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!  

ServSafe: Important Tips for your Everyday Life

By Nikki Bolduc

 

The 2012-13 UMD Dietetic Internship class had the opportunity to take the ServSafe Food Protection Manager Certification Examination today.  While no one enjoys studying for exams (well, as far as I know), the ServSafe study material provided useful information that is not only important for food service managers and employees, but also for people with no connection to the food service industry.  Below are a few key points from the ServSafe material for your everyday use. 

1. Hand Washing:  The most important way to prevent foodborne illness is to wash your hands.  Hand washing should last at least 20 seconds and water should reach at least 100°F.
2. Foodborne Illness:  Common bacteria responsible for foodborne illness include salmonella, shigella, and enterohemorrhagic and shiga toxin producing E. coli.  Common viruses associated with foodborne illness include Hepatitis A and Norovirus.  Symptoms of foodborne illness include diarrhea, vomiting, fever, nausea, abdominal cramps and jaundice. 
3. Food Allergies:  Common food allergens include milk, eggs, peanuts, tree nuts, shellfish, fish, wheat and soy.  Symptoms of allergic reactions include nausea, wheezing, shortness of breath, hives, rash, swelling, vomiting, diarrhea, and abdominal cramps.
4. Cold Food Storage:  Ready-to-eat foods can be stored in the refrigerator at a temperature less than or equal to 41°F for a maximum of 7 days.  On day 7, foods must be eaten, served or thrown out. 
5. Receiving Temperature:  Cold foods should be bought or received at or below 41°F and hot foods should be bought or received at or above 135°F.  Never buy or accept foods that look off-color or with a torn package and always inspect for evidence of pests.
6. Thawing Food:  To correctly thaw foods, use one of the following methods - (1) refrigerate at or below 41°F, (2) use running water less than or equal to 70°F for no longer than 4 hours, (3) microwave and cook immediately after, or (4) thaw during the cooking process. 
7. When to Throw Out:  Cold food can be held without temperature control for 6 hours before it must be thrown out (not to exceed 70°F) and hot food can be held without temperature control for 4 hours before it must be thrown out.

I hope you find these tips helpful.  Have a happy, healthy, and safe holiday season!

Class Room Management with FSNE

By Wendy Baier

            Melissa and I recently completed our third rotation.  Things are flying by!  We have officially completed all of our technology rotations, finishing off the set with Food Supplement Nutrition Education (FSNE).  This experience was slightly different in that we worked on technology by composing texts for their “Text2BHealthy” program and writing blogs, but we also were in the classroom.  FSNE works to educate Supplemental Nutrition Assistance Program (SNAP) eligible people on nutrition.  While working with them, we were involved with 3^rd and 4^th graders as well as teachers of various grades. 

            Something that I found incredibly valuable was observing different types of classroom management.  Especially with the elementary students, it can be hard to hold their attention and keep everyone on topic.  Here are a couple tricks that I learned: 

• Have established rules from the very beginning and enforce them consistently.
• Ask questions and continue to encourage answers from the students
• While reading books, make connections to the lesson.  This will break up a long story and make it relevant to the students. 
• If students have connections that you don’t have time for, ask them to hold on to it for later. 

            These general rules may seem simple but seeing them in action demonstrated that when used together, you can run a class very effectively.  Our first couple of days, we taught classes ourselves and didn’t have a good grasp on how to run things.  When we got a couple of rowdy classes in a row, it definitely shook us up.  It was a challenge to continue teaching.  Later in our rotation, we were able to observe different teachers and see the tips above in action. 

            Seeing successful teachers in front of the class after being in front of one myself, I feel that I understand how to teach better.  I realized that it’s not just whether or not you understand the material; you need to understand your audience.  A lesson to future interns is to absorb as much as you can about how to manage students.  These skills will come in handy in a variety of jobs and can prevent some rookie mistakes. Overall, I enjoyed this rotation and feel that I learned a lot from each classroom that I was in.

Holiday Food Safety

Throughout my rotation at the international Food Information Council (IFIC) in Washington, DC, I wrote about various health and nutrition-related topics, one of which was food safety. With the holiday season fast approaching, and food at the center of our gatherings, it seems only appropriate to discuss this topic.

