I began my in-patient clinical rotation in early January, hence the lack of posts since then. My clinical site is about 1 hour away from where I live, which makes for early morning. Acute care is the longest rotation, 8 weeks, two of which are staff-relief. The first week was spent with the clinical nutrition manager (CNM) and was focused on building a foundation for the remaining weeks. 

Week 1:
Nutrition focused physical exam
Thorough chart reading
Obtaining subjective history, from patient, family and or long term care facility
Assessment chart note

Weeks 2 & 3: 
Diabetes and renal with assessments and rescreens of patients on the medical floor

Weeks 4 & 5:
Oncology and surgical assessments and rescreens with an intro to nutrition support

Week 6 (this week):
ICU nutrition support during critical care

Each week the CNM and I review two notes and discuss any and all aspects of the patient and why I chose the given diagnosis. Each day includes discussions of the metabolic state of patients with medication interactions and altered needs due to disease(s). 

I am thankful that my acute care rotation is later in my internship, as I have had experience working with other members of the medical team and patient interactions prior. 

So far the most interesting highlight has been working with the speech therapist. She let me observe a video swallow study and explained each component. In relation to another patient she explained the difference in a swallow study of a patient post-stroke compared to a patient who has a neuro-degenerative disease (such as Parkinson’s). It was important to learn this as the diet order and nutritional concerns for these two diagnoses vary.

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