Name: Marisa Shook

Facility Visited: Creighton Dialysis

For my clinical shadowing experience I chose to shadow Danette Gupta, a dietitian

currently working at Creighton Dialysis. This was my first time ever being in a dialysis clinic and
I found everything that I learned to be very interesting. Upon my arrival, the first thing that
Danette showed me was how she prepared herself to talk to the patients. To make sure that the
patients are meeting their goals for important lab values, they get a lab report card once every
week. For dialysis patients the most important lab values include glomerular filtration rate,
serum creatinine, blood pressure, hemoglobin, serum iron, total cholesterol, triglycerides,
albumin, phosphorus, potassium, glucose, and calcium. Each lab value has an ideal range and
if the patient did not fall within those values then Danette made sure that she found out what
was going on. I noticed that in general most of the dialysis clients were 50 years of age and
older, however there were some outliers. Also, most of the patients had more going on with
them than just kidney failure, therefore a team of medical professionals were needed. Besides
a dietitian, the clinic also had a medical doctor, nurses, and a social worker on staff. The
medical doctor made the decision as to what specific treatments each patient would be
receiving. This included decisions such as what medications, how much of the medications,
what potassium cleaning solution should be used, and how long each dialysis session should
last. Then the job of the nurses and the dietitians was to essentially carry out the doctors
orders. However, the dietitian focused more on diet and food/drug interactions whereas the
nurses were more concerned with actually performing the treatment. While I was there I
witnessed them constantly in action making sure there were not problems during treatment and
that the patients were safely disconnected at the end of their sessions. Finally, the main job of

the social workers were to make sure that the patients had the financial help needed to pay for
medications and treatment.
During my 8 hours of shadowing, I mostly just followed Danette around while she talked the
patents. Her job at the clinic is a good blend of the clinical aspects of dietetics while still being
able to get to know the patients on a personal level. Since, each case was highly individualized
it was important for Danette to have a thorough understanding as to what was going on with
each person so that she could best help them. As she was spending time with the patients the
nurses were constantly buzzing around making sure that everything was running smoothly.
Then on the one day the doctor was there I watched him briefly talk with each client to see how
their treatment was going and find out if anything needed to be adjusted. Of all of these
activities that I observed I would not say that there were any that I did not like. In fact, I actually
found it all very interesting and I liked the effectiveness and efficiency of the clinic. One of the
aspects of the clinic that I was the most fascinated with was the peritoneal dialysis patients.
They received almost identical care to the patients receiving hemodialysis, except for they only
have to come in occasionally for check-ups since they are administering their own treatment at
home. I just think it is amazing that another way has been found to perform dialysis that gives
patients the freedom to move around and the independence to take care of themselves. For
this reason, I thought that these patients were some of the more interesting people that I got a
chance to meet. They still had to meet with all of the medical professionals to make sure
everything was being properly taken care of, but they seemed happier in general than the other
patients, probably because they did not have to spend 3 to 4 hours of their day 3 times a week
stuck in a chair. Besides the peritoneal dialysis patients, there was also another patient who
was on hemodialysis that stuck out in my mind. He was around 50 years old, started dialysis
when he was in his 30s, then had a kidney transplant which was successful for about 7 years,
but then his kidneys failed again putting him back on dialysis. Currently most of his labs are

decent, except for protein. His protein labs are very low and Danette described him as being
basically malnourished. However, when she suggested to him that he be put on TPN nutrition
while he is receiving his dialysis treatment to help get his protein up he refused. He said that he
already felt bad all day after treatment and he did not want to feel even worse. Even after
Danette explained that most people did not experience sickness and that it would add more
years onto his life, he still refused the treatment. It just made me a little sad because a patient
can only be helped if they accept the assistance offered, but it is possible that after all his years
on dialysis he is just sick of the process and not willing to keep suffering with his condition.
Overall, I really enjoyed my time at Creighton Dialysis and I felt as though I really got a good
idea as to what Danettes job is like on a daily basis. I could definitely see myself holding a
position similar to hers because the clinical aspect to dietetics is very interesting to me, but I
also like how she was able to develop a person relationship with the patients. The one thing
that left an impression on me was how much the patients valued Danettes opinion and advice
to help with their treatment. Most of them seemed genuinely happy to see her and hear what
they could be doing to improve their lab values. In conclusion, after this experience I would
definitely consider working in a dialysis clinic someday, confusing me even more as to what I
would like to focus on as I move into my masters program. This was my first time ever being
able to shadow a dietitian and I definitely view it as a positive experience and I cannot wait to
start moving forward in the career.