Tuesday, December 20, 2011
The major case study assignment is the final project of each intern’s main clinical rotation. It is an opportunity to explore an area of clinical interest by researching a chosen patient’s medical condition or disease, the nutritional implications, and appropriate medical nutrition therapy.
I have completed both the main ten-week clinical rotation as well as an elective two-week clinical rotation focused in neonatal intensive care. Because of my strong interest in working with infants, I selected a preterm neonate for my major case study. Specifically, my research explored neonatal abstinence syndrome in preterm infants. Here is the executive summary which encapsulates what I learned:
“Neonatal abstinence syndrome (NAS) refers to a collection of withdrawal symptoms observed in a newborn child including, central nervous system excitability, vasomotor dysfunction, and gastrointestinal distress. NAS is caused by fetal drug exposure secondary to maternal drug use. Since women who abuse drugs often use more than one drug, NAS may result from the combined impact of multiple exposures. Opioids are the most common drugs to give rise to NAS and include illegal drugs, such as heroin, as well as prescription medications including, oxycodone, hydrocodone, and OxyContin.
Maternal drug abuse impacts the fetus directly through drug exposure in utero as well as indirectly through compromised maternal health. For this reason, NAS is not the only health concern for drug-exposed infants. Poor maternal health habits, such as lack of prenatal care, poor nutritional status, exposure to violence, and exposure to infectious disease related to unprotected sex or intravenous drug use, increase the risk of prematurity, low-birth-weight, and fetal demise.
Medical management of a premature, low-birth-weight infant with NAS involves primary and secondary treatment and should always be individualized. Primary treatment is supportive and non-pharmacologic. Pharmacotherapy, with a drug from the same class as that causing the withdrawal, is considered secondary treatment of NAS.
Medical nutrition therapy (MNT) plays an important role in neonatal care for both prematurity and NAS, helping to ensure adequate growth and nutritional status. Nutritional considerations include elevated caloric needs and ability to feed. Preterm infants are prone to feeding difficulties due to developmental delay and fatigue. NAS further compromises feeding ability and therefore nutrition status of an already high-risk patient. NAS symptoms may also increase energy expenditure as well as caloric loss through vomiting and diarrhea.
Close monitoring of feeding and growth are essential components of MNT for the preterm infant with NAS. Human milk is the preferred energy source for all infants. Breastfeeding with regard to maternal drug use is controversial, however it must be considered due to the numerous known benefits human milk provides to the preterm baby. Infant formulas designed to meet the nutritional needs of prematurity are available when breastfeeding is not an option. “
References and full report available upon request, please email firstname.lastname@example.org .
Thursday, December 15, 2011
Monday, December 12, 2011
As we approach the holiday break and the near mid-mark of the internship, I have begun to reflect on what I have been able to accomplish so far during this program, and it’s a lot! I am currently in my last week at the International Food and Information Council in D.C. completing the last of my information management rotations. Through IFIC and FNIC (Food and Nutrition Information Center), I have learned how to communicate to a variety of audiences via the web and have sharpened my researching, presenting, and writing skills. I have completed one of two of my foodservice rotations at College Dining, where I learned about College Park’s dining facilities and their initiative to “go green.” I was able to collaborate with many of the dining services’ team members to learn how they provide nutritious, diverse, and safe food to the university.
Also checked off on my internship list are the majority of my community rotations. I spent two weeks at Food and Friends in DC, a food bank that provides specialized nutritious meals, groceries, and nutrition counseling to people living with HIV/AIDS and cancer. I was able to go on a home visit where I observed the dietitian counsel a cancer patient with an ileostomy bag and spent a day with their delivery driver bringing meals to clients. I spent one week with Maryland’s Food Supplement Nutrition Education program, where I was able to teach the community about general healthy eating practices. My favorite activity was reading a nutrition-related book to elementary school children and making a healthy snack with them. Way back during the first week of the program, I spent a few days with the Montgomery County School Lunch program. I learned about the regulations of school meals on the federal level and how they implement these rules on the county level. I was able to observe several of their school’s kitchens and toured their central production facility.
