Examinations, Educations and Vaccinations

Believe it or not, It didn't take too long for me to start living out my very own version of Grey's Anatomy. Although I may just be the dietetic intern here, I am trying to soak up every piece of clinical and dietetic knowledge that I can. Instead of binge-watching doctor shows, I'm watching a real cardiac catheterization right here at TJ Samson. You could say I was excited about that one.

This competency was most definitely fulfilled during the viewing of that surgery, "RDN 2.11 Show cultural competence/sensitivity in interactions with clients, colleagues and staff." The cardiologist and nurses in that procedural room explained every single thing that was happening during the heart cath; They could not have been more helpful and patient.

These past two weeks have been full of watching and learning what it takes to be a clinical dietitian, starting with NFPEs (Nutrition Focused Physical Exams). In undergrad, you always learn about the findings of NFPEs, but you never fully understand what that examination looks like in reality with a patient lying directly in front of you. Watching my preceptor, Carrie, show me all the body parts that can define malnutrition through the NFPE has been extremely informative. I have a much better understanding of what malnutrition looks like, and before I leave here, I'll be performing an NFPE on my own, so I'll know what muscle wasting and fat loss feels like.

According to Eatrightpro.org, "Research shows that early nutrition intervention of a patient with malnutrition can decrease length of stay, falls, pressure ulcers, infections, complications, re-admissions and overall health care costs." It is so vital that registered dietitians adequately perform nutrition focused physical exams to provide patients with a nutrition diagnosis of malnutrition. The NFPE Pocket Guide is really useful when writing out which ASPEN criteria a specific patient is categorized under for moderate or severe malnutrition.

We see on average one patient a day who qualifies for severe malnutrition. According to ASPEN criteria and the Academy of Nutrition and Dietetics, this is an example of how I would write out a patient's diagnosis: "Patient meets ASPEN criteria for severe malnutrition in the context of chronic illness with loss of subcutaneous fat of the triceps (for example) and loss of muscle mass of the shoulders, scapulas, clavicles, and thighs."

It has been insanely interesting for me to finally apply all that I had learned in college to the real world. This especially applies to educations and consults that we do at the hospital. In undergrad, for instance, we may have been given a case study for a patient with diabetes mellitus type 2 and how that individual may not be able to read, and we were to figure out how that education would work. To my surprise, that is not a difficult case at all. At TJ Samson, there are individuals every single day who are fighting several states of disease: heart problems, diabetic issues, a decline in renal functioning, obesity, hypertension, cancers, etc. I feel that this competency, "CRDN 3.6 Use effective education and counseling skills to facilitate behavior change," has been fully understood. Educating patients using visual, written and verbal aids on how to improve their diets, options for exercise and overall lifestyle changes has been a helpful way for me to learn as well. Hearing some of the reported diets from clients and patients has been quite surprising to me when I myself always lived in a home where healthy eating and exercise were not only options, but absolute priorities. Seeing how others put their health on the back-burner of life has been shocking to me, but educational.

I have become increasingly interested in diabetic educations. Diabetes is truly a public health epidemic. According to Kentucky Cabinet for Health and Family Services (KCHFS), Kentucky ranks the 8th highest state in the U.S. for diabetes prevalence. In 2018, Kentucky hospitals had 11,078 inpatient hospital discharges with a primary diagnosis of diabetes. It is the 6th leading cause of death by disease in Kentucky and in the United States. These numbers are unreal to me.

The Barren River where Glasgow and TJ Samson Hospital are has an 11.6% prevalence of diagnosed diabetes. The KCHFS also states that "an estimated 158,200 adults have diabetes, but are undiagnosed." These numbers are not okay. The prevention and management of diabetes needs to be pushed much further.

Although those numbers are quite upsetting, it is uplifting to know that I am helping at least one person a day improve their diabetes and am encouraging lifestyle changes through education. I thoroughly enjoy listening to Carrie educate different patients on easily understandable steps to take when trying to manage diabetes. I know the steps are difficult to implement into life, but I love seeing people really engage with her information and ask questions. It is exciting to know that one day I can help people with their diets and nutrition all on my own.

On another positive note, I am utterly grateful to have gotten the opportunity to receive my first COVID-19 vaccination through TJ Samson Hospital.

Without my internship and employment at the hospital, this wouldn't be possible, so I am appreciative to be able to do my part in ending this pandemic once and for all (eventually). Go Moderna!

I will now go back to putting on my Meredith Grey hat by continuing my pursuit in helping all those that I can with their nutrition at TJ Samson. Here's to six more weeks!

References:

Diabetes prevention and control program. (n.d.). Retrieved February 11, 2021, from https://chfs.ky.gov/agencies/dph/dpqi/cdpb/Pages/diabetes.aspx

Kentucky Public Health (2018) "Prevalence of Diagnosed Diabetes by Kentucky Regions" [Image]. https://chfs.ky.gov/agencies/dph/dpqi/cdpb/dpcp/diabetesfactsheet.pdf

Mordarski, B., & Wolff, J. (2018). Nutrition focused physical exam pocket guide. Chicago: Academy of Nutrition and Dietetics.

Nutrition focused physical exam hands-on training workshop. (n.d.). Retrieved February 11, 2021, from https://www.eatrightpro.org/practice/professional-development/face-to-face-learning/nfpe-workshop