I wrapped up my last week at the Brown Cancer Center! It was a great experience and I'm so happy to have had a wonderful preceptor!! In my last week I made a handout for high risk breast cancer patients and It was very helpful! On my last day I had the chance to counsel three high risk breast cancer patients and use my newly updated breast cancer handout! They loved the colors! I also took pictures of some of the books that were very helpful to me during the internship. The Oncology book had some great information on everything cancer related. The cancer from a dietitians POV was also a great book that I would like to read in the near future! I had to turn in my badge on the last day and it was very bittersweet. I'm so blessed to have had the opportunity to meet and form relationships with everyone at the cancer center and I will never forget what I learned!
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It is amazing how fast all of the weeks have passed! It is already the ⅚ week of the internship! I have 1 week left!! Time flies when you are having fun right!? :) One activity that I experienced was the Kentucky Legislative day! It was a great experience and our group had the chance to talk to Ruth Ann Palumbo! We spoke to her about House Bill 200, senate Bill 112, and the Drug screen for SNAP recipients bill. The House Bill 200 helps to provide fresh food to benefit the needy and kentucky farmers. Senate Bill 112 was important because it provides reimbursement for telehealth services, and it affects patients who have medicaid insurance. The opportunity to provide telehealth to patients who would otherwise not be able to make it to the hospital is HUGE, and health providers would get reimbursed for this. Lastly, we also spoke about the possibility of SNAP recipients being drug screened for qualification. We did not agree with this because a lot of SNAP recipients have children and we believe the children should not be affected by the possible actions of their caregivers. Ruth Palumbo agreed to vote with us on these issues and she also took a picture with us!! CRDN 1.3 Justify programs, products, services and care using appropriate evidence or data. CRDN 2.7 Apply leadership skills to achieve desired outcomes Another activity that I did this week was the presentation to breast cancer survivors! It was such a great experience. I planned for it for 2 weeks and it was very rewarding. I enjoyed being around so many inspiring and strong women. I would definitely do this again! I gave them a presentation on the ketogenic diet and breast cancer. The women were so appreciative of me giving them the information dn they were engaged throughout the entire conversation. The presentation was at the Gilda’s Club in Louisville. I would definitely go back!! CRDN 3.4 Design, implement and evaluate presentations to a target audience. CRDN 2.9 Participate in professional and community organizations. Over the last week I had the chance to have several counseling sessions with patients. It is very interesting to see how the couples interact with the strain of cancer on their relationship. After one counseling session the goal of the meeting was to change the patient's tube feed formula so that the patient will get more calories with less volume. The patients go through a lot throughout their diagnosis and treatment. After our counseling session my preceptor and I walked the couple to the elevator and the care and unconditional love shown between the couple was so amazing to see! It’s great to know that even after news that seems like it can be overwhelming people can still see the bright side of life. CRDN 2.4 Function as a member of interprofessional teams. CRDN 2.11 Show cultural competence/sensitivity in interactions with clients, colleagues and staff. CRDN 3.3 Demonstrate effective communications skills for clinical and customer services in a variety of formats and settings. CRDN 3.6 Use effective education and counseling skills to facilitate behavior change One competency that I achieved this week was CRDN 2.9 Participate in professional and community organizations. I did this by attending the competency meeting for the Registered Dietitians in the Kentucky area. This meeting was held in the University of Louisville Hospital Meeting room. One dietitian had to give a presentation and every came to support! Something new that I learned this was from a presentation that I went to for an inpatient Dietitian who works at the University of Louisville Hospital! Her name is Kathy Murakami, and she did a wonderful presentation on Chyle Leaks. A chyle leak is a milky odorless fluid from the lymph system. It is specifically lymph coming from the small intestine via the thoracic duct. My preceptor and I had a patient with a chyle leak and Kathy used the patient as a case study at the end of the presentation (Bibby, AC). CRDN 2.9 Participate in professional and community organizations. One activity that I did well was the presentation to breast cancer survivors! Competency: CRDN 3.4 Design, implement and evaluate presentations to a target audience. One activity that needs improvement is CRDN 4.9 Explain the process for coding and billing for nutrition and dietetics services to obtain reimbursement from public or private payers, fee-for-service and value-based payment systems. We talk about this sometimes when billing for tube feed formulas. I sent my first order the other day! We coordinate with LinCare/Option Care depending on patient insurance. References: Bibby AC, Maskell NA. Nutritional management in chyle leaks and chylous effusions. Br J Community Nurs. 2014 Oct; Suppl Nutrition: S6-8. doi: 10.12968/bjcn. 2014. 