I already feel like I am well on my way to becoming a dietitian and am looking forward to what’s to come in the New Year. I will be starting my 8-week clinical rotation in January (eek!) followed by 2 weeks each of staff relief, pediatrics, and second clinical experience, which means I should probably use this break to brush-up on my medical nutrition therapy knowledge :)
Until next year,
Thursday, December 8, 2011
During the 6th week of my clinical rotation I was able to participate in a Modified Barium Swallow (MBS) evaluation performed by a Speech Language Pathologist (SLP). In order for a patient to have a MBS performed they must have some sort of dysphagia, aka difficulty swallowing. The first step to determine if a patient has dysphagia is for a SLP to perform a bedside swallow evaluation. During this evaluation the SLP feeds the patient a number of liquids and foods to determine if the patient is at risk for aspiration. Have you ever had a drink or a piece of food "go down the wrong pipe"? If you have, you've aspirated. The problem is that if enough foreign body gets down into the lungs via aspiration bacteria can grown and an infection can spread making a patient very ill.
Below is a video showing a MBS with aspiration:
- Thin liquids: any regular beverage, ie water, juice, iced tea
- Nectar-thick liquids: easily pourable & are comparable to apricot nectar or thicker cream soups
- Honey-thick liquids: slightly thicker, less pourable, & drizzle from a cup or bowl
- Pudding-thick liquids: hold their own shape; are not pourable & are usually eaten with a spoon
Monday, December 5, 2011
Thursday, December 1, 2011
By Joyce L. Hornick
Would you get food from a salad bar that didn’t have a sneeze guard? How about eat at a restaurant that didn’t clean their dishware properly? Or at a place that served week old food? Yuk! Definitely not! Luckily, laws are in place preventing the above scenarios from happening, but do you follow the basic rules of food safety at home?
The FDA, USDA, and the CDC all work together to ensure our commercial food supply is safe. State and local governments have standards for food safety that restaurants, food manufacturers, grocery stores, and other food-related commercial establishments are required to follow. Many jurisdictions require restaurants to have food service employees trained via the ServSafe® method and take an exam to be certified. The system isn’t perfect. Foodborne illnesses still occur, but the US has one of the safest food supply systems in the world. At home, we can continue with safe food handling practices to keep our food safe. We have many resources about food safety at our fingertips. Web sites such as foodsafety.gov, fightbac.org, cdc.gov, and fda.gov all have a lot of useful information.
The five most common risk factors that cause foodborne illnesses as reported by the CDC are:
- Purchasing food from unsafe sources.
- Failing to cook food adequately.
- Holding food at incorrect temperatures.
- Using contaminated equipment.
- Poor personal hygiene.
These risk factors have been identified, with protocols in place, to help minimize foodborne illnesses within our commercial food supply.
With all of this information available, what are the most important things you can do as a consumer to keep your food safe at home?
- Only buy perishable foods from grocery markets you trust. Look at the packaging of meats and poultry to make sure it is sealed properly and the meat looks fresh. Check the sell buy date to make sure it isn’t expired. Try to buy meat and other perishables last while at the grocery store and put them in the refrigerator first once you get home.
- Always make sure food is cooked to the proper temperature. It’s the best way to lower your risk from bacterial contamination. An instant read thermometer is a must for every kitchen. For a quick list of proper cooking temperatures, look at or print out this chart.
- Put leftovers in the refrigerator right after finishing your meal. Put the food in shallow containers with a loose fitting lid to allow heat to escape. Seal tightly once they have cooled. Don’t let leftovers sit out on the counter to cool off.
- One of the easiest ways to prevent cross-contamination of foods is to have different cutting boards for different tasks. Always clean knives and other utensils thoroughly after using for one task before using for another. Thoroughly clean work surfaces after working with raw meat, poultry, and fish. Never put cooked food on a plate that had raw meat on it.
- Wash your hands, wash your hands, wash your hands. Mom knows best on this one! This is the easiest way to prevent cross-contamination, reduce the spreading of bacteria and viruses, and is just good hygiene!
Food service establishments are required to follow these guidelines to keep their food safe. Following these guidelines will help make your home “restaurant” kitchen safe as well. As we head straight into the holiday season, think about the large number of people you may be cooking for and make sure your kitchen and your food is safe for everyone.