 

Following proper food safety guidelines prevents against the spread of harmful bacteria. Ingesting these bacteria can result in serious illness. In fact, according to the U.S. Department of Agriculture, food poisoning sends more than 100,000 Americans to the hospital each year and can even lead to long-term health effects. This season, be sure to follow proper food safety guidelines to protect you and your loved ones from food-borne illness. Below are four great food safety tips to follow.

1. Clean

• Wash your hands frequently

• Scrub for at least 20 seconds with soap and warm water

• Don’t forget about the backs of your hands, between your fingers, and under your nails

• Sanitize countertops, cutting boards, and cooking utensils

• Use hot, soapy water after preparing each food item

• As an extra precaution, combine 1 tablespoon of unscented, liquid chlorine bleach in 1 gallon of water to sanitize washed surfaces and utensils.

• Rinse fruits and vegetables

• Scrub fruits and vegetables under cool, running water with a produce brush

2. Separate

• Separate produce, meat, poultry, seafood, and eggs in your grocery cart and your refrigerator

• Use separate cutting boards, plates, and utensils for uncooked meat, poultry, seafood, and eggs

3. Cook

• Use a thermometer and cook foods to a minimum cooking temperature

• Keep food temperatures above 140°F after cooking by using chaffing dishes, warming trays, or slow cookers

4. Chill

• Refrigerate perishable foods within two hours

• Make sure your refrigerator is below 40°F and your freezer is below 0°F

• Thaw foods in the refrigerator, under cold running water, or in the microwave, not on the counter

• Learn when to throw foods out

Remember to follow these four simple steps (clean, separate, cook, and chill) this season. Doing so will protect you, your family, and friends from food-borne illness.

Clinical: Looking Back

This week, I begin the last week of my clinical rotation.  I can't hardly believe it - 12 weeks, gone just like that!  It seems like just the other day, I was walking the halls of Harbor Hospital, scared out of my mind, writing down every word the RD's were saying.  Now, I'm almost done my staff relief and feel as if I'm really an employee with my own patients.  It's been a super 12 weeks and I'm sad I'll be leaving so soon.

As I mentioned before, when I first started my clinical rotation, I was absolutely terrified.  I kept thinking of all the things I didn't know, all the labs from MNT that were long forgotten... but I have to say, the RD's I shadowed at Harbor Hospital were the nicest, most understanding mentors.  They all took their time teaching me and imparting a great deal of knowledge.  When you first start your clinical rotation, it'll be scary.  But I learned so much, so quickly, I felt up-to-speed in no time.  There is still a great deal that I need to learn, but when I think back to where I started I know I've come far.

Surprisingly enough, the weekend before staff relief began, that nervous feeling came back.  Two weeks all by myself!  Well... the RD's are always a page away, but still, it was a scary thought!  But in all reality, staff relief hasn't been much different than the last few weeks.  The RD's had enough confidence in me that I was already seeing patients by myself.  The jump to staff relief was much easier because of that!  The only difference is that I've been officially assigned my own floors and am responsible for screening and receiving the consults for those floors.  

It's been great!  I'm loving staff relief more than I thought.  And it's working out just as well as the previous weeks of clinical.  I think the key, is having confidence in yourself but at the same time understanding and being aware of limits.  I'm still in "student phase" and have so much more to learn.  But I know I can do it and I know my RD mentors at Harbor know I can do it.  That's what really makes a difference.  If I don't understand a term, or a disease process, I never hesitate to login to the Nutrition Care Manual (or google for that matter) and look it up.  The staff and the RD's won't expect you to know everything just yet, but they do expect you to be quick on your feet!

I will certainly be excited to move onto a new rotation next week, but I will definitely be missing the staff at the hospital and my patients.  I'm so pleased at how much I've learned about nutrition, the hospital setting and caring for patients.  Those are skills I would never had learned anywhere else - not in the classroom or through volunteer work.  I'm thrilled with how much I've learned and how my knowledge and skills have grown in such a short time.  When its your turn for clinical, don't let fear hold you back!  Be confident in what you know and what you can learn and I promise it will be one of the best rotations you go through!