19, Sup11. S6. PubMed PMID:25381927. This week has been amazing! The first activity I did this week was a swallow study with the speech language pathologist Jen! I had to wear protective gear during the video swallow study. During the swallow study the patient couldn’t swallow without aspirating (choking). The swallow study wasn’t completed, so the patient couldn’t be cleared for a specific consistency of liquid. The next activity I completed was a counseling session with a phone interpreter. The patient required a Spanish interpreter, and the quickest interpreter was a phone call away. I remember learning about this during our counseling class! There were two phones, one for the doctor to speak in and one for the patient to speak into. It was very interesting to see how language barriers can affect health care. You could see the patient’s verbal reactions, but not understand what they were saying at that specific time. Then the interpreter listened over the phone and translated from Spanish to English. It’s also so interesting to watch the interaction. The doctor would make eye contact with the patient and then there would be a delay in the translation, and then the patient would respond. Sometimes the conversation would be delayed and the patient and the doctor would speak at the same time. If this happened the interpreter would first say the doctors response and then the patient's response. The interpreter told us she would do this in english, then she told the patient in spanish. It was a barrier in communication but everything ended up working out for the patient. It was a very serious conversation, so the patient was a little frustrated with the delay and the content of the conversation. The last activity I did was the completion of a breast cancer flyer for a breast cancer nutrition education session! I used canva and it came it came out so well! I had to put the James Graham Brown Logo at the top of the handout. In the education session the patient came to Loran’s office and wanted to know of some healthy ideas to add to her diet currently. In the session the patient was already eating a lot of health conscious foods. She just wanted to make sure she was doing the right thing in relation to her breast cancer. I made sure to tell her the importance of having smaller portions, limiting fat intake, and increasing fiber and protein. If she did this she would feel full for longer periods of time. The nutrition education session went well and I gave her the handout at the end of the session. I achieved CRDN 3.5 Develop nutrition education materials that are culturally and age appropriate and designed for the literacy level of the audience. On Monday I have my presentation to a breast cancer survivorship group. The presentation I am giving to them is about the ketogenic diet and breast cancer. The ketogenic diet is high fat, low carbs, and moderate to low protein. The group is looking to learn more about the ketogenic diet and how it affects breast cancer. The ketogenic diet was historically used to treat epilepsy in children (Champ, CE). The ketogenic diet is a very strict diet that requires a gram scale to weigh your food, and ketone urine strips to test your urine. The diet has not been approved to manage cancer by itself, but some people are very interested in learning more about it. One activity that I did well was forming a handout for the breast cancer counseling session CRDN 3.6 Use effective education and counseling skills to facilitate behavior change. One CRDN 4.10 Analyze risk in nutrition and dietetics practice. Competencies Achieved: CRDN 2.2 Demonstrate professional writing skills in preparing professional communications. CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings. CRDN 2.4 Function as a member of interprofessional teams. CRDN 3.5 Develop nutrition education materials that are culturally and age appropriate and designed for the literacy level of the audience. CRDN 3.6 Use effective education and counseling skills to facilitate behavior change CRDN 3.8 Deliver respectful, science-based answers to client questions concerning emerging trends. Sources:
I finally started my internship. This week has been amazing. For this rotation I will be a Dietetic intern at the James Graham Brown Cancer Center! I have been blessed with such an inspiring and passionate preceptor and her name is Mrs. Loran Griffith! Every morning we get to the office around 7:30am and we check our schedule at the beginning of the day. I have my own desk and we just upgraded my laptop to a desktop computer. Mrs. Griffith is so organized and in the first week we had all of my access turned on so I could get into the cancer center, my passwords to log on to the system, and my parking lot access. In the first week we started by seeing patients and touring the facility. It’s so funny because on the first day of the internship classes were cancelled at UK due to snow and I was nervous to drive in the snow because I usually don’t in GA. I made it safely and when I got to know my preceptor during our weekly lunch chats she told me she lived