Lesson 6: Changing Hats

flickr photo from splinkyhoo

The dietetic internship goes on: first week on the Intensive Care Units (ICU) is over!  Learning-induced headache?  Yes.  Excited to work this weekend?  No.  Thankful for the amazing ICU staff?  Yes.  These nurses and docs are the best!

The ICU houses the very sickest patients in the hospital-those most likely to need breathing support, fluid stability, and pain control.  From a nutrition standpoint, many of these patients need feedings through tubes and IV catheters.  Calculating IV nutrition is a new role, and a new hat that I'm adding to my closet.

(Photos from a NYC trip last month.  Pardon my randomness.)

People often ask me, "What is a dietitian?  What are you learning in the hospital?"  Earlier I wrote about a dietitian's contribution within the larger medical team.  As a member of this team, a dietitian must don different hats depending on the situation.
Examples From the Hat Rack:

• Educator:  (A unique role that doctors do not have time to do!)  In a few brief minutes, dietitians provide knowledge and application on a variety of topics spanning carbohydrate foods for a newly diagnosed diabetic, to food safety instructions post kidney transplantation.  No poking, no prodding, just talking.  And I love the talking!
• Cheerleader: After 10 days of nausea and vomiting, a patient wakes up with an appetite.  What to do?  A dietitian pulls out her pom poms to cheer her on, shouting out tips and encouragement to optimize eating and nutrition.    
• Nutrition Support: Sometimes a patient needs IV nutrition or tube feeding because they cannot eat.  That's when a dietitian whips out their calculator to calculate and concoct a feeding formula to meet a patient's individual protein, calorie, and fat needs.  I like doing this work.
• Consultant: A man with cerebral palsy is admitted with breathing problems and a mysterious 40 pound weight gain in recent months.  While the doctors tend to his respiratory needs, a dietitian is consulted to assess the weight situation.  What are the specific energy and protein needs for a man with cerebral palsy (they are actually decreased due to less muscle mass and activity)?  How much weight, if any, should this patient lose?  Dietitians use their expertise to investigate and provide recommendations for the medical team.

Note: This is based on my opinions and experiences thus far at Tufts Medical Center.  Outside of the hospital, dietitians enjoy a variety of roles in diverse settings which may include outpatient clinics, private practice consulting, sports nutrition, research, public health, culinary arts, corporate wellness, and food industry.

Have a fabulous Friday.

Rach
ps- Thanks for bearing with my journal entries and absurd titles.  I love sharing my thoughts, and I also want to promote the field of clinical dietetics!