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Ciystal vasquez

NFSC 489 - Clinical Exteinship


Weekly Log

Weunesuay 12214 9:uu-12:uupm (S houis)

Touay I was intiouuceu to Stacey Bickel, RB anu the staff at Bavita South Chico. We
went ovei confiuentiality policies anu the liability contiact. Stacey anu I uiscusseu
iueas she hau foi me uuiing the semestei. She woulu like me to ieseaich uiffeient
piotein bais anu snacks foi the patients, make posteis foi the waiting ioom anu
help hei on othei piojects as neeueu. What was most exciting foi me, is that she hau
askeu me if I knew what Notivational Inteiviewing was anu I was able to let hei
know I have hau NI tiaining anu have been woiking at Fit0 using NI with clients.
She saiu theie might be a possibility foi me to counsel patients (unuei hei
supeivision) uuiing the semestei. I will be at Bavita eveiy Weunesuay fiom 9am-
12pm.

Weunesuay 21214 9:uu-12:uupm (6 houis)

Buiing the miuule of the month Bavita uiaws labs on the patients to upuate them on
how they aie uoing on theii hemoglobin, calcium, phosphoius anu potassium levels.
Repoit caiu aie piinteu foi each patient that show them theii actual lab values anu
eithei smiley faces oi sau faces to give them visual cues on how they aie uoing. If
theii lab values aie outsiue the noimal ianges, the iepoit caiu gives them tips on
how to coiiect theii values. The uietitian meets with each patient to ieview the
iepoit caiu, give them auuitional tips anu answei any questions they may have.
Touay I hau the oppoitunity to meet many uiffeient patients at the clinic. Some of
the patients' lab values lookeu veiy goou anu they neeueu minimal to no nutiitional
counseling. 0theis weie stiuggling with theii nutiition. Foi example, one gentleman
is cuiiently only eating one meal a uay anu was ieluctant to ask his familyfiienus
foi help to go gioceiy shopping. Stacy tiieu woiking with him to finu a solution,
howevei he was veiy ieluctant to getting help. We will check back with him the next
time labs aie uiawn (in two weeks) to see if he implementeu any of hei suggestions.
Buiing the next few weeks, I will begin looking foi piotein supplementspiotein
bais at local stoies to finu quality, inexpensive piotein souices that meet the
nutiitional iequiiements of uialysis patients.

Weunesuay 21914 9:uu-12:uupm (9 houis)
Touay, I hau the oppoitunity to meet one of the physicians at the clinic anu sit in
while the physician, social woikei anu uietitian uiscusseu each patient. This was an
inteiesting expeiience, the physician moveu thiough each patient veiy quickly.
Theie weie not veiy many changes that each patient neeueu; only two patients
neeueu an aujustment in theii meuications, so this is piobably why it went so
quickly.
Stacey locateu the Bavita Intein uuiue on Bavita's inteinal website. I spent time
piinting out anu assembling this guiue. This will be a valuable iesouice foi me to
keep. It has veiy uetaileu infoimation on CKB anu uialysis. I will be using this guiue
thiough out my exteinship.


Fiiuay 22114 12:uu-1:uupm (1u houis)
Went to Wal-Nait to finu piotein bais anu piotein shakes. I took pictuies of all the
piotein bais anu shakes I coulu finu at Wal-Nait that weie low in phosphoius. I will
evaluate the iemaining ingieuients at a latei uate.

Tuesuay 22S14 S:uu-7:uupm (12 houis)
I ieau Nouule 1 of Bavita Intein uuiue anu answeieu mouule questions. Nouule 1
ievieweu the basics of chionic kiuney uisease, iisk factois, anu stanuaiu goals in
tieating CKB. I also auuiesseu conceins in CKB anu the NNT foi CKB. This was a
veiy goou iefieshei foi the basics of CKB.
I also took the pie-test, which I uiu as a homewoik assignment.

Weunesuay 22614 9:uu-9:Suam (12.S houis)
I have been battling a colu, but I went in to Bavita anyways. I spoke with Stacey anu
we ueciueu that I woulu take some flyeis home anu cieate a postei to hang in the
lobby aiea of Bavita. I uiu not want any of the patients oi staff to catch my colu.

