First Day at Craven Regional

I really enjoyed my first day of clinicals. I felt like the dietitians are doing a good job of easing me into the experience. I started my day learning about their electronic charting system and how it works. It is very overwhelming and I will definitely need more experience before I can become comfortable using it. The dietitian showing me the system mentioned to me that Craven has not yet switched over to solely using Nutrition Care Process but that they are in a weird intermediate phase and will eventually be switched over to using that. I then spent most of the rest of my day practicing equations and assessment calculations for the dietitians, Harris Benedict, IBW, BMI, protein and fluid needs. I would do their calculations for their consults and they would check behind me and give me pointers. One of the dietitians uses Harris Benedict or Mifflin for everyone, the other dietitian uses kcal/kg but I couldn't figure out where she had gotten her values from and she wasn't sure either but she assured me they were standard values. One combination of issues I saw 2 or 3 times today was congestive heart failure combined with severe dehydration. Quite a connundrum my dietitian told me, since CHF patients need fluid restrictions often. She told me these kind of catch 22's happen a lot in critical care; like someone will have a wound and need protein but they will also have kidney failure, so she generally just gives many critical care patients intermediate amounts of these nutrients to cover her bases. I also witnessed a brief education session for a breastfeeding mother and about a 20 minute long education session with an 82 year old man newly diagnosed with diabetes. The dietitian said that often older patients are not willing to make a lot of changes and that she goes into sessions with the Stages of Change in her mind. She will go in and ask them if there is anything in particular they want help with and she gauges their readiness to change and bases her education on that. Sometimes she says it even involves her just giving them her business card.

Overall I feel like I learned so much today, it was really helpful to practice calculations and watch the dietitians in action!