Wednesday, November 30, 2011
Admittedly, at first I wasn’t excited to get a smart phone. I didn’t want to learn all the ins and outs of a complicated phone. Trusty red and I had a long history together and I knew how to use it well. But recently the time came for me to upgrade phones, so I finally said goodbye to my little red phone and upgraded to a shiny new iPhone.
Sunday, November 27, 2011
There has not been a lot of research on the significance of IgG testing and food elimination diets. However, I myself, have seen a great difference in those who have followed their tailored food sensitivity list and have heard comments of those who have changed their eating habits around this idea.For those of you who have not heard about these “food elimination diets” or want some further clarification on what they are, let me explain. It first starts out with a blood draw. Your blood samples are then tested against a panel of different food antigens to see if your body reacts to any of the additives. If there is a sensitivity present, your body produces an antibody (IgG) and then each of those receive a grading of a +1, +2, +3, or +4 in regards to the strength of the sensitivity (remove from the diet for three months, six months, nine months, or one year, respectively). Immunoglobulins G (IgG) are found in all body fluids, they are the smallest and most abundant of the antibodies in the body. They are the most important antibodies for fighting bacterial and viral infections. Since these antibodies are so prevalent in our bodies you might wonder what kind of a reaction you might get when for example consuming some items you show a sensitivity to. Anywhere from the obvious signs/symptoms such as a stomach ache, delayed digestion, and heartburn to a slower reaction time or mental clarity.
While in Arizona, I got to analyze many of these results just as a nutrition professional would for their client. Once the lab results are received, I would go through the food items that elicited a reaction, then determined if there were any similar food families present, most commonly: Bovine (cow’s milk, goat’s milk, eggs, beef, dairy products, etc.), Nightshade (peppers, potatoes, tomatoes, etc.), Legumes (all beans, peas), Grains/Grasses (rice, wheat, oats, corn, etc.), and Fungi (baker’s and brewer’s yeast, cheese). Many foods fall into “families”, this means that they have a similar structure and make-up, therefore, also causing a similar “reaction”. These foods are then eliminated from their meal plans and substitutions are made when necessary (almond or coconut milk instead of cow’s milk). After the allotted time for elimination foods are then cycled back in (one at a time) so the individual can try and read how their body feels upon reintroduction.
Many of the athletes found this plan difficult and hard to follow at first, then you would start hearing the responses about how they “cheated” and for instance, ate a wheat product when they weren’t supposed to and how they felt so slow and sluggish the rest of the day. This is when you start believing that some of this really might make a difference even on a smaller level.
There still needs to be a lot of research done to prove the significance of eliminating foods that your body shows a higher sensitivity to from the diet. You must remember that this testing does not prove you have a full-blown allergy, but that your body shows sensitivity. However, I believe that the ideas behind the diet are good. If you eat the same items over and over again, your body will most likely show sensitivity to them due to overexposure. It probably is a smart idea for everyone to start cycling food items most often consumed and add some variety into your refrigerator and pantry. Stay tuned for more information!
Wednesday, November 23, 2011
Now that we were both feeling stress-free and energetic, we were invited to work at the Student Government Association sponsored UMD Crab Fest. WOW. I don’t know if these students know how lucky they are to have an event like this on campus. They had everything there. Potato salad: check. Macaroni salad: check. Adorable single-serving butterballs: check. The list goes on. Dining services purchased sixty-six bushels of crabs. (I’ll admit, to me that meant “a lot” so I had to dig further for a number). At an average of sixty-seven crabs per bushel, that turned out to be a whopping 4422 crabs ordered for about 900 students. That’s a lot of crabs! I’m not even a student and I had a blast.
After our much-needed Thanksgiving break, we’ll be entering our third and final week at this rotation just in time to see the pilot launch of the “OZZI” reusable to-go containers in the dining hall. This program is an effort to reduce not only waste, but costs associated with disposable containers used in the dining hall. If we had left before the holiday we wouldn’t have been able to see this happen! Like I said; it’s all about location. It’s those extra things we were fortunate enough to experience that made this rotation all the more special to me. We got lucky!
Until next time,