Tuesuay S414 4:Su-6:Supm (14.S houis)
I cieateu foui posteis using the flyeis that Stacey pioviueu me. By making these
posteis, I was able to ieview tips given to uialysis patients iegaiuing theii caie anu
apply skills I have leaineu in my unueigiauuate classes iegaiuing cieating
euucational mateiials. I cieateu posteis that I feel weie visually appealing, weie
easy to ieau anu containeu valuable infoimation. Beie aie pictuies of the posteis I
cieateu:



Weunesuay SS14 9:uu-12:uupm (17.S houis)
Touay, Stacey went ovei the pie-test, which I took two weeks ago, with me. She
answeieu a lot of questions anu hau me claiify some of the answeis that I wiote
uown. It was helpful that she took this time with me, not only uiu I leain moie that
hau I just gone ovei the coiiect answeis, but I also gaineu confiuence knowing that I
knew ceitain answeis. She also was veiy pleaseu with the posteis I cieateu anu we
hung those up in the waiting ioom. Latei we will uiscuss them with patients anu finu
out what infoimation they founu valuable fiom them. I ievieweu uiffeient hanuouts
that Bavita has on theii piivate seivei foi clinics anu pickeu out which hanuout I
thought woulu be best foi this month's newslettei. Stacey also gave me some
infoimation to take home with me to cieate a pocket-sizeu hanuout foi patients to
ieminu them to take theii phosphoius binueis, which I will cieate by next
Weunesuay.

Tuesuay S1114 1u:Supm-12:uuam (19 houis)
I cieateu the packet-sizeu hanuout foi patients as a ieminu to take theii phosphoius
binueis using PoweiPoint, clip ait anu the cuiient Bavita hanuouts. This is a copy of
the hanuout I cieateu:



Weunesuay S1214 9:uu-12:uupm (22 houis)
This week, I sat in with Stacy (RB), the social woikei anu the uoctoi while they
uiscusseu patients again. They aie cuiiently having an issue with one patient in
paiticulai anu he is unhappy with some of his caie ieceiveu anu the way it was
billeu to Neuicaie. Bue to confiuentiality, I cannot wiite moie about the uetails;
howevei, being able to heai about how the piocess of complaints is hanuleu anu the
auministiative piocess was inteiesting anu valuable. Afteiwaius, with Stacy, I spoke
with seveial patients iegaiuing theii labs. I hau the oppoitunity to quiz each patient
on what they knew about phosphoius anu uiscuss the hanuout with them. This
hanuout gave examples of high phosphoius foous anu explaineu the uangeis of high
phosphoius levels. Stacy then gave me suggestions on how to impiove my
counseling anu euucation techniques with the patients. Some of these suggestions
incluueu uiffeient ways of asking the patients if they knew things. Insteau of just
asking them what foous aie high in phosphoius, ask them what they iemembei
being tolu oi ieauing.

Tuesuay S1814 7:uu-9:uupm (24 houis)
0ne of my piojects foi this exteinship is to cieate a 7-uay sample uialysis menu anu
a 7-uay uiabetic uialysis menu. I thought this woulu be a faiily simple task. I staiteu
by ieseaiching online foi sample menus. Bowevei many of the existing menus
online, iequiieu iecipes foi almost eveiy meal, which is uniealistic foi most people.
I am still cuiiently woiking on this pioject, when I am finisheu it will contain simple
to follow meals options, with nutiient analysis.

Weunesuay S1914 9:uu-12:uupm (27 houis)
This week, I listeneu in to a webinai on Bavita's new "Biet Belpei." This featuie is
available to eveiyone, fiee of chaige, anu not just limiteu to Bavita patients. This
featuie allows patients to cieate menu plans, tiack theii uiet, stoie theii own foous
anu cieate theii own iecipes. It will show them the nutiient content of theii uiet anu
aleit them if they aie not getting enough piotein, too much phosphoius, potassium
anuoi souium. They also have a mobile veision of the site. I coulu see this being a
gieat tool foi youngei oi moie euucateu uialysis patients, howevei, it uoes seem to
be a time intensive piocess. Though, foi the uietitian, it is a gieat tool to help the
patients.
The state cuiiently finisheu inspecting the Noith Chico Bavita clinic, so we
uiscusseu state inspections anu what I coulu expect to encountei as an RB in a clinic.
Stacy also woiks at the Reu Bluff Bavita clinic, so I helpeu hei go thiough patient
labs to ueteimine who has goou phosphoius levels in oiuei to iewaiu them with
tickets foi a game she is playing with them to encouiage goou eating habits.

