/01/11, suggestions were needed for improvement)
Project #3: Nurses Review of Roomservice (Top 10 observations which were explained in the surveys I compiled)
