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Food Diary

I chose a Saturday to track my eating. I have done projects like this in the past, and I always find it interesting because so much of what I eat has no label and contains many ingredients, making it difficult to track contents exactly. For example, on this day my roommates and I made a giant bowl of ceviche for dinner, with fresh speared yellow tail and about a dozen other ingredients. It was too difficult to track every ingredient as several people worked on it. This brings me to a concern I have: When we tell people to closely constrict certain food components, are we sometimes dissuading them from eating fresh whole foods? On the flip side, during this process I thought a lot about how hard it can be to avoid certain food components if you do eat packaged or prepared food. As a new years resolution this year I gave up processed sugar, honey, syrup, and any other incredibly sugar dense foods. I have not regretted it since, but it can make it so difficult to buy certain foods and to eat out. Even things like multigrain flakes and whole grain bread have a surprising amount of sugar in them. When I buy these foods, I have to sort through so many labels to find one that works for me, even at a place like Whole Foods. Added salt is just as ubiquitous, so I imagine It must be very hard for people to select food with that restriction, especially if they shop at a store that doesn’t strive for healthy options.

Breakfast:
Whole wheat bagel with cream cheese, sprouts, tomato, cucumber, and onion
Coffee with cream

Snack:
Smoothie- whole milk yogurt, blueberries, banana, 2% milk

Lunch:
Large Salad- many veggies, sunflower seeds, avocado
dressing- olive oil, garlic, vinegar, hemp seeds, salt and pepper, miso

Dinner:
Ceviche with chips, salad, and beans

Approximate salt for day (not including ceviche): 1,687 mg
Approximate fat for day (not including ceviche): 104.g g

I think it is easier for me to limit salt because we make most food from scratch in our house. I did pretty good on the salt score. I was pretty high for fat though. However, a decent chunk of that came from olive oil and avocado. All in all, I think the take home is that it is very difficult to keep track and restrictions can be very limiting.

Heart healthy diet

I imagine how difficult it would be for a patient to suddenly switch their diet of comfort to a low-sodium heart healthy alternative. I’ve only experienced a patient’s reaction to this new diet once in clinical, and the first sentence expressed when looking at the cardiac tray was “That’s not real food, that’s cardboard”. I can’t help but think I would react similarly, as according to my daily assessment of sodium intake, a reduction in sodium would serve me well.

My meals consisted of:

Breakfast

-Whole wheat toast with 1/2 avocado (Na+ 280 mg + 10 mg)

-1 cup orange juice (Na+ 2 mg)

Lunch

-Trader Joe’s Field Fresh Chopped Salad with Grilled Chicken (Na+ 220 mg)

-1 cup seedless red grapes (Na+ 3 mg)

-Water

Snack

-Peanut butter pretzels (Na+ 160 mg)

-Water

Dinner

-1 cup Magic Mineral Chicken Broth with vegetables (Na+ 880 mg)

-1 serving Simply potatoes mashed potatoes (Na+ 330 mg)

 

Total sodium intake: 1,885 mg

Recommended 24 hour sodium intake: 1,500 mg

What’s the count?

I decided to take a look at my diet on a day where I hadn’t slept too much, didn’t have time to cook, and had to work a very busy night shift. While I know that I have been eating healthy other days – incorporating salads and healthy snacks like hummus and carrots – I knew this day would be pretty bad. I thought it would be a good day to pick because I sort of had to eat what was quickly available to me, plus the sleep deprivation didn’t help me make the healthiest of choice. Basically, doing this meal check, I saw that just the burger put me well over the Heart Healthy diet needs. The sodium alone put me well over how much I would need to consume on a heart healthy diet. You have to wonder, how some patients manage to make the adjustment, especially if they are leading very busy lives both at home and work. I’m not saying it is not possible, but I can see it being very hard to change habits of eating out if it is something they do 1-3 times per week. Essentially they would have to stop all together or switch to healthier dining out options that can include fruits or salads.

 

“Breakfast” – Almond butter and honey toast

Almond butter (1tbs): Na 72 mg, Fats 1 g

Whole wheat bread: Na 132 mg, Fats 0 g

Honey: Na 1mg, Fats 0g

Water – Na 0, Fats 0g

 

“Lunch” – Habit cheeseburger and fries with water

Cheeseburger: Na 1,770mg, 36g fat

Fries: Na 164mg; Fat 3g

 

“Dinner” – None

 

Snacks – none because I forgot them on the counter at home before work, so LOTS of water on my overnight.

