A Closer Look Into My Community

Spending the first third of my dietetic internship in clinical was great.  I really got a great handle on medical nutrition therapy, dealing with patients, learning hospital policies, and getting the lingo down for writing up my notes.  I got very comfortable in that setting used to the daily routines.  But when my next two rotations were within the community section of the internship I really had a complete 180 degree spin from my clinical setting.  My initial idea of what the community rotations would entail was far short of what I got to experience.  I loved both rotations and really got to learn a completely different side of nutrition.

I spent 4 weeks total, really getting into and knowing my community here in DC, Maryland and Northern VA.  My first rotation was with the Food Supplement Nutrition Education program (FSNE) and the second rotation was with Food and Friends located in DC.   I originally thought community nutrition just consisted of going into school or other community settings and giving a quick lecture on healthy eating and proper nutrition.  Wrong!  

Now that I've completed the 4 weeks of community I've realized that these dietitians and the rest of their staff really are a lot more than community educators.  Especially at Food and Friends, the dietitians and staff are not only educators, but they are friends and a much needed life line.  At a hospital the patients may or may not want your input on their diet and lifestyle or want your advice.  But many times the client's in the community center not only want your knowledge, but are happy to get it, happy to see your face, happy to know your there to help them.  Because sometimes there is no one else to help them.  

Being a community dietitian is so much more than the MNT we are all so used to.  You need a big heart, patience and strength too.  It's a hard position to hold, but the dietitians I shadowed at both FSNE and Food and Friends are incredibly passionate and love their job and their clients.  It really opened my eyes and heart to a whole new side of nutrition...and a whole new side to my community that I never knew.  I truly have a new appreciation for nutrition and the needs of my local community.  It was an inspiring 4 weeks and I'm excited to be able to help even more once I get my RD!

Assessing Risk Level

During clinical rotation, interns spend eight weeks learning what it is like being a clinical dietitian and for the last two weeks they are in staff relief putting together the new skills that they have learned. I am happy to announce that I am officially done with my first clinical rotation and time flies by so quickly! I have spent one week alone in the critical care unit and two weeks of staff relief on a general medicine floor. During the past few weeks I learned that in a clinical setting it is important to look at the bigger picture when determining risk levels. Is the patient stable, low/moderate, or high risk?

Here are some things to consider when determining the patient’s nutrition risk level:

• How was the patient eating prior to admission? Was the patient well nourished and is the patient weight stable?
• Does the patient’s medical diagnosis increase calorie or protein needs?
• Is the person ventilator dependent? How will the patient meet estimated nutrition requirements?
•  How is the patient’s skin integrity?
• What type of diet was the patient previously on? What type of diet do they have in the hospital?
• Is the patient tolerating their current diet?
• Are there any medications that may have caused nausea, vomiting, diarrhea, constipation, hypokalemia, hyperglycemia and etc.?
• Has the patient been NPO for a prolonged period of time?
• Is the patient at risk of aspiration and are there any difficulties chewing/swallowing?
• Does the patient have a functioning gut?

During my time in the critical care unit I realized that it is not easy to gather all the information because most of the time patients are nonverbal since they are intubated. This makes communication between the medical team crucial in order to provide the best care for the patient. With the information gathered, I can assess the patient’s nutritional risk and develop an intervention that best meets the patient’s nutrition needs.

Where do Fruits and Vegetables Grow?

Two books -- "Up, Down and Around" and "Tops and Bottoms" -- both teach how fruits and veggies grow in the ground, above the ground, or in the middle.  These books are part of the Maryland FSNE "Read for Health" curriculum.

At Baybrook Middle School's after school program sponsored by Child First Authority -- "Cooking Venue" students read "Up, Down and Around" -- with 1/32 of the class being "growing up", 1/3 being "growing down" and 1/3 being "growing around".  The next book "Tops and Bottoms" taught us that while some veggies grow up and some veggies grow down -- that veggies like beets and radishes -- actually both tops and bottoms can be eaten.  It also taught us that one character -- the hare was a bit of a trickster and very smart.

After reading the books -- we went into our cooking class where we cut up veggies to make a salad using romaine lettuce, celery, summer squash, peppers, carrots to which we added fruits -- pomegranate seeds and raisins and then our salad dressing.  We also made hot corn tortillas with salsa and cheese.

All the noise in the room ends when we start chopping veggies and making our hot tortillas.  And after we have made our foods -- we get to eat -- the best part.  Of course we want to try everything that we have worked hard ot make.  And we also like any second helpings that remain.





















Check out the YouTube video for "Tops and Bottoms" which is a paraphrased read of this truly delightful book in less than 3 minutes.  Both books are a great way to introduce elementary and pre-elementary children to how veggies grow. 


Posted on behalf of Phyllis McShane

A New Outlook on Bariatrics

Margery Swan

 

     This Monday we attended a joint class day hosted by the Johns Hopkins Bayview Dietetic Internship.  I was particularly looking forward to the second half of the day focusing on weight loss surgery or bariatrics.  Bariatrics was not a subject we spent much time on in my undergraduate studies and therefore I had been hesitant to form an opinion of my own.  I left the session with a new understanding of bariatric patients and why weight loss surgery may be the only option for some individuals. 

 

   Although weight loss surgery is not for every patient and should be considered only as a last resort it has the potential to improve someone's quality of life drastically.  For some patients it may even reverse certain chronic diseases, such as diabetes or hypertension. 