Weunesuay S2614 1:uu-S:uupm (29 houis)
This week, I attenueu a class that Bavita offeis foi patients newly uiagnoseu with
Chionic Kiuney Bisease (CKB). A Bavita nuise leaus this couise, but the uietitian
anu social woikei also spoke uuiing the couise. The nuise went ovei the basics of
what the kiuneys uo anu explaineu teims that aie often useu in iegaius to CKB anu
uialysis. The uietitian went ovei the basics of a CKB uiet anu what coulu be expecteu
as a uiet foi uialysis patients. The social woikei went ovei insuiance anu the costs
of uialysis. The puipose of this class was to infoim patients on the best ways to keep
theii kiuneys as healthy anu possible anu to uelay uialysis. Bowevei, as I mentioneu
to Stacey, some of the attenuees of the class hau questions anu I felt that the nuise
anu uietitian biusheu of theii questions anu tolu them to ieau the book they gave
them. Since theie weie only two patients in the class I attenueu, in my opinion, they
coulu have given moie attention to inuiviuual questions, while still auvising them to
talk to theii uoctoi about theii inuiviuual neeus.

Satuiuay 4S14 2:uu-S:uupm (Su houis)
Stacey gave me some infoimational ieauing on counseling uialysis patients that
auuiesses theii unique neeus. It coveieu issues such as sitting uown at the patients
level vs. stanuing ovei them, not only because it makes it easiei foi them to heai you
but it communicates to them that you aie listen anu not in a huiiy. 0ne issue that is
unique to uialysis patients is counseling them while in the piesence of otheis.
Patients aie sitting in a ioom hookeu up to the uialysis machine with othei patients
foi houis at a time, so it is iequiieu (unless the patients woulu piefei to be
counseleu aftei theii tieatment in a piivate ioom). It is impoitant to talk louu
enough foi the patient to heai you, but quiet enough so the othei patients uo not
ovei heai. It also gave tips, such as quizzing the patients to help them iemembei the
infoimation you have given them.

Weunesuay 41614 9:uu-12:uupm (SS houis)
This week, I was able to counsel a patient one-on-one. She has hau a histoiy of high
phosphoious levels, but as also been calleu foi a tiansplant a few times. (She has not
yet been able to have a tiansplant.) Stacey was hoping that by having someone new
talk to hei, we might be able to convince hei to take hei binueis anu aujust hei uiet.
I ieally enjoyeu having this oppoitunity. The woman I counseleu saiu she hasn't
been eating haiuly anything because she has been having stomach pioblems (which
she is getting suigeiy foi next week), so she has not been taking hei binueis. I talkeu
to hei about taking hei binueis befoie she ate anything that way she woulu get hei
binueis befoie she filleu up anuoi staiteu feeling nauseateu. While hei situation
was sau, I felt that even if I uiu not make a uiffeience in hei lab values, I at least gave
hei a sympathetic peison to talk to anu sometimes, that alone can help someone feel
a little bettei. I also biought othei patients theii lab values anu went ovei theii
numbeis with them, though foi the most pait all of those patients hau goou values
anu I was able to give them theii info anu answei questions foi them.

Tuesuay 42214 7:uu-9:uupm (SS houis)
I went to Taiget to look thiough theii piotein bais anu powueis. I was looking foi
high piotein, low souium, low potassium anu low phosphoius souices. I ieau the
labels of all the piouucts on the shelf anu took photogiaphs of all the items that fit
the ciiteiia. Then I put all of this infoimation into a spieausheet with the bianu
name, flavoi, nutiition infoimation anu piicing infoimation. In two weeks (my last
uay at Bavita) I will be uoing a taste-testing with the patients to hopefully give them
easy ways to get moie piotein into theii uiets while still being able to keep theii
phosphoius levels uown.

Weunesuay 42S14 9:uu-12:uu (S8 houis)
Touay, Stacey anu I wen ovei the piotein bais anu shakes that I founu. Some of the
piouucts I founu weie missing infoimation, which I was unable to finu online. So I
calleu the companies to see if they hau the phosphoius infoimation. 0nfoitunately,
because they aie not iequiieu to analysis foi this, they weie unable to give me these
uetails. Bowevei, I think that with the new labeling laws anu with consumeis'
uesiies to know this infoimation, it will be easiei to get this infoimation in the
futuie.
I also counseleu a patient iegaiuing his high phosphoius levels anu what he was
uoing. We uiscusseu what he was eating anu the impoitance of taking enough of his
binueis. The week piioi his binuei piesciiption was incieaseu, so I encouiageu him
to follow the uoctoi's oiueis.

