Renal Dialysis Unit

This past week marked my first pre and post hemodialysis clinic in the Renal Dialysis Unit (RDU) in the hospital. What a pre and post day includes in that the dietitian (and myself) go to the clinic three times (10:00, 14:00, 19:00) on Wednesday and Thursday to see the hemodialysis (HD) patients. For those of you whom are unfamiliar with dialysis, here's the basics: depending on how often each patient needs to have HD, depends on how many times they need to go to the clinic to have their blood cleaned (remove PO4, K+, fluid, add calcium, etc. depending on the individual - i.e. not everyone will have fluid removed or calcium fortified above the norm). Some people go to the clinic three times a week (M, W, F), some go four times (M, W, F, Sat), or some can go twice (T, Th). It all depends on what the nephrologist determines would be best for each individual patient. There are different start times in the RDU for HD, which is why the dietitian and I went at three different times each day. This allowed for the patient to be set up on dialysis and for their pre-dialysis blood work to be returned from blood services.

What the dietitian and I did while we were in the RDU: we looked at the patient's pre-dialysis blood work (urea, creatinine, phosphorus, potassium, calcium, magnesium, and albumin), wet weight, dry weight from the previous HD day, and ask the patient how they have been doing in regards to eating (compliant with individualized renal diet?), if they have been or are on any phosphate binders such as Tums or Renegel (which help to bind the phosphorus in foods that are eaten to reduce the phosphate load in the body) and when they take them if they are on them. We asked how their bowels are doing, if they had any nausea or vomiting or illnesses over the past month (which could have an affect on their blood work and weight), any supplements taken (Nepro, Ensure, Glucerna, Boost), if medications have changed (we also check in the chart to verify), and provide encouragement or diet education when required. It is quite the busy time going from patient to patient - seeing ~ 4 or 5 patients in each time slot, then charting on each one.

I was able to the various routes of HD, i.e through a central line access or through fistulas made via surgery in the arm (fusing together a vein and an artery to help the vessels handle the increased blood flow when the blood is being pumped out of and into the body). I was able to see a very interesting patient who had a fistula in his left arm, but had multiple aneurysms in his arm that throbbed and pulsated. I asked the nurses if this was common, and apparently it is. Patients can be given a protective sleeve to help protect the aneurysms, but usually the patients just try to be careful.

I found it very interesting to see the HD machines up close, look at the lab values of each patient, and to speak with the patient regarding diet compliance, medication compliance, and chatting with each patient. Because the patients do frequent the RDU numerous times a week, a rapport is able to be established whereas with in-patients in the hospital, this is difficult as they are only in hospital for limited amounts of time.

While in the RDU, I was "tested" on my knowledge of the nutrient content of foods (phosphorus, sodium, potassium) as well as on my knowledge of renal and diabetic diets. I learned a lot about ideal lab values for dialysis patients vs. pre-dialysis patients vs. the average healthy population. Very interesting and educational experience.

Interprofessional Learning Experience

This past week marked the first of 5-weeks that I will be involved in an Interprofessional Learning (IPL) Experience. 

What is IPL?
"...it provides opportunities for learners from two or more disciplines to learn with, from, and about each other to improve collaboration and the quality of care" (CAIPE definition 1997 revised).

The different students that I will be working with over the next 5-weeks are from the following disciplines: nursing (2 students), recreation therapy, pharmacy, and dietetics (me!). We're a group of only 5, but I can see from our first meeting that we'll get along very well and each are driven to get as much out of the experience as possible. We meet twice each week: once on Wednesdays over lunch with just the 5 of us and two instructors (one from nursing and one from dietetics), and then we all attend stroke rounds Thursday afternoons. On February 10th, we are to present to a group of people from various disciplines, including our individual preceptors, regarding our experiences in IPL. I have an idea for the presentation, and I'm eager to bounce it off the other IPL members next Wednesday to get their input and opinions on it.

In our first meeting, January 11th, we had an activity where our disciplines were written on large white paper and stuck on the walls. We were then to go to every discipline but our own and write down the roles and responsibilities of each. Well, I had thought I had a good understanding of what nursing, pharmacy, and rec therapy professionals do, but I clearly only knew the basics. This activity was the first, of what I believe, will be many educational opportunities that I will experience over the next 5-weeks. I have no doubt that this group will provide me with a better understanding, respect, and appreciation for allied health care.

My experiences working with multiple-disciplines has not before been with a group of students, but rather with me being the only student amongst a group of professionals. In the different facilities and hospitals that I've either worked in or volunteered with, this has been the case, so I hadn't before had the chance to ask questions regarding roles and responsibilities of other disciplines (in a comforting and supportive environment). I am excited to see what unfolds over the next 5-weeks and to assess my own personal mental and creative growth that I know will occur during the IPL experience.

New Year, New Rotation

Handy book I was given for Christmas.

After a fantastic Christmas at home, in my new home, I am back in Yarmouth and have finished my first week in my Clinical rotation. I am currently in the area of stroke and renal and I anticipate learning a lot over the next 4-weeks.

Each week there is an assignment to complete. Week one's was focused on dysphagia, aspiration, and the dysphagia diet. Week two's is more in-depth focusing on protocol, what to look for when doing swallow assessments, etc. I have yet to read through week 3, but will let you know in the not-too-distant-future.

So here's a recap of my week:
Tuesday and Wednesday I essentially observed and answered questions the P.Dt. asked me. On Wednesday, however, I got to see my first Modified Barium Swallow which is a video x-ray of a person showing how they swallow (ie. the physiological function of the muscles, how well/easily/safely the food is swallowed or aspirated) to determine if they are safe to have food by mouth (po) or if they should be NPO or nothing by mouth. I had seem YouTube images before and recordings of MBS' in school, but seeing it live was so interesting! Hearing the Rad. Tech and the Speech-Language Pathologist and the Dietitian discussing what they saw on the screen, each inputting their own specialty wealth of information, was really impressive to witness. Thursday I started charting and having a more active role, and by Friday I was charting, calculating tube feeds (rate, formula, and energy, protein, and fluid requirements of the Pt.), and interviewing patients. I know that this week is going to be even busier so I best keep on-top of my studying to keep all the information fresh and "at the ready".