 

Meal Check

My meal for today consisted of the following:

Breakfast:

-2 pieces of Orowheat Country Potato Toast and 2 pieces of  Laughing Cow Swiss Cheese  (Fat: 10g// Na: 650 )

Lunch (Sharky’s Wood Fire Mexican Grill):

-Chicken Breast Half Power Plate with Mexican Rice and Grilled Vegetables (Fat: 10.1g// Na: 1391.7 mg)

Dinner

-Habit Charburger and 1.5 size order of fries (Fat: 62g// Na: 2370 mg)

Based on my diet for today, I think I will have a difficult time adjusting to a low fat and low sodium diet because most of the foods that I enjoy eating are dependent on fats and sodium. Also, being from a Filipino culture, most of our dishes are high in sodium and fat. Therefore, the taste would just be different and maybe difficult to adjust to.

Week 2: Meal Check

Yesterday I spent the day entertaining some friends who were visiting for Labor Day weekend. A huge part of showing someone a good time in Santa Barbara, besides seeing the mission and the courthouse, is taking them to all the best restaurants and the local hipster ice cream shop and so on. I try to be conscious of my eating habits, for both health and financial reasons, but yesterday my single goal was to keep everyone happy– dieting took the backburner. For breakfast I ate my kale, pear, lime, ginger, celery smoothie that I try to make a habit. But once I met up with my friends we had tacos and ice cream downtown for lunch. The taco meat was definitely salty and fatty, and the ice cream was probably all the saturated fat I was supposed to eat all day. However, I don’t know the exact amounts of either; there was no food label or calorie counter in the taco stand. Eating at restaurants must be so difficult for Cardiac patients when they really don’t have a choice what type of food their loved ones are asking for. It seems like many people would end up being polite, and choose not to make a fuss and tell their children, “Actually my doctor told me I can’t eat this type of food.” Without knowing the content of the food the food you’re ordering, and often not being able to choose a restaurant with healthier options, eating out must be a source of stress and discouragement for many adults trying to limit their salt and fat intake. After dinner, another friend made us all steak and yams and cold slaw. When eating the yams, I mentioned “These are amazing, what did you put in them?” My friend replied, “Heavy cream and a big stick of butter.” I had thought the yams were the “healthy” part of the meal! Unless you are sitting at home, cooking for yourself, reading every label and measuring your daily allotment of fat and salt specifically, it seems impossible to really know what you’re eating. In one day of being social and polite, I ate salty, fatty red meat twice and washed it down with ice cream and butter mixed with yams– all without ever seeing a single food label or any nutritional information.

DIGITAL TECHNOLOGY AND HEALTHCARE

The “Digital Trends in Nursing” blog is a comprehensive opinion based blog designed to bring fourth changing technologies and how it is being incorporated into the nursing world.  Unfortunately the blogger (Raney Linck) has not kept up the site, and the most recent post is almost a full year old. With the continued advances in technology, and integration of that technology in healthcare, it is important to remember that changes happen everyday.

I feel like the technology referenced in this blog is becoming more mainstreamed and is available to the masses, not just health care providers.  I feel in the next few months the department I work for will be utilizing the technology available; in fact, today I participated in an inservice for my hospitals new tele robot.  This robot will be replacing the current tele stroke robot, that essentially video conferences a neurologist to a potential stroke patient, and will be used to conduct follow up appointments in the emergency room and connect patients with specialists that would otherwise have to travel to the facility.  This robot, and technology like it, enhances the assessment process, it does not replace it.  It remains the nurses responsibility to be the eyes and ears in the physical room and participate the in advanced assessment process.

It is also important to remember that these technologies are made to enhance the assessment process and do not necessarily replace the need for more “basic” or “primitive” testing; example being an EKG monitors the electrical activity of the heart, but does not replace the importance of auscultating for heart and valve sounds.

It is also important for follow up and proper education if people are bringing these technologies into their homes for self care.  Home health agencies or monitoring companies must be notified to follow up to ensure the patient is truly being cared for and does not have a false sense of safety.  Continual monitoring and health applications could give a better overall picture to the patients daily health status but must be interoperated by a medical doctor and not the redly available “doctor google”.

