Nutrition and Food Science: Be Part of the Solution

Corinne Bardsley, 2008-2009

Corinne Bardsley, Diary Entry #4

February 19, 2009

Hi again, this is the 4th entry of my intern diary. Since my last entry I have learned a great deal of information on Nutrition Support and have gained a tremendous amount of experience in utilizing it for critically-ill patients. Since then I have finished rotations in the Surgical Intensive Care Unit (SICU), Shock Trauma, and I am currently in the Pediatric rotation.

During my rotation in the SICU I really got to focus on patients who were status post major surgeries involving their GI tract and other organ systems affecting nutrition. I performed a vast number of TPN calculations, and even controlled electrolyte balances in those patients. I had to determine calorie and protein needs for patients who had minor surgeries whose needs were only slightly elevated, to those who had just had major, extremely complicated surgeries and other comorbidities, and therefore had calorie and protein needs through the roof! I learned about particular micronutrients that were important for certain conditions and the amounts to supplement in the patients, and overall just had a very great experience!

In the Shock Trauma rotation, I got to be a part of the only free-standing trauma hospital. It is the P.A.R.C of Maryland, has 92 beds, 36 of which are ICU, 36 IMC, and 20 Acute Care. It also admits neurotrauma, multitrauma, inhalation injury, minor burns, and necrotizing fasciitis patients. The Shock Trauma Center at UMMS is one of the largest in the nation, has 3 helipads for emergency helicopters to land in patients, and was the primary research institute for "the golden hour." During this rotation I learned about the difference between starvation and stress, the neuroendocrine response, the 2 phases of the stress response, the benefits of early nutrition and immunonutrition in trauma patients, and nutrition care for shock trauma victims, as well as those with neurotrauma (i.e. closed head injuries), and the bacterial infection of necrotizing fasciitis. It was a very crazy and insightful 2 weeks!

I am currently in the first week of my 4 week long Pediatric/ NICU rotation, and I am loving it! Pediatric nutrition is so very different from Adults, in that you're constantly reassessing everything about them, such as their nutrition intake, their anthropometrics via growth charting, and overall status. I have been seeing things in children that I would never see in adults, as children with these conditions either don't make it to adulthood, or by the time they are adults, the condition has been treated/ cured. I love seeing the little babies and cute little kids, the fact that they're ill does make me a little sad, but the fact that I'm able to help them feel better makes me very happy, so it's a little complicated!

After I have finished the Pediatrics/NICU rotation, I will be finished my clinical rotations and will begin my 3 weeks of Community. At this hospital, the community rotation is a mesh of multiple different things. During the 3 weeks I will spend some time with the Failure to Thrive Clinic here at the hospital, a Breath Mobile for Kids with Asthma that goes to schools in the Baltimore Area and educates about the link between nutrition and asthma (i.e. food allergies), the Bariatric Surgery Outpatient Clinic, and an outpatient dialysis clinic called Bon Secours. I will also be performing events for National Nutrition Month at the Hospital, which should be a lot of fun!

After Community I will spend 4 weeks doing Staff Relief at the hospital, and I am hoping to go back to the SICU. I will definitely let you know how it goes!

Once I have finished Staff relief, I will be starting the last 5 weeks of the internship in Food Service, which will be at St. Agnes Hospital. I will let you know how this goes as well!

Well, I think that's enough for now. I am going to get back to work planning my wedding for this July and working on my internship projects! It's going to be a very busy 4 months!

Please feel free to e-mail me any questions! I look forward to hearing from you!

Sincerely,

Corinne

Corinne Bardsley, Diary Entry #3

December 5th, 2008

Hello again! This is my third passage in my Intern Diary. It has been a crazy few months since I started my internship. Already I have learned so much, and gained so many experiences, and there are still 6 months to go!

Since the last time I wrote I had rotations in Renal Disease, Liver Disease, Transplant, Chronic GI Disease, Neurology, and the Medical Intensive Care Unit. In each of these rotations I studied the disease state and its nutritional complications, and then the nutritional therapy. In addition to learning about these diseases and therapies, I have also been increasing my patient interviewing skills, my cooperation and effectiveness in interaction with other medical personnel, such as Physicians, Nurses and Nurse Practitioners, Respiratory Therapists, Social Workers, etc..., and my patient care plan development. I am seeing more patients every day, being exposed to patients with multiple nutritional complications and adapting and developing the important skills needed as a clinical dietitian.

