Prior to starting a clinical rotation, it’s not uncommon for interns to feel intimidated.There’s so much information to know at such a detailed level that it can be overwhelming. Preparation can make the rotation easier but, you can’t prepare for everything. Here are a few things I learned during my clinical rotation:
- There’s no such thing as a textbook patient. In MNT classes, case studies are typically focused on one specific disease that is being covered, such as stage 4 chronic kidney disease. Students learn how to create a diet for a patient with that disease. In the hospital, though, you’re more likely to see a patient with multiple health issues, such as chronic stage 4 kidney disease with uncontrolled type 2 diabetes and a stage IV pressure ulcer. With the guidance of my preceptors, I have learned how to prioritize the nutritional needs for each disease a patient has in order to create a diet that best fits their immediate needs.
- Oral Nutrition Supplements for the Obese. A common long term goal for obese patients is weight loss, however this is not the goal for these patients while in the hospital. They often have higher needs than normal because they are experiencing some level of stress. To meet these increased needs, many obese patients will receive oral nutrition supplements. While weight loss would be beneficial in the long run, patients need to have a healthy weight loss. Developing malnutrition can only worsen their condition.
- Alcohol for withdrawal. Alcohol addiction is not uncommon in clinical patients. Addiction can further complicate a patient’s treatment, especially if they go through withdrawal. The policy for handling alcohol addiction varies from facility to facility. The hospital where I am currently rotating uses the pharmacological approach to reduce the side effects of withdrawal. In contrast, a hospital that I shadowed at during my undergraduate studies served alcohol to patients with alcohol addiction. The hospital kept a bottle of every type of alcohol - vodka, wine, brandy, etc. The patient would be served their drink of choice with their meals to prevent withdrawal from occurring.
- Doctor’s Orders! Another thing that varies between facilities is who writes tube feeding, parenteral nutrition and diet orders. In some facilities dietitians write recommendations for these orders while in other facilities they write the actual orders. This policy can also vary between doctors at the same facility. Some doctors take the opportunity to be certified to write TPN and maintain their certification by completing continuing education credits. This is beneficial in ensuring the doctors and dietitians are communicating and working together for the patient’s nutrition!
Clinical rotations have much more to teach interns than just about different disease states and appropriate nutrition. Dietitians work with the rest of the health care team to make decisions that best meet the patient’s needs. How these decisions are made will differ between facilities, but the goal is always to give the best care to each patient.