Dietetic Internship
WEEKLY REPORT #
Name Emily Brantley
Facility Central Florida Kidney Centers
Cindy RD
22
Date: February 10, 2014
Supervisor: Donna, Michelle and
OBJECTIVES MET THIS WEEK (List the objective # directly from your Dietetic Internship
curriculum for each rotation you were involved with):
1. Rotation: Clinical – Renal
CRD 1.1 Learn the rationale for use of formulas for kinetic modeling, urea reduction ratio
and PET (peritoneal equilibrium test)
CRD 1.2 Review the basic physiology. Learn terms used in kidney disease. Review and
observe process of:
a. Hemodialysis
b. CAPD (continuous Ambulatory Peritoneal Dialysis
Learn common medications in ESRD. Calculate
a. Energy Needs
b. Protein
c. Sodium and fluids
d. Potassium
e. Phosphorus
f. Vitamins
CRD 1.3 & 1.4 Calculate meal plan for hemodialysis client and a CAPD client. Learn
rationale for diet restrictions after transplant. Learn about immunosuppressant medicines
CRD 2.4 Counsel Hemodialysis client on individual meal plan or specific aspect of dietary
noncompliance. Provide nutritional instruction for patient with renal disease.
CRD 2.5 Participate in the interdisciplinary team conference and refer patients to
appropriate community programs
CRD 3.1 Perform the nutrition care process for patients with ESRD. Assess client’s
knowledge of and adherence to diet restrictions and CRF (chronic renal failure)
a. Assess nutritional status of patient with ESRD
b. Diagnose nutrition problem and write a PES statement
c. Calculate diet plan for pre-ESRD client. Observe diet counseling and participate in
counseling and documentation in medical record
d. Monitor patient’s progress. Complete documentation that follows the guidelines
required by the practice setting
DESCRIBE THE ACTUAL ACTIVITIES PARTICIPATED IN THIS WEEK:
This week I completed my dialysis rotation with Kylee, the Andrews intern at Florida
Hospital Waterman. We had a great experience working together under the guidance of the
three different Dietitians.
1.1 & 1.2 With each dietitian we spent time learning the ins and outs of dialysis. For instance,
we learned how the hemodialysis machine works and how medications or even parenteral
nutrition can be infused into the blood before returning back to the body. We also learned
* There is a total of 30 weekly reports. It is important that you send them weekly to both the Dietetic
Internship Director and the Office Manager. The Verification Statement will only be given to those
that submit most of their reports.
Updated-04/2010
27
Dietetic Internship
about peritoneal dialysis and the calculations that determine how much volume is
administered into the peritoneal cavity. At these centers, I was exposed to fistulas and
patients with calcification. These are things that I had only seen previously in textbooks or
online. Throughout the week we got a lot of information on the medications and supplements
that nearly all dialysis patients are required to take. For example, Renvela, a phosphate
binder, must be taken with meals to avoid hypophosphatemia. Likewise, Vitamin D and
Calcium must be taken to delay or diminish the development of bone disease.
2.4 Together, Kylee and I did the monthly themed nutrition education to the patients at the
dialysis centers. This month the theme was potassium. We administered printed references on
low and high potassium food items as well as information on how to “dialyze” potatoes so to
leach out some potassium. It was evident that most of the regular patients had heard the
information before but they took the references to use when they are at home.
2.5 This CRD was met by attending the Pediatric rounds with other health care professionals
such as the Nephrologists, Nurses, Social workers and Case Managers and Donna, the Pediatric
Dietitian. Here we learned about the status and plan of care of every child that attends
dialysis at the Central Florida Kidney Centers from birth to 18 years of age.
1.3, 1.4 & 3.1 We discussed possible PES statements for different patients on dialysis. Some
of the problems that we saw were knowledge deficits for people who did not have a previous
need for dialysis nutrition and excessive mineral (phosphorus) intake for those whose levels of
phosphorus were very high. In reviewing the issues seen at the center, Kylee and I created
meal plans to meet the patients’ increased calorie and protein needs while keeping the
potassium, phosphorus and sodium within their allotted limits. This proved quite difficult for
a vegetarian patient as many of the high protein items, such as legumes or soy products were
very high in potassium.
COMMENTS (continue on next page if necessary):
The Renal rotation really helped me see what it is like to have to spend multiple days a week
connected to a machine that is essential for living. I don’t think I ever fully understood how
very committed dialysis patients have to be to the dialysis process for it to prove successful.
On a personal level, I have an Uncle who has been on dialysis for twelve years. I never went
with him to go receive dialysis so seeing it firsthand in this rotation made me realize how
complex the process is. On another note, I thought that the mindset of nutrition education in
dialysis centers is backwards of that in the hospital setting. That is, in the hospital, I find
myself promoting intake but at dialysis centers, I found the focus to be more on the
nutritional boundaries and restrictions. The dietitians that I worked with during this rotation
were phenomenal. Their knowledge of dialysis covered issues concerning nutrition,
medications and social circumstances.
* There is a total of 30 weekly reports. It is important that you send them weekly to both the Dietetic
Internship Director and the Office Manager. The Verification Statement will only be given to those
that submit most of their reports.
Updated-04/2010
27