FNCE Reflections -- Jennifer Vargas

A few weeks ago at the 2012 FNCE conference (Food & Nutrition Conference and Expo), one lecture I was excited to see and attend was “Calling all Food Bloggers: Stay in the Game”.  Why is blogging important to dietitians?  Well, blogging is important for many reasons, all of which were covered by the presenters Toby Amidor and Dana Angelo White, both successful bloggers.

The first reason is that we are Registered Dietitians - or RD(s)to be!  We are the nutrition experts and we need to get our expertise into the world.  There is so much misinformation available in the media today that we need to make sure the correct information is reaching the public.  The Internet is one of the best ways to accomplish this because more people find their health information from the Internet today than ever before.  However, there several points we need to keep in mind when blogging: here are a few from the speakers:

n  Keep it short.  No more than 250 – 600 words.  People are looking for the quick, take-home message.

n  Link out!  Always give credit and a link to any information that is not your own.  For example, if I want to talk about the UMD Dietetic Internship, I need to provide you a way to get to it… like that.

n  Get a conversation going.  Open up your blog to comments.  Many comments can range from agreement to criticism to questions about nutrition news in the media and are food for new blogs.

n  Have fun!  Blogging doesn’t need to be a chore.  It should be something fun that you look forward to doing, so write about topics that are fun and interesting to you.  Put some humor in it and use contractions!  It’s ok to use every day speech; people will relate to it better.

Hopefully this helps you figure out your niche in the blogging world.  So give it a try and promote it on social media.  Don’t worry if you don’t think you’re that great of a writer.  Practice and gain some confidence in it… you’re probably a lot better than you think.

Happy blogging!

FNCE Reflections -- Melissa Grindle

This year I was fortunate enough to attend the 2012 Food and Nutrition Conference and Expo in Philadelphia.  A wide variety of sessions were available, including an entire track on informatics.  One session, “Calling All Food Bloggers”, caught my attention as I have been writing my own blog for two years now.

The moderator and speakers, all well versed in the blog world, gave helpful insight into the world of food blogs for dietitians.

As dietitians, we compete with the voices of so many self-proclaimed experts in health that populate the World Wide Web.  Many bloggers who write about food, nutrition, and health have no such background, which shows there is a need for the experts to break into the conversation.  It is our chance to get accurate and credible nutrition information out there. 

So where to start?

Toby Amidor and Dana Angelo White of the popular Healthy Eats blog gave strategies on how to set up and maintain your own blog.

·         First:  Figure out what you have time for.  Readers like regularity, so figuring out early whether you have time to devote to 1 post a week or 5 is important.  Take into consideration how much research you will need for each post.  Recipes may take less time, while giving information on a hot topic such as coconut oil may take more time with research and fact checking.

·         Second:  Find the best tools for you.  Many different blogging platforms exist: wordpress, blogger, etc.  Which one will you use?  What will you do for pictures?  Buy stock photos or take your own?

·         Third: Engage your readers.  Twitter and Facebook are great ways to inform readers of new content or to reach out to new readers.  While you could just tweet a link to your newest post, there are better times of day to reach viewers:  morning, lunchtime, and after dinner.  These are the times when most people are checking social media and actually have time to read blogs.

These three things are a perfect jumping off point for creating and starting your own blog.  Other tips?  Make sure you write about topics that interest you!  Only then will you engage your readers, because you are engaged in your topic.

Now…what will you blog about?

FNCE Reflections -- Wendy Baier

While attending the 2012 Food and Nutrition Conference and Expo (FNCE) this year, I had the opportunity to attend Appetite for Technology: Food, Nutrition and Cooking in the Digital Age.  This session discussed the emerging trends in technology used in everyday grocery shopping, meal planning and nutrition. One of the most striking topics was how grocers are utilizing technology to better serve their customers.

Considering that there are 91.4 million smartphones in the United States, it makes sense that grocery store specific apps are now available. Currently 29% of moms with smartphones use a grocery related app while they are in the store.  Some common features include being able to create a shopping list and accessing coupons on your phone.  Based on your purchasing history, these coupons can be customized to what you may actually want, rather than flooding your mailbox with coupons for every item on sale.  This way, customers can stay organized and go paperless.

