I’m a week behind on my internship posts, but it just so happens the last two weeks of rotations were pretty similar – so posting them back to back will be good for y’all to read!
At this point, I’m done with 8 weeks of the 40 week program. I’m officially done with 6 weeks of clinical and I’m moving to foodservice for 3 weeks starting this week. I have my 1 hr graduate level research seminar in 3 weeks, so I’m really happy to have a lighter load with my foodservice rotations so I can dedicate extra time to that. You better believe I planned my seminar date around this key factor in my schedule.
So, two weeks ago I was in GI med – which was quite interesting. Of all the body systems, the one that impacts nutrition more than ANYTHING is the gastrointestinal tract. And just so we’re all on the same page, this runs from the mouth to the anus and includes the esophagus, stomach, small and large intestine (in general). It also involves a lot of the accessory organs in the abdomen as well – like the liver, pancreas and gallbladder.
Knowing this, it would seem like we play the biggest role here than we would anywhere else. In a way we do, but I also learned the last two weeks that we have to defer a LOT to the medical staff because if there is a disease/procedure/problem with the GI tract medically, we can’t always give nutrition the way we would like, based on what the body needs.
I see GI med as more diagnostic than treatment oriented, which was great for me to have first (last week I was in GI surgery, which is treatment related). In GI med, we had a lot of people who were having GI problems and were in the hospital to have tests or to determine the source of their symptoms.
As for the patients I saw, it was a lot of the following:
- GI bleeds– both vomiting blood and have bloody stools.
- A lot of unexplained nausea/vomiting/diarrhea.
- People who had ostomies who had problems with their output – both too much and too little.
- GI obstructions and things blocking the GI tract
- Liver diseases
- Gallbladder diseases
- Esophageal strictures (widening of the esophagus)
- Complications of bariatric surgery
We also had a 25 bed ICU that I was in this week, so I did see some non GI related stuff that was crazy. That ICU has a lot of the drug overdose patients, bad wounds, people who have dementia/altered mental state. All the staff in this ICU calls it the psych ICU because there are a lot of people with some mental/psych issues going on.
Overall I did a lot of tube feedings, which I LOVE, and was awesome. I also got more practice with TPNs (the vein nutrition), though I never wrote one on my own throughout the week. And for the nutrition management of most of the patients, I did what the doctor ordered the patient could have with their GI problem. A lot of people were on liquid diets and a lot of people weren’t allowed to eat anything – so my job was just being there to support the patient and assess when they were going to be able to eat/advocate for the patient to be able to eat or advance their diet in an appropriate amount of time.
I spent 1 full day of the rotation watching a GI seminar on DVD. This was 8 hours of sitting, which isn’t my favorite thing to do – but the conference was fascinating. It was more designed for nursing and given by a RN, but I learned a lot about the different GI diseases and medical/pharmaceutical management of them. Definitely glad this was part of the rotation!
I also spent a few hours in the GI lab, or where GI diagnostic procedures are done. I watched a EGD and Colonoscopy be done. An EGD is where an endoscope (camera) is put down a patients mouth and used to look at their stomach and their small intestines. During the EGD I watched, the patient had a few tumors that were biopsied and from there, it will be determined if they will be removed/what the next phase of treatment is.
The colonoscopy was fascinating. They removed quite a few polyps during the procedure, as well as biopsied part of the tissue as well. I saw polyps be removed two different ways – one without electricity and one with. I also decided I never want to have a colonoscopy, though I know one day I will have to have one.
I definitely never want to be a GI doctor who performs these procedures all day, but it helped me SO MUCH to see them done and get a better idea of the types of problems people have in their GI system.
I had a Chart Presentation from this week as well that I gave last week. This involves a 10 minute power point presentation on a patient that we saw to all the RDs in the hospital. We have to discuss the medical information (and teach what some things are) for the patient and then our nutrition care plan that we followed to treat the patient. I spent a TON of time on mine and had great help and advice from my preceptor. Everyone loved my presentation and I got a lot of great feedback from everyone, so I was glad to get the first one of these done already!
Really there isn’t too much else I can say. Every patient was different and we really had to tailor our nutrition care to what the doctors said the patient was able to tolerate. There were a lot of unique cases that I can’t go more into detail about – but just know it was a great experience. I understand the GI system much better than I did before the week and I was so happy to see some of these diseases/treatment in practice.