in Alaska with her husband before moving to Louisville!! Talk about a lot of snow!! She said her coworkers would cross country ski to work!! I’m overjoyed and blessed to be able to experience my community rotation at a cancer center! Usually when you think of a community rotation you think YMCA and children’s nutrition. I was pleasantly surprised when I read I would be at an outpatient cancer center for my community rotation. I’m so glad my teachers saw this would be a great fit for me because I love it! I enjoy getting to talk to the patients to see how they are doing. Most of the patients at the brown cancer center have head and neck cancer, but we see different kinds of cancer everyday day including but not limited to: breast, pancreatic, liver, colon, prostate etc. It’s amazing to see the progression of chemotherapy and radiation treatment. Most patients complain of extreme burning sensations and swallowing difficulty when they have had around 10 cycles of treatment. On the outside the treatment site has a similar look to a very bad sunburn. I am glad I have the opportunity to learn more about different kinds of cancer. My nana passed away from lung cancer and we also see a lot of patients with lung cancer as well. The high amounts of head and neck cancer is due to the excessive amounts of smoking, alcohol intake, and HPV diagnoses in the area. Some people have to travel from different areas in Kentucky to come to their appointments at the Brown cancer center and they come almost every day. You can only imagine the emotional stress this can place on the patient and the families. During some of the consults with patients they can get emotional and it’s important that you recognize that they are going through so much and it’s important to listen and give them the best nutrition assessment you can! This is an example of CRDN 1.3 Justify programs, products, services and care using appropriate evidence or data. We had to give a nutrition assessment to a patient on the first day of my internship. I watched my preceptor ask all the pertinent questions regarding how the patients is feeling and if they are getting adequate nutrition. This week I counseled my first patient on my own. I had to first prep my counseling visit by getting the necessary patient background. then I had to locate where the patient was in the hospital. then I had to use the counseling skills of motivational interviewing to see why the patient had such a low BMI. This was due to thelack of taste and difficulty swallowing that comes with H&N cancer patients. I learned about cancer cachexia and how important it is to keep patient weights stable during treatment ( Buchalla, 2017). Then I had to see what I could do to help the situation by providing different nutrition supplements to help them gain weight. I had the opportunity to watch a tube feed teaching session from my preceptor to a patient with a newly placed PEG tube. She did a great job of breaking down the steps to the family of the patient. The family had a lot of questions and she provided them with a info booklet and step by step written directions regarding the care and maintenance of the tube. It’s important that the patient continue swallowing for as long as they can to keep the throat muscles strong. The PEG tube is a feeding tube that goes directly to the stomach. Another activity I had the chance to participate in was a presentation done by one of the Registered Dietitians in the area on wound care. She spoke about the importance of knowing the different stages of wound care and knowing when to increase protein in patients with wounds. The correct answer is through all the stages you want to increase protein. The healing benefits of protein really allow patients to get better faster. I had the chance to watch a laryngectomy patient have their treachoesophageal prosthesis (TEP) placed today. This tube pushes air from the windpipe to vibrate against the esophageal walls. This creates a “burpy” sound that will be the way that patient talks for the rest of their life. Lastly I had the chance to see a barium swallow test. This barium swallow test was interesting because the patient had a heated high flow nasal canula. This funnels 55 liters/min of oxygen into the patient!! If you breathe through your mouth regularly you are only taking in about a liter of oxygen. This week I did a great job at working with others in a professional setting (CRDN 2.4 Function as a member of interprofessional teams.). I would like to work on CRDN 2.8 Demonstrate negotiation skills. Competencies Fulfilled:
CRDN 1.2 Apply evidence-based guidelines, systematic reviews and scientific literature CRDN 1.3 Justify programs, products, services and care using appropriate evidence or data. CRDN 3.8 Deliver respectful, science-based answers to client questions concerning emerging trends. CRDN 2.2 Demonstrate professional writing skills in preparing professional communications. CRDN 1.1 Select indicators of program quality and/or customer service and measure achievement of objectives. CRDN 1.4 Evaluate emerging research for application in nutrition and dietetics practice. References: Buchalla , N. (2017). Computed tomography diagnosed cachexia and sarcopenia in 725 oncology patients: is nutritional screening capturing hidden malnutrition? Retrieved January 29, 2018, from https://www.ncbi.nlm.nih.gov/pubmed/29271097 University of Kentucky, Orientation: Week 1 Welcome to my blog! My name is Jada Linton and over the next 7 months I will be in 3 locations. I will begin at the James Graham Brown Cancer Center in Louisville, KY for my community rotation. Then I will travel to Owensboro, Kentucky for my food service rotation with Owensboro public schools. Lastly, I will be in Louisville, KY again with the Jewish Hospital for my clinical rotation. I am officially a dietetic intern and couldn’t be more excited for the new opportunities that I will experience in the upcoming months! Rotations: Community: James Graham Brown Cancer Center~Louisville, KY~ January.16-March. 