Amanda Hodnett - Region 3

​During my clinical rotation I had a special interaction that quickly became a memorable experience in my internship. It was one of the first times I saw a patient on my own. After learning all the information and skills from nutrition classes and seminars I have attended, I felt fully prepared and confident entering this patient's room.
 
Before visiting a patient for an initial assessment I will always look over their charts to see their diagnosis, diet order, past medical history, any important notes relating to their health condition and their reason for admission. While looking over her chart I noted that she was currently NPO (nothing by mouth) and did not have a diet order in place. This brought immediate concerns, such as how long has she been NPO, what is the reason for her not eating, and did she receive a dysphagia screen or swallow evaluation.
 
I did a little more reading into her chart and found that she was diagnosed with thyroid cancer in the past year and she was admitted into the hospital for an aspiration episode. The patient has reported recent difficulties with swallowing at home. She had failed her dysphagia screen and received a swallow evaluation by the speech language pathologist. In the swallow evaluation note, they recommended keeping her NPO with the exception of puree liquids for pleasure, they also recommended alternate means of nutrition for her. The doctor agreed with this and they were planning on starting her on Jevity 1.5 that day through a nasogastric tube. Since she failed her dysphagia screen, I was going to visit her that day. In the meantime we got a consultation to provide this patient with a feeding tube goal rate. With all my practice doing enteral tube feeding calculations through Sodexo, I felt fully confident while making her recommendations to meet her needs.
 
When I visited her, she was clearly anxious and scared. I introduced myself and told her my reason for the visit. I used my motivational interviewing skills to ask her a few questions. After receiving some information from her, I mentioned that the nurses were going to place a nasogastric tube. This brought her a lot of worries and questions. We discussed that alternate means of nutrition doesn't always mean it's permanent, and that we will order another swallow evaluation to further investigate. In the meantime, I assured her how important it was to receive nutrition for her body to get stronger.
 
I also talked to her about her options with puree liquids so that she can have some pleasure. She kept expressing her gratitude for me listening, calming her worries, and providing her with information about the NG tube and how it works. She was very grateful for me providing her with medical nutrition therapy. It was one of the first times during my internship that I felt like I made a positive impact on a patient's life and their hospital stay.

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