 

  As a fun way to sum up the session, I created the infographic below to highlight the different types of bariatric surgeries offered at John Hopkins Center for Bariatric Surgery. 

A Mediterranean Lunch

by: Melissa Grindle

To end our three week rotation at UMD College Park Dining Services, we are asked to create a menu for a luncheon that will coincide with our final presentation.  With the help of Chef John, our menu is then tweaked to perfection, and we spend our last day at dining services with him preparing our feast.

Wendy and I decided that our love of Mediterranean food should be the focus of the meal.  With our knowledge of that type of cuisine and some internet research, we created our menu.  However, not without a few edits from Chef John.  His expert opinion helped shape our dishes from so-so to delicious. 

Here is our final menu:

Appetizer
Mushroom and Crabmeat Crostini Gratin

Salad
Mediterranean Crunch Salad

Entrée
Chicken Souvlaki Calzone with Tzatziki Sauce

Sides
Israeli Couscous with Dried Fruits and Roasted Squash
Slow Sautéed Carrots with Turnips, Kale, and Parsley-Mint Sauce

Dessert
Pear Baklava Turnover

Arriving at 8am the Friday of our final presentation day, Wendy and I chopped, sautéed, baked, and grilled until our meal was complete – approximately 4 hours!  It was such a fun day since we both enjoy cooking, plus we learned a lot about knife skills, roasting temperatures, and seasonings that we both felt like better cooks by the end of the day. 

Here are a few pictures of the luncheon and menu items:

 Wendy slicing the pears for the turnovers.

Me, mixing up the walnuts and pecans with some honey.

A woodfire oven to bake our calzones.

Pear Baklava Turnovers 

 Mushroom and Crabmeat Crostini Gratin

 Mediterranean Crunch Salad

 Israeli Couscous and Sautéed Carrots, Turnips, and Kale with a Parsley Mint Sauce

 Chef John!  Our wonderful educator and leader for our luncheon.  Thanks so much for all you did!

Lesson Learned:  Don’t fear new flavors!

Happy Birthday SuperTracker!

For the last 5 weeks, I’ve been at the Center for Nutrition Policy and Promotion (CNPP) in Alexandria, VA. During this rotation I worked directly with the Nutrition Marketing and Communication Division. Despite being a very small staff, this division has produced some truly remarkable and innovative nutrition resources, such as MyPlate and SuperTracker.

Coinciding with the end of my CNPP rotation is the 1-year anniversary of SuperTracker’s debut. By merging state-of-the-art technology with USDA nutrition guidance, SuperTracker provides the public with a credible resource for tracking their food intake and physical activity.

During its first year, SuperTracker has reached several milestones, quickly becoming CNPP’s shining star. Accomplishments achieved by SuperTracker during its first year include:

•  Reaching 1 million users in 9 months, with the number of new registered users growing each day 
• Awarded the 2012 Government Computer News (GCN) Award for Outstanding IT Achievement in Government

After working directly with the creators of SuperTracker, I can say that this tool comes from a group of forward-thinking and passionate individuals. As registered dietitians and IT professionals, they are a unique faction within the nutrition world that I hope to emulate as an RD. I feel that in order to improve our nation’s health innovative professionals and resources, like SuperTracker, are essential.

If you don’t have a SuperTracker account, click here to make one today!

Can You Define Critically Ill?

What comes to mind when you hear the term “critically ill”? When we hear that someone is in the critical care unit (CCU) or the intensive care unit (ICU) in the hospital we know they’re probably in bad condition, but what qualifies someone as being critically ill?  Surely, someone with a terminal condition such as malignant cancer or end stage renal disease is critically ill, right? Would they be in the CCU? This concept may cause confusion because there is no standard definition for the critically ill. Rather, the term broadly refers to someone who has a sustained, acute, and life threatening injury or illness.

As I near the end of the 8^th and final week of my basic clinical rotation at Carroll Hospital Center, I have developed a greater understanding of conditions that warrant a patient the constant and intense attention of the health care team in the Critical Care Unit of the hospital. The first thing my experience cleared up is that a patient in the CCU is there with the expectation that they will only be there for several days and thus cases of chronic life threatening conditions, as I listed above, are not always appropriate for the CCU. Scenarios that commonly land someone in the CCU include:

1. Hemodynamic instability: Dangerously low or high blood pressure.

2. Ventilator Dependence: A condition in which breathing fails because the exchange of gases, (CO2 and oxygen) are insufficient to sustain bodily organs thus the patient is dependent on a ventilator.

3. Multiple organ dysfunction syndrome: Progressive failure of multiple separate organ functions.

Underlying diseases that may cause the conditions above include: respiratory distress, inflammation, sepsis, shock, heart attacks, drug over dose, cancer, and end stage renal disease.

Dietitians play a critical role in the care for patients in the CCU. Some important lessons I picked up from my experience in the CCU include:

• ·      Many patients’ in the CCU have increased energy needs due to metabolic stress, ventilator dependence, and wound healing. However, just because a patient is in the CCU does not automatically mean that have increased energy needs. Each patient demands an individual assessment to determine his or her needs.
• ·      Many patients in the CCU are unable to communicate so it is important to gather as much information as possible from family, physical examination, and their medical chart to determine the appropriate nutrition treatment.
• ·      The CCU in the hospital can be an excellent learning opportunity for dietitians, taking the opportunity to work closely with nurses and physicians is an excellent time to enhance medical knowledge and understanding.

Hope this helps clear somethings up!