Nutrition Communications: Pyramid to Plate

After hearing my fellow interns speak highly of their rotation at The USDA’s Center for Nutrition Policy and Promotion (CNPP), I was excited for my turn. In the University of Maryland College Park Internship many of our rotations are referred to as acronyms (FSNE, IFIC, NAL, CNPP)  and sometimes its’ hard to keep them all straight.

Upon arrival to the USDA’s Alexandria, VA office I was assigned to work with the Nutrition Communications and Marketing Division. Within minutes of being there I was thrown into a team meeting to discuss social media strategy that included topics such as, next month’s Facebook editorial calendar, the newest MyPlate initiatives, and a new Pinterest Page. The CNPP staff sought and valued my opinion from the start and I knew I was in my element.

           The Nutrition Communications and Marketing Division at CNPP are extremely energetic and always striving for excellence. I was intrigued to learn that my preceptor, Jackie Haven, was hired to market the USDA’s first Food Pyramid and has been championing the campaign all the to The MyPlate today.

What started as a one-person team soon grew into a small independent agency tasked with transforming the science behind the dietary guidelines into consumer friendly messages.

            With the rise of social media 2.0 and the launch of the new MyPlate Facebook page it was an exciting time to be at CNPP.  Technology is changing so rapidly, impacting the way consumers learn and make decisions.  This means its critical time for the USDA to be key a player in the technology scene. I dove right into the social media projects during my time there and thoroughly enjoyed it. I will be keeping an eye out for nutrition communication jobs as I embark on my career search! Thanks CNPP!

For a brief history of the USDA Food Guides check out this link from ChooseMyPlate.gov: http://www.choosemyplate.gov/food groups/downloads/MyPlate/ABriefHistoryOfUSDAFoodGuides.pdf

Experiences in Pediatrics

Today was my last day at Children’s National Medical Center (CNMC) in Washington, DC, and what a fantastic experience! Throughout these past two weeks, I worked with four dietitians specializing in varying areas of pediatric nutrition. This week I rotated through the oncology/hematology and bone marrow transplant units. It was truly incredible to see physicians, surgeons, nurses, dietitians, pharmacy, speech pathologists, physical therapists, music therapists, art therapists, and others working together to provide the absolute best treatment for these patients. Rounds with the attending, fellow, residents, pharmacy, and nurses provided an incredible learning experience each morning. The best part of everyday, however, was seeing these patients and watching them progress towards health.

Last week at CNMC, I spent time on the cardiology floor and the cardiac intensive care unit. I was exposed to varying diseases and conditions specific to pediatric patients. Most of these patients had some form of congenital heart defect (CHD) which is a heart abnormality present at birth. These patients require special medical and nutritional care. Most of these patients have very elevated nutritional needs, and some receive oral, enteral, and parenteral nutrition simultaneously to meet their metabolic demands. During this week I chose a case study patient to assess, develop a plan of care, and follow-up with. I used this experience to research more about CHD and its impact on growth, development, and nutritional status in infants.

Because today was my last day, I presented my findings and case study to the other dietitians at CNMC. Overall, I learned so much more then I had anticipated. I found that I actually really enjoyed working with the pediatric population, and I am so grateful for this experience

Below are a few screen shots of my presentation.

The Benefits of Being a Renal Dietitian

Last week, I finally confronted my biggest fear as a dietetic intern and completed my renal rotation at a dialysis center.  While at first anxious, due to my past history of squeamishness and brief lapses of consciousness at the sight of blood, I managed to complete the rotation without any problems.  To my surprise, I actually really enjoyed working with the folks on dialysis and could see myself becoming a renal dietitian at some point in the future.  Some of my favorite aspects of being a renal dietitian in an outpatient dialysis setting are listed below.    

11)      Developing a Rapport with Patients

a.       Since patients are usually at the dialysis center long-term and must be present 3 days a week, it is easy to develop a rapport with patients.  Through your role as the dietitian, you begin to familiarize yourself with each patient’s different lifestyle habits and diet preferences.  Knowing a patient’s preferences and dietary patterns makes it easier for you to tailor diet educations and recommendations to each individual patient. 

22)      The Opportunity to Observe the Impact of your Dietary Interventions and Educations

 

a.       With labs drawn constantly and consistently, you are able to track trends with your patients and monitor their compliance with the renal diet and certain medications.  

33)      Chance for General Health Promotion 

a.       Although, most of my time spent at the dialysis center focused on interpreting laboratory results and patient education, there was also a chance for some general health promotion through the lobby bulletin-board.  This allowed my partner and I to design a lay-out and materials for the month of May that focused on one specific component of the renal diet. 

A Look Into the Future

During our first week at Riderwood, we had the opportunity to experience a theme meal unfold and come to life.  Jennifer and Melissa decided to do a baseball theme, where their menu highlighted typical baseball stadium fare from around the country.  An example of menu items included soft pretzels, chili cheese dogs, sloppy joe’s and salmon sliders.  It was a great menu and the food was delicious. 

We were scheduled to help Jennifer and Melissa on Thursday and Friday in the kitchen, which was helpful for us as we began to think about our theme meal.  Below are a few things we’ll be keeping in mind as we plan our meal:

1.       Know your recipes inside and out!  It can be fun to choose recipes that are unique, but realized how important it is to thoroughly read the entire recipe.  Some parts may need to be made in advance and you may need to order special products, so it is good to be familiar with the items we choose to make.

2.       Stick to your production schedule.  If you make too many deviations from your schedule it can make you feel overwhelmed.  It is important to stick to your schedule to make sure you finish everything on time.