There is a never ending story of research conducted by multiple agencies, hospitals, and educational centers.  It is important for the health care provider to be alerted to the ever powerful “evidence based practice” research.  Only when research is conducted, tested, and proven in a clinical setting does it become the standard for health care.  As technology advances new tools will be available for clinicians and for people to use at home.  Some pros of mobile technology include the potential for fewer hospital stays, monitoring patients, better recovery outcomes, and an overall better quality of life.  Some cons of mobile technology include false sense of security, interrupted or malfunction of equipment, and poor knowledge of equipment available.

In the hospital I work at, we encourage patients to utilize the technologies available; from blood sugar checks, blood pressure machines, heart rate and oxygen saturation finger probes, and an ACCURATE thermometer.  These are now basic technologies that are common in many homes that, when utilized appropriately, can alert a patient or practitioner of acute health changes that need additional treatments.

Meal Check!

I had planned on tracking my food for today, September 8th, as I kept forgetting to take photos of my meals over the last few days and thought it would be nice to add some photos to the post. Then I started thinking about it and to get a realistic view of what I actually eat I decided to analyze what I ate yesterday. I try to be pretty conscious of what I eat and yesterday wasn’t necessarily a “bad” day but I was at home studying with not much food left in the fridge so I ended up snacking for lunch instead of prepping a healthier meal.

I plugged my meals into the USDA’s SuperTracker website to get a good analysis of my nutrient and calorie intake. Some foods were a little difficult to input, but I did my best to reconcile the nutritional information of what I ate with the options they had available on their site.

This is a summary of my meals from yesterday:

Breakfast: Quinoa sauteed red bell pepper, onion, and mushrooms topped with sheep’s milk feta and a boiled egg

Lunchtime Snacking: Seedless green grapes, carrots and white bean hummus, TJ’s flattened bananas, and TJ’s thai chile and lime cashews, TJ’s mango icecream bar… not the best lunch :)

Dinner: Rice noodles with broccoli, onion, and mushrooms in a garlic, ginger, soy sauce. Apfelshorle to drink (sparkling water and apple juice).

Looking at my daily food group targets I don’t think I did a bad job:

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I went slightly over for my fruit intake but the majority was whole fruits. I also went over for my veggie intake which I think is great. I almost hit my protein target and was under on my grains target but feel I had plenty of fiber.

I was significantly under on my dairy but I thought I would have hit my calcium and B12 needs with other food groups. Unfortunately I was under the target in both of these nutrients. I usually snack on more cheese, eat meat a couple times a week, and have quite a bit of fortified almond milk so I hope this isn’t an issue. It would be interesting to track my intake over an extended period of time to see if I hit the targets.

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Now for the heart healthy diet… I went over the limit on both saturated fat and sodium intake!

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My overall fat intake wasn’t too bad. It made up 34% of my daily calories, largely in part to my large snack of cashews which I definitely don’t eat on a regular basis.

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My saturated fat was a bit high (13% of my total calories). There is a lot of information that has recently circulated about cooking with olive oil at high heat so I’ve tried to start cooking more with coconut oil and ghee or butter. Researching more about different types of oils and how they are affected when used for cooking has been on my to do list for awhile. Regardless of their safety when heated, I should be conscious of the amount of oil I use when cooking.

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I was also over on my sodium intake but thankfully not by too much. I typically don’t cook with a lot of soy sauce but I do use salt and love salty cheeses like feta. Despite this I did go on a long run yesterday and think I sweat out my fair share of sodium in the heat. I also try to stay away from processed foods and know that many are prepared with large amounts of sodium.

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I think following a heart healthy diet or any kind of restrictive diet would be difficult. I love food and tend to let myself eat what I want as long as it is in moderation. However, I definitely can’t say I always moderate myself appropriately, especially when studying or writing a paper :)

Thankfully there are many tools available that can help an individual monitor how they eat and exercise and how it affects their health. I know a large part of keeping myself active involves setting goals and tracking my workouts. It can be very motivating when you’re able to track your progress and see improvement.