Tuesuay 42914 9:uu-1u:uupm (S9 houis)
Lookeu online foi pie-set sample menus foi uialysis patients that I coulu use anu
aujust foi Bavita to fit the neeus of uiabetic anu non-uiabetic patients. Theie aie
veiy few sample menus online foi uialysis patients, only lists of goou foous anu pooi
choices. Because of this lack of easily accessible infoimation, it woulu make things
even moie uifficult foi a patient tiying to finu iueas on what a typical uaily uiet
shoulu look like in oiuei to meet theii piotein neeus, while staying within theii
phosphoius anu potassium limits. I will be cieating a menu with nutiitional
infoimation by my last week of the semestei.

Weunesuay 4Su14 9:uu-12:Supm (42.S houis)
Touay, I uiscusseu labs with patients anu counseleu patients, on my own. I spoke
with one patient that was uoing well as fai as his labs weie conceineu anu we talkeu
foi a while about how he lost his legs (tuins out he hau complications fiom an aoitic
aneuiysm, so foi me peisonally it was ieally an eye openei foi what my husbanu
coulu have been uealing with). I also spoke with one patient who has hau a histoiy
of high phosphoius. Thiough motivational inteiviewing we uiscuss what she neeueu
to uo to get hei levels uown anu why she neeueu to get hei levels unuei contiol.
While, she was veiy ieceptive to the infoimation I gave hei, it seems as she has a
histoiy of being tolu infoimation anu stating latei that no one tolu hei. Bowevei, I
hope that by having anothei peison talk to hei, it will make a uiffeience. It
ieinfoiceu foi me, how often you may neeu to tell a patient something ovei anu
ovei, yet to still be unueistanuing anu have patience with them. I ieally enjoyeu
counseling the patients touay anu was honoieu that Stacey hau the confiuence in me
to speak to them on my own.

Tuesuay S614 9:uu-12:uupm (4S.S houis)
Tonight, I finisheu cieating 7-uay sample menu foi uialysis patients with no othei
iestiictions anu a 7-uay sample menu foi uiabetic uialysis patients. I useu the
"Nutiition Tiackei" on Bavita.com. This tiackei alloweu me to seaich foi foous, as
most online uatabases, howevei, it keeps a iunning total of the piotein, souium,
phosphoius anu potassium anu has visual cues (ieu oi gieen font) to let you know if
you aie in the uesiieu iange. The only uiaw back to theii website, is it coulu be veiy
slow at times. Also, foi example, when I lookeu up "iice", noimal white cookeu iice
woulu no be the fiist item on the list, but iecipes with iice weie listeu fiist. This
maue it moie uifficult to finu the foous I was looking foi. I will tiansfei these menus
to a Woiu uocument anu email them to Stacey.

Weunesuay S714 8:uu-11:Suam (49 houis)
Touay, I set up a taste testing with samples uiffeient piotein bais anu gave patients
the flyei that I cieateu that lists uiffeient ienal-uiet fiienuly piotein bais with the
nutiitional infoimation anu piices. I hau the oppoitunity to meet with patients anu
theii caiegiveispouse in the waiting ioom anu uiscuss with them the impoitance of
piotein anu give them uiffeient options foi getting moie piotein in theii uiet, while
keeping theii phosphoius intake low.
I also followeu up with a patient that I spoke to two weeks ago about the impoitance
of taking his phosphoius binueis. When we spoke pieviously, the uoctoi hau
incieaseu his binuei piesciiption, howevei, he hau not been taking them as
piesciibeu. We uiscusseu what foous aie in high in phosphoius, what high
phosphoius levels can uo to his bouy anu the impoitance of ieauing labels anu
taking his binueis. I feel that I may have maue a bieak thiough with him iegaiuing
his binueis.
Touay was my last uay at Bavita, Stacey gave me valuable feeuback anu tolu me
what she thought my stiong points weie (listening to patients anu being about to ie-
uiiect the conveisation back to nutiition). She encouiageu me to continue to seek
out uiffeient expeiiences as a stuuent anu uietitian.

Weunesuay S714 4:uu-6:uupm (S1 houis)

I completeu the menus I cieateu by putting them into a woiu uocument anu
foimatting them so they weie easy to ieau. (I have also attacheu these menus.)

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