3.       Delegate delegate delegate.  Figure out what you can delegate to others that are available to help out.   This will help you complete multiple tasks at once and use all of your available resources.

4.       Have fun!  It was obvious that Jennifer and Melissa enjoyed interacting with the residents and chatting about baseball.  Choosing a theme that is interactive and relevant to the population can make for an enjoyable experience.

Overall, it was a really great learning experience for us.  We are looking forward to our theme meal on June 7^th. 

 

Posted on behalf of Nikki Bolduc and Maria Winebrenner Tadic

Pediatric Hospitals: A Whole New Ball Game

Before my rotation at Children’s National Medical Center, I completed 10 weeks at the Baltimore VA Medical Center.  I felt pretty confident in my clinical skills and ready to try a different type of hospital.  I knew that that CNMC was going to be different, but I don’t think I really knew what to expect.  Here are what I think are the top differences between working with the adult population and pediatrics.

1.      Parents over Patients

When gathering information traditionally, you can just ask the patient how they have been feeling and so on.  When your patient is 18 months old, that becomes a less realistic scenario.  As a clinical practitioner, you need to direct your questions to the family members, usually parents, and work with them to provide the best care for your patient.  Usually, they are fully aware of feeding behaviors, symptoms and general habits so you still get all of the information you need. 

      A pediatric hospital can serve patients from birth through their 20’s so there is a wide range.  You need to develop your own clinical judgment to determine at what point the child is included in the conversation. 

2.      Calculating Needs and Evaluating Values

The calculations are different, which is something that I had not thought of ahead of time.  Rather than calculating needs in total calories or grams of protein, everything is presented in relation to the patient’s weight.  For example, the needs of an infant that weighs 3.73kg would be documented as 102kcal/kg/day rather than 380kcal.  Weight is constantly fluctuating so this is a more appropriate method. 

The reference ranges also differ depending on age.  At different stages of development the body has changing needs, so a value that is in range for a baby could be outrageously high for an 18 year old and vice versa.  Practitioners need to be tuned into these differences to give the most accurate assessments.

3.      Growth

Growth can be the main reason you are seeing this patient.  During my rotation, I was on the GI and General floors so many of our patients were underweight and came in for Failure to Thrive.  In adults, changes in weight can be important in addressing an acute condition while weight changes in a child can impact their development and affect them lifelong. 

My impression is that nutrition in the pediatric population can do more good by preventing these problems long term and setting a child up for a healthy life.

I learned a great deal during this rotation and these are only some of the highlights.  Pediatric nutrition is fascinating and I loved being able to work with this population.  If you ever find yourself in a pediatric population, just remember some of these differences to improve your understanding and hopefully the quality of care you are able to provide.

The Implications of Food Allergies in College Dining Services

By Nikki Bolduc

UMD South Campus Dining Hall 

As part of our University of Maryland Dining Services rotation, Maria and I recently had the opportunity to attend a food service meeting at Penn State University.  This regional meeting took place as part of the National Association of College & University Food Services (NACUFS) organization and included food service professionals from five different colleges.  Topics for the meeting focused on specific issues that dining services face as they relate to food allergies (i.e. gluten-free, dairy-free, nut-free) as well as vegetarian, vegan and kosher food preferences. 

Each college shared information about some of their biggest challenges when dealing with food allergies and food restrictions.  Some of the subjects that were discussed in the meeting included best practices when dealing with food allergy signage, how to effectively market special events, the future of healthy menu trends, the use of social media outlets, and green initiatives.  It was interesting to hear what each school was doing to tackle some of these challenges as well as their future plans.  The meeting was very productive and demonstrated how effective peer collaboration can be. 

Overall, I learned a lot about the obstacles registered dietitians face when dealing with food allergies and food restrictions in a food service establishment.  Schools are extremely concerned with keeping their students safe.  Finding the best method to reach students who have food allergies, keep foods separated, communicate which foods are safe, and provide a variety of safe foods can be a huge challenge.  Each school used a different method to do each of these things and while there are no best practice guidelines for schools dealing with such issues, it will remain interesting to see exactly where the future of food allergies and food restrictions in food service go.

A Modified Barium Swallow

Today I had the opportunity of observing a modified barium swallow study on one of my patients. A modified barium swallow is a type of procedure used to investigate the coordination of muscles and structures in the mouth and throat. The purpose of this study is to identify patients who are at risk for aspiration (when matter enters the lungs). It also serves as a tool for identifying safe food/liquid consistencies for patients to consume. 

How it works:

• Barium sulfate, an opaque substance when viewed by X-ray, is added to liquids of different consistencies
• Types of liquid consistencies:
• Thin – non-restrictive
• Nectar – some liquids require thickening, consistency is most similar to tomato juice
• Honey – all liquids require thickening, liquids become very slow to pour
• Pudding – liquids must be spooned
• The patient sits or stands in front of a fluoroscopy machine (X-ray) while swallowing the prepared liquids
• Fluoroscopic images are taken simultaneously, capturing the bolus as it travels from the oral to the pharyngeal phase
• The speech language pathologist views the fluoroscopic images and can then determine the safest consistency for the patient

Unfortunately, my patient suffered from silent aspiration, meaning her epiglottis was delayed in blocking the trachea (passageway to the lungs), allowing thin liquids to enter into her lungs. Nectar thick liquids however did not cause her to aspirate so for the time being, her nutritional needs must be met entirely by a nectar thickened liquid diet, and that’s where the dietitian’s job begins! 

If you want to see a barium swallow check out this short clip.