2 Foodservice: Owensboro Public Schools~Owensboro, KY~ March. 5- May. 11 Clinical: The Jewish Hospital~ Louisville, KY~ May. 21- July. 27 This week was orientation week and we had a lot of time to reflect on the book we read over winter break: The Energy Bus. We also went over all course materials, paper work, questions, past intern reflections, a farm tour, and a service project. This week was a great chance to come together as a team and tie up any loose ends before we all departed to our respective locations for our first rotation! During the book club discussions we met the following competency: the CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings. On the first day of orientation we started at 8:30 am. We all introduced ourselves to the group. We also had a wonderful overview of the Nutrition Focused Physical Exam done by Katie Lewis, RD. We had the chance to familiarize ourselves with his process by pairing up to do a physical exam on the person sitting next to us. The nutrition-focused physical examination (NFPE) can identify or confirm muscle wasting, subcutaneous fat loss, and edema and clarify information gathered during the medical record review (Green Corkins. (2015). Nutrition-focused physical examination in pediatric patients. PubMed). The process was new to me, and I was happy we had the chance to try this before our internship. We now have basic knowledge about how to begin the Nutrition Focused Physical Exam. We started at the head and worked down to the toes for the physical exam. Ms. Lewis made sure to tell us to use our three fingers between the thumb and pinky finger to conduct the exam. The orbital fat pads are right under the eyes. The orbital fat pads should be bouncy to the touch, and in someone who is wasting the skin would be less elastic. After we finished up the physical exam we had past interns come to talk to us about their internship experience. I always love this part because you can see how much growth the interns have experienced from the way they talk about how they felt about the internship before and after completing it. After the internship reflections we continued with our schedule and Dr. Plasencia introduced our DHN 518 course. We went over the research paper for DHN 518 and possible questions we could think of pertaining to the class. After this we had Mrs. Gladstone walk us through any remaining paper work. This was helpful for the people who could not register for all of their classes. I'm glad our program is so thorough with making sure we have all of the materials we need completed before moving on the next step. Mrs. Gladstone always makes some of the more complicated matters much easier by coming organized and prepared! On day 2 of orientation we went over the rest of the courses we will be enrolled in during the internship: Community, Medical Nutrition therapy, and Food Service. Chef bob made us an amazing on campus lunch. The sweet potatoes were definitely my favorite part! Sweet potatoes are my favorite fall vegetable. On this day we had a farm tour of Elmwood stock Farm. I rode to the farm with Lauren and Melanie. When we arrived at the farm it was a little chilly outside. The most interesting part of the tour was finding out that the public funds the farm. It was also interesting to know that everything is organic, and if needed there are places they can order ladybugs and praying mantis’ from to spread across the farm to help ward of pests! Finally on the last day we had the chance to complete a service project at God's pantry! It was so fun, we re-packed 967 pounds of flour!! I'm glad I had the chance to bond with the UK SPP group and complete this service project. Together we can solve hunger and we did a service project to help push Lexington in the right direction! One competency that I did well with was the CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings. We completed these competencies during each group discussion, and service project. One that I need to improve on would be: CRDN 3.2-Conduct nutrition focused physical assessment. I’m glad Ms. Lewis gave us a brief overview of the Nutrition Focused Physical Exam; however, I would like to be more comfortable with it! Competencies completed: CRDN 2.3 Demonstrate active participation, teamwork and contributions in group settings. CRDN 3.2-Conduct nutrition focused physical assessment. Sources: Green Corkins. (2015). Nutrition-focused physical examination in pediatric patients. PubMed. |
AuthorHello! My name is Jada Linton and I am Dietetic Intern at the University of Kentucky. Welcome to my blog, follow me on my journey through my internship, it is going to be exciting!! Archives
March 2018
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