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Veterans Administration Central California Health Care System Preceptor: Clarissa (Cris) Stilwell Duration: August 26 t h to August 30 t h , 2013

FRESNO STATE dietetic internship

Location: VACCHS Medical Nutrition Therapy Working with Cris was a great experience but I learned so much and had more opportunities to apply textbook knowledge. I want to work in clinical once I become a dietitian and working with Cris confirmed hat clinical is a passion. The population at the VA is not widely varied, however the diversity of disease conditions range from diabetes to pancreatitis. During my rotation here I worked with patients in the intensive care unit and telemetry. In telemetry, I worked with a middle aged male patient admitted with pancreatitis. Cris stated in the VA, most patients with pancreatitis also had a history of alcohol abuse. During the interview the patient shared he has a history of alcohol consumption but has quit since; his wife prepare meals for him and he eats out often. His diet recent diet history consisted of Kentucky Fried Chicken and McDonalds; he is not compliant with the recommended low fat diet. During the time of his interview he was on day five of NPO status with active symptoms of pancreatitis. I was unable to help the patient while he was NPO, but over the course of the rotation I would visit him to check progress. At the conclusion of the rotation, his symptoms began diminishing. However it was difficult to discern if it was from the aid of pain medication. On my last visit with the patient, he stated that the doctors would be advancing him to a clear liquid diet. Unfortunately, before the conclusion of the day I was not able to check on his progress. I loved working in the ICU. In the ICU I observed an indirect calorimetry procedure on a ventilated patient. The process takes about 45 minutes to complete and the machine produces a detailed graph of Harris-Benedict equation for energy expenditure and actual energy expenditure. In this rotation it was my first gowning up before walking into a contact precaution room. My first patient was an elderly gentleman who was suffering from a multitude of comorbidities.

Veterans Administration Central California Health Care System

FRESNO STATE dietetic internship

In his room he laid alert but a bit gaunt looking; he was experiencing decreased appetite, diarrhea and significant weight loss. At the bedside was the patients wife who was crocheting dishtowels. I spoke with his wife because the patient was having difficulty orienting to time and place. His wife has been very diligent in caring for her husband and she was well educated in the diabetic diet. After the discussion, I concluded perhaps nutritional supplements two times daily will help increase his PO intake. Prior to the conclusion of the rotation I visited the couple again to say good bye and to wish them well.