Case Studies: Decisions, Decisions

Well it feels like just yesterday that I was writing about my first few weeks at the hospital and now I'm finishing up with my last week of the rotation. I cannot believe how fast it has gone by. I have learned so much during these last few weeks and just like my partner who just posted last week, I have been involved in many aspects of the daily routine of a clinical dietitian including:

-Calculating a fair share of enteral and parenteral nutrition support recommendations

-Educating on a variety of topics including: diabetic, renal, diverticulitis, low sodium and fluid restriction diets

-Assessing and following-up with patients of all conditions and disease states

-Observing a modified barium swallow with the Speech Language Pathologists (SLP)

Now as my closing project for the rotation I'm working on my major case study, which let me tell you, like it says in the description, is a MAJOR task! After the last 7 weeks you would think that I would have a better idea of a clinical segment or condition that interests me, well…guess again. Since I really enjoy the medical etiology and pathophysiology more than a specific condition I found it extremely difficult to pick someone to model my case study after. In the end, I decided on putting the deciding on a back burner and waiting around until a patient and their condition “spoke to me”. This did not happen as quickly as I had hoped and I ended up letting patient past medical histories (PMH) decide it for me as the weeks passed by.

It was really difficult to make a decision on someone that you are going to spend so much time researching and examining. Plus, I was told not to choose anyone “too difficult” or with “too many problems”. Well nowadays, especially in a smaller community hospital within a lower economic status neighborhood, the PMH section is usually quite lengthy.

Then, I found a patient (more like the CHF order set found me) in need of a low sodium/fluid restriction diet education with NO PMH except for one condition and a treatment that was associated with his current diagnosis! I couldn’t believe it and swiftly claimed him among my preceptors as “my case study”. Unfortunately for me…few problems lead to a shorter hospital stay. Therefore, he didn’t have a lengthy clinical course for me to follow in depth, but after looking into congested heart failure (otherwise known as CHF) a little more I realized that there was still a lot to work with.

I am still making progress on the project as a whole, but really enjoying all of the research behind the condition and with this marking the end of the rotation I will be sad to see it fall into the “rotations completed” section of my internship.