Nurses with “White Caps” and now with “Apps”

Technology….to me…is amazing, wonderful, and once you learn how to use it effectively, is so helpful! I have been using my electronic medical record (EMR) at my job for almost two years and I still learn a new trick and short cut at least every couple of weeks. I have some reservations about the accuracy, generalizability, and the overall safety, but all in all, I feel that these are helpful tools that will only provide practitioners more knowledge right at their fingertips. I have already witnessed the providers searching on their phones for pharmacology.

For my own nursing future, I believe it will make my job easier in terms of finding the necessary information in times that I am unsure. A couple examples are, accessing Epocrates when a patient is on a medication I am unfamiliar with; also, the app for medical Spanish or google translator…I often have patients that have language barriers and with a little help it would make a world of a difference in their understanding and compliance.  A downside that I foresee, is having patients feel a false sense of empowerment with the information and they may either incorrectly self-medicate, or they may come in and argue with me or the providers because they are sure they have what they researched on the internet (I have already encountered this).

I feel like I will use technology more in the next few months because just going through the new apps available enticed me to download more and I am excited to try out my new sleep cycle app. I sleep talk and sleep walk so I have Excessive Daytime Sleepiness (EDS) and I am curious to see my data charted on this app of how often I stir. I also downloaded Medscape which may come in handy as a quick reference for my triages. I like to look things up and figure things out when they are new, so this app will expedite that.

I feel that the patient portals where they enter their data for blood pressure (BP) and blood sugars (BS) will be very helpful for providers if the patients are completing them correctly. This will eventually become a staple of assessments. The app for continuous heart monitoring will also be a helpful assessment tool.

Managing care at home through mobile technology will be extremely difficult for many people. Patients have difficulty operating their BP and BS monitors, let alone all these different devices. I do, however, feel that where there is a will there is a way and if any individual sees the benefits outweigh the costs, they will make stronger attempts at mastering these new technologies.

The safest way to evaluate the effectiveness of these technological advances is by testing them against evidence based data and our assessment skills. The patients will still need to come in for check-ups, this is not a replacement for face-to-face evaluations, this is just a tracker for continuity of care.

There is plenty of research that has been done to evaluate the effect of technology on patient care. Informatics has been a part of nursing for quite some time and the data is always evaluated as part of the nursing process. The more and more technology that is introduced, the more research will be completed.

As I mentioned before, some of the things I can anticipate as a “con” are the patients’ false sense of completely understanding their healthcare needs, the lack of knowledge on how to use the technology properly, the accuracy of their recordings, the accuracy of our technology for each patient, the lack of face-to-face assessments and treating the individual, and more. Some of the “pros” are the continuity of care, the accessibility to information, the patients’ involvement in their care and the encouragement towards health promotion. More pros are the savings in cost for the patient and healthcare agencies, the patients have access to their records faster, and more.

About Me

 

Hello, name is Vannessa Barretto. I have lived in Oxnard throughout my entire life, except for one year in 2010-2011, came back for school but not for long….

It was a difficult decision for me to head back into school after graduating with my ADN from Ventura College this past year 2014. I have been going to college ever since high school graduation without any real break the last 8 years (hah I could’ve gotten a doctorate already).

In 2010, I headed off to North Dakota being offered an athletic scholarship with collegiate softball. I took advantage of the scholarship and pushed my luck in nursing while being a full time student, employer,  and athlete traveling the U.S missing classes, didn’t work out the way I wanted it to. So came back home to save money and focus on school and my future career.

I had played softball for 15 years straight, to add year round and it was a huge change for me that took some time to get use to. I realized all things happen for a reason and I couldn’t have been more thankful for how it all played out.

Now since after graduating with my ADN, I have been working for Community Memorial Hospital in Ventura since last November working in the Medical-Surgical/Oncology Unit. The experience I gained from North Dakota doing a full year of nursing opened my mind set of what nursing can be, how the culture is so different even in the United States. As I gain more experience in the nursing field I plan to work in Public Health/Travel RN, possibly in a manager setting or work my way to a Nurse Practitioner in years to come. However with all this schooling taking longer than expected, I have been thinking of taking a break after our graduation this upcoming May. I would like to travel with partner in crime (whom you see in the picture below). Actually for the first time, I will be traveling outside of the country in a few months for a short period in time but as a glimpse of what is yet to come.

Look forward to all your posts/responses.

Ciao!..See you soon.

Partner in crime

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