My internship officially ended Friday, so expect a lot of catch-up posts today and tomorrow!
After HBPC, my next rotation was Cardiology, my last clinical rotation before Staff Relief. For Cardiology, I worked with the dietitian who covered the in-patient Telemetry ward and the out-patient HemOnc clinic. This allowed me to get a little oncology nutrition experience, too.
It’s probably not a surprise to anyone who’s ever worked with cardiac patients, but I spent a lot of time encouraging patients to adopt a low-sodium diet. I spent a lot of time explaining that sea salt is just as bad as regular salt in terms of sodium content and reducing hypertension. For my patients who were cooks, I often went over different ways to prepare foods while cutting back the sodium content (using herbs instead of salt, looking for hidden salt in their seasonings, etc). For patients who didn’t cook and typically microwaved their food, I went over label reading, provided sodium guidelines for foods they purchased, and suggested ways they could reduce sodium in general. (A tip that everyone seemed to love and feel like they could manage was rinsing canned beans.)
I also promoted the DASH diet a lot, spoke about reducing dietary cholesterol, reducing saturated fat, and fluid restrictions. Talking about reducing dietary cholesterol and saturated fat was primarily done with patients with hypercholesterolemia, since lately the link between saturated fat and heart health has been questioned. While diet recalls are always an important thing to gather during assessments, it felt like they were really important in Cardiology because I felt like more often than not the patient’s dietary and lifestyle habits had contributed to the CHF or CAD diagnosis.
In addition to nutrition education from me, patients also got nutrition and lifestyle education from a cardiac nurse. There were three who met with every patient who came in with a new diagnosis of CHF, CAD, or AMI. The lead cardiac nurse also managed the heart healthy lifestyle classes, where patients came for a once a week class on different topics to help improve heart health (exercise, nutrition, smoking cessation, medication management, etc). My preceptor and I taught the nutrition class which focused on a low-sodium diet. Initially, I was just supposed to observe, since the class was on my second day in the rotation and the other interns didn’t have the class until a week into the rotation, but I showed initiative (key thing to do in the internship, btw) and jumped right in. My preceptor told me she got good feedback on how well we played off each other and how good a team we made, which made me extremely happy to hear.
One of the best experiences in the Cardiology rotation was being able to watch a patient get a stent placed. This meant I ended up hanging out with the Cath Lab (video’s not of the lab I worked in but gives you an idea of what a cath lab is like) and the really cool team that works there. The day I was there, there were a couple of nursing students so I didn’t get to be in the actual room during stent placements (the surgery room was too small for that many people) and I ended up watching from the observation room. Still pretty cool since I could see and hear everything, plus a sales rep was there and he was able to explain everything that was happening. Because we had to wait for test results, I had some time before the procedure to ask questions, and afterwards, I spoke with the doctor who had done the procedure. I ended up spending most of the morning with the Cath Lab who were all very friendly and willing to explain everything to me. In the afternoon, I ended up providing nutrition counseling to the patient.
As for the bit of oncology nutrition experience, there was a lot of focus on just getting oncology patients to eat. Often, when going through treatment, patients lose their appetite, their taste changes, or they experience frequent nausea and vomiting. So you really have to focus on getting the patient to just eat so they have the energy to get better. Check out this guide from the American Cancer Society for more information about the challenges of food and nutrition during cancer treatment. We didn’t really talk about diet for cancer prevention – that’s something that after treatment was completed and the cancer in remission was covered by the outpatient dietitians.
For more information about nutrition as it relates to cardiac health, check out the American Heart Association’s Nutrition Center. For information about cancer prevention, check out the National Cancer Institute’s Division of Cancer Prevention website.