Clinical Week 6

Clinical Rotation –  Week 6 Journal

Dates of rotation: Monday – Friday (May 7, 2018 – May 11, 2018) + Thursday (May 3, 2018)

Location: Springfield Dialysis Center

Activities & Assignments:

Thursday 5/3 (8 hours)

  • Mental Health First Aid training at Atlantic Dialysis main office at College Point, NY

Monday 5/7 (9 hours and 15 minutes)

  • Preceptor explained her role and job responsibilities.
  • Did rounds for different patient shifts
    • First shift starts at 5:30 am and then second shift starts at around 10 am. There are between 3-4 shifts each day but the first dietitian only covers the first 2.
    • Thoughts: It was very interesting to observe a renal dietitian interact with patients.  This was my first time being in a dialysis center, so I wanted to learn as much as I can.  Renal dietitians really must build up a good relationship with their patients since they see them multiple times a week.  As a renal RD, I have observed that you really need to develop empathy since these patients are going through such a difficult time.
  • Observed preceptor write her patient notes
    • Monthly case notes – preceptor needs to write monthly reports regarding each patient.
    • Progress notes – these are notes all the medical staff need to write on every day regarding any new information they find out regarding the patient.
  • Observed preceptor print labs and report cards
    • Thoughts:  I enjoyed looking through the patient report cards since I got to see their progress.  There are some patients who are very compliant with their diet. On the other hand, there are others that basically do not pay attention to what they eat.  The contrast was interesting to see.
  • Helped set up for in-service
    • Finalized preceptor’s PowerPoint presentation.  She wanted to make sure that everything will work on the television for her staff in-service tomorrow.

Tuesday 5/8 (9 hours and 15 minutes)

  • Observed rounds
    • Preceptor handed out patient “report cards” to patients in the first and second shift.  The patient report cards contain calcium, potassium, phosphorus, PTH, blood glucose, and other pertinent renal laboratory values.

      Thoughts:

  • Some patients are compliant with the renal diet while most patients do not follow it at all.
  • Preceptor has a different counseling approach for every patient.  I think it is more effective to have a personalized approach so that you can get the message across to each patient in a way they can understand.
  • Preceptor counseled a new patient that just started dialysis.
    • I observed and took notes.  I will be writing my own assessment of the patient based on the information I have collected and the information that will be provided to me (eg. patient’s lab work).
  • Coordinated care of patient with social worker
    • Patient had an issue and I asked if she wanted me to get the social worker for her
  • Observed In-service facilitated by preceptor for the dialysis staff
    • Preceptor gave a presentation about Fluid Management. Staff was receptive to the information and asked questions.

Wednesday 5/9 (2 hours)

  • Searched for renal recipes to be used during Lobby Day
    • Entree and dessert
      • Try to make these as protein dense as possible while being low in potassium, phosphorus, and sodium.

Thursday (9 hours and 15 minutes)

  • Rounds
      • First and second shift patients.
  • Care Plan and Notes
      • Care plans need to be filled out by the doctor, nurse, dietitian, and social worker once a year.  The care plan basically states what everyone involved in the patient’s care is planning to do for the next year.

Friday (9 hours and 15 minutes)

  • Rounds
      • First and second shift patients
  • Lobby Day materials
      • Started developing ideas as to what my plans are for this event.
        • Recipes
        • Flyer – made 2 flyers promoting the event
        • Educational handouts
        • Poster

Learning Objectives Met:

CRDN 2.1: Practice in compliance with current federal regulations and state statutes and rules, as applicable and in accordance with accreditation standards and the Scope of Nutrition and Dietetics Practice and Code of Ethics for the Profession of Nutrition and Dietetics.

CRDN 2.3: Demonstrate active participation, teamwork and contributions in group settings.

CRDN 2.4: Function as a member of interprofessional teams.

CRDN 2.5: Assign patient care activities to NDTRs and/or support personnel as appropriate.

CRDN 2.10: Demonstrate professional attributes in all areas of practice.

CRDN 3.1: Perform the Nutrition Care Process and use standardized nutrition language for individuals, groups and populations of differing ages and health status, in a variety of settings.

CRDN 3.3: Demonstrate effective communications skills for clinical and customer services in a variety of formats and settings.

CRDN 3.5: Develop nutrition education materials that are culturally and age appropriate and designed for the educational level of the audience.

Total Clock Hours: 48 hours

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