There are some more advanced features that make shopping much easier.  For example, after entering your shopping list, the location of each item appears next to the name.  No more aimlessly wandering through the store looking for a specialty item.  Some apps also include a recipe builder.  Say you get to the store and realize that avocados are on sale.  Right there, you can search and develop a recipe around avocados.  The app will then automatically import the rest of the ingredients into your shopping list, ensuring no return trips to the store.

Beyond convenience and organization, grocers are utilizing their loyalty card programs for public health purposes.  When there is an outbreak of a food-borne illness, officials can access the shopping histories of those affected (with permission of course) in order to identify the contaminated item.  From there, alerts can be issued to other customers that have made that same purchase.  The sophisticated use of this data can prevent the spread of disease and possibly save lives.

These technologies are still being fine-tuned but show great promise in making busy lives a little less stressful.  Keep an eye out for an app relating to your grocer and dive into the digital age!

Posted on behalf of Wendy Baier

           

FNCE Reflections -- Bethany Beaver

At this year’s 2012 Food and Nutrition Conference and Expo (FNCE), I was able to attend the Appetite for Technology: Food, Nutrition and Cooking in the Digital Age lecture presented by Beth-Ann Eason and Sylvia Geiger. What a fantastic presentation!  We were introduced to current and upcoming innovative technologies focused on simplifying grocery shopping, menu planning, and nutritional messages. Two topics discussed, that were particularly interesting to me, were “virtual grocery stores” and the use of “radio frequency identification (RFID) tags”.  

With approximately thirty-nine thousand products lining grocery store shelves and about fifty thousand products in mega stores, grocery shopping has become a complex and time-consuming endeavor.  In 2005 many urban areas were introduced to online shopping. This concept allowed individuals to shop and order from the comfort of their home or office. It saved time and stress. Because of its success, companies are further expanding on this concept by developing virtual stores.  Virtual stores will be placed at convenient locations readily available to consumers, such as subway stations. A virtual store will consist of a large poster with printed products and QR codes. Consumers will be able to use their smartphones to scan any product they would like to purchase and add it to their virtual shopping cart. After shopping they can virtually check-out and the products will later be delivered to the customer’s desired location. Virtual stores will be more convenient and save even more of the customer’s valuable time.

Long, frustrating supermarket check-out lines may soon be obsolete with the use of radio frequency identification (RFID) tags. These smart tags will communicate electronically with each product placed into the customer’s cart. After finishing their shopping, customers can simply leave with their items. Their charges will be billed to their bank account. No more scanning and waiting in long check-out lines. This new concept allows for simple, fast and effortless shopping.

 

photo courtesy of thekoreaguide.com

 

Posted on behalf of Bethany Beaver

 

It’s Easy to be Green at College Park Dining

A few weeks ago my partner and I finished our rotation at the University of Maryland Dining Services.  While experiencing the world of College Dining, I was surprised by all the sustainability efforts the University of Maryland was implementing.  

 

Currently at Dining Services  . . .

-          Rooftop gardens inhabit the roofs of the dining halls.  The picture on the right is the newest student led rooftop garden. On the roof, students grow anything from basil and thyme to corn and peppers.

-          Reduce and Reuse

o   For the past few years, the University has offered both compostable and reusable carry-out containers. 

o   Each Dining Hall has a composting system in place and in 2010, Dining Services composted 20 tons of food waste and paper products.

-          The Farmer’s Market!

o   While on campus, we were fortunate enough to experience Dining Service’s Food Day celebrations at the local Farmer’s Market. 

-       The recently renovated Dining Hall North 251 was awarded the LEED Silver certification because of the building’s energy conserving measures. 

Shopping at the Farmer's Market.

My experience at Dining Services proved to me that large scale food institutions can institute energy savings and sustainable options without breaking the bank.  I encourage other food service institutions to adopt sustainable practices and for individuals to think about their carbon footprint.   

To learn more visit: http://dining.umd.edu/greendining or calculate your carbon footprint at http://www.nature.org/greenliving/carboncalculator/index.htm.