UMMC is world famous for performing transplants and follow-up care, so being there was very cool as this is a very interesting area to me of nutrition care. Renal disease has such significant nutritional complications, and during this rotation I developed a handout on foods that are high and low in phosphorus for use to educate patients at the hospital. I'm published! So far, however, the MICU has been the most interesting rotation, as this is the rotation where I first started seeing unconscious, intubated patients with multiple disease states requiring enteral tube feeds and possibly TPN. I liked it because all of the medical team was waiting on my notes for recommendations for feeding my patients. I got to make convincing arguments for different feeding tube formulas and rates, and the need for nutrition support. I got to look at the different lines and tubes that are coming in and going out of patients and what they are for, how they may affect my nutritional recommendations, and all sorts of other things that I would never have learned in school!

My next rotation will be GI, which will begin my experiences with TPN, which I am really looking forward to. Interestingly, at UMMC the Dietitians are responsible for not only the carb, pro, and lipid content of tube feeds as we learned how to do in school, but electrolytes, acid/ base balance, and vitamins and minerals, as well as changes needed to make for administration of particular drugs that is affected by or affects the TPN. I am so excited!!!!

Well, that's it for now. Good luck on finals and Happy Holidays!!
Sincerely,
Corinne

Corinne Bardsley, Diary Entry #2

October 11th, 2008

Hi again everyone, so I have finished my first two combined rotations, cardiac/ diabetes, and they were awesome!

In the cardiac rotation I spent time in the Telemetry Unit, Cardiac Surgery Step-Down Unit, and Cardiac Surgical Intensive Care Unit (CSICU). In the Telemetry and Step-Down Units I saw patients who had recently had cardiac surgery and were in recovery, eating and not on any ventilation devices, and just needed extra attention as they healed. Whereas in the CSICU I saw patients who were having problems before, after, and between their surgeries, and many of these patients were on ventilators or had recently been removed from them, so it was very interesting and challenging to get them proper nutrition. Between all of the units I saw about 3-4 patients a day, wrote SOAP notes and follow -up notes about them, and performed Heart Healthy Diet and Weight-Loss educations. I also was able to be in the operating room twice during my cardiac rotation, the first time I was able to see a 3 valve replacement/ Cryomaze procedure, where I was in scrubs and literally 2 feet from the patient's heart and got to see some really cool stuff! The second time I watched a cardiac catheterization where the patient had a severe blockage and had a stent placement. The blockage was so bad that the patient started having a heart attack on the table, but at the end of the procedure she was feeling much better. It was a very cool experience!

During my diabetes rotation I went to the Joselin center in the hospital, which is a kind of one-stop-shop for outpatient diabetes care as it has Endocrinologists, Opthamologists, Nurse Practitioners, and R.D.s all in one place to help individuals afflicted with diabetes in all facets of the disease. While I was there I was able to sit in with the R.D.s on educations and counseling sessions, I saw adults, adorable children, some with type 1 and some with type 2, a GDM patient, and a pregnant woman with type 1. The R.D.s there were great to work with and let me interject as often as I wanted during the sessions with any questions, suggestions, or comments that I had that would help the patients. I even got to sit in with a NP during her physical exam of the patient so I could see the patient's visit from that angle too. Also, the Joselin center lets me come back every Friday when they have lunch conferences where they discuss new journal articles and current findings related to diabetes disease and treatment. It is very interesting to see that they keep so up to date with their care, and the discussions are very thought provoking.

At the end of each rotation we have a post-test to make sure we got what we needed to learn out of the experiences and study guides, and since mine is Monday I had better go and study!

If you have any questions feel free to e-mail me, and good luck with exams!
Sincerely,
Corinne

Corinne Bardsley, Diary Entry #1

September 9, 2008

Hello all, my name is Corinne Bardsley, and this is the first passage of my intern diary. I am currently in my second week of orientation at my internship at the University of Maryland Medical Center in Baltimore, MD. I am writing this diary to give you students a better grasp of what it is like to be an intern. However, my internship is a very clinically based program, so the majority of my rotations may be different than those at other programs. Hopefully my experiences will be useful to you nonetheless.

The beginning of the internship is orientation, which for this program is two weeks of introductions, lectures, tours, and even a scavenger hunt! So far I have had lectures on on-line charting, SOAP notes, biochemical assays, triage of nutrition care, foodservices relating to patient care, formulation of pediatric tube feeding, nutrition assessment, etc. and I am even spending time with diet techs and Registered Dietitians while they do their work, and this is just during orientation!

Next week I will be starting my first clinical rotation (2 week period) in Cardiac care, and to prepare me for this rotation I was given an extensive study guide with terminology, pertinent articles, and many helpful and really cool reference materials to help me gain an even better understanding of cardiac nutrition. I am extremely excited to begin working with patients and enhancing the skills that I learned from my classes at College Park.

I hope this is enough to get you guys started, and if you have any questions please don't hesitate to ask me by e-mail: cbardsley@umd.edu.

Sincerely,

Corinne

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Last updated: 07/7/2010