RIFT VALLEY TECHNICAL TRAINING INSTITUTE

INDUSTRIAL ATTACHMENT REPORT AT KITALE COUNTY AND REFERRAL

HOSPITAL

NAME: CHEPCHUMBA JAEL

ADMISSION NUMBER: 121R00933

DEPARTMENT:APPLIED AND HEALTH SCIENCES

COURSE: CERTIFICATE IN NUTRITION AND DIETETICS

PERIOD OF ATTACHMENT: FROM 7TH SEPTEMBER TO 28TH NOVEMBER 2021

DECLARATION

I declare that this report is the work I did during my attachment period and it has not been
presented to any other institution for certification.

Sign................... Name.,...........................................

Submitted to the field supervisor.

Madam Linda Bahati sign ...............

Head of department

Kitale County Referral Hospital

 ACKNOWLEDGEMENT

I want to thank God for His protection and good health He has granted me.

To all my trainers at RVTTI I wish to thank you all for giving us an opportunity to go for attachment to
learn more.

I am not forgetting my supervisors who has been working with me teaching me a lot during the
period, thank you.

To my colleagues and friends it was nice working together as team.

This attachment could not have been a success without the support of my parents ,thank you for all
your support.

LIST OF ABBREVIATION

HTN - Hypertension

DM - diabetes mellitus

TBSA- Total burn surface area

PID - pelvic inflammatory disease

ISS - immuno suppressive system

RVD - Reto viral disease

LBW - low birth weight

PUD - Peptic ulcer disease

UTI - Urinary tract infection

CCF- Congestive cardiac failure

HAART - Highly active anti retroviral therapy

AKI - Acute kidney injury

ITP - Idiopathic thrombocytopenic purpura

DKA - Diabetes ketoacidosis

 TABLE OF CONTENT

-Declaration

-Acknowledgement

-List of abbreviation

CHAPTER ONE : Background of kitale county referral hospital

1.1 vision

1.2 mission

1.3 core values

1.4 Objectives

CHAPTER TWO:Work done

2.1 departments

CHAPTER THREE: CHALLENGES , CONCLUSIONS AND RECOMMENDATION

Background of kitale County and Referral Hospital

Formerly known as Kitale district hospital, Kitale County Referral Hospital is the only largest health
facility situated at Trans-Nzoia County's headquarter in Kitale .It is a level 5 hospital in Kiminini
constituency along Kapenguria road in Trans nzoia county.It was started in 1920 as a dispensary by the
whites who had settled in highland of Trans nzoia then later after independence it was moved to Kenyan
government and was promoted into a district hospital. It offers medical services for inpatient and
outpatient.The hospital also offers 24 hours emergency medical care services.

1.1 Vision
To be an efficient and cost effective medical care system for a healthy nation

1.2 mission

To promote and participate in the provision of integrated and high quality curative rehabilitative services
to all Kenyans

1.3 core values

Teamwork

Timeliness

Integrity

Professionalism

Innovative

Quality

Honest

Objectives:

To be able to use what I acquired in school practically

To interact with other students and my supervisors to be able to acquire more skills from them

To rotate in both outpatient and inpatient clinic to see what nutritionist do in both clinics.

CHAPTER TWO

Workdone

The first day I was oriented then allocated in various departments:

Medical ward

Chronic Disease Model

Mother child health care

Peadiatric ward

Maternity and NBU

Surgical ward
Medical ward.

Top ten conditions in medical ward.

Malaria

Hypertension (HTN)

Peptic ulcer disease (PUD)

Diabetes

Meningitis

Liver disease

Urinary tract infection (UTI)

Congestive cardiac failure ( CCF)

Anaemia

Pneumonia

Nutrition assessment

Nutrition intervention

Case study:

Patient x

Age:34years

Dx : Diabetes

NDX: Overweight related to excess intake of fats as evidenced by BMI of 27.8kg/m2

Type 1 DM - it is where the body is not able to produce insulin

Weight : 78kg

Height: 167.5
Bmi 27.8kg/m2(overweight)

Nutrition plan

Frequent feeding after every 2 hours

Reduce intake of carbohydrates

Avoid sugary ,salty and fatty foods

Consume more of green leafy vegetables

Avoid red meat ,use white mean

Avoid carbonated and caffeinated drinks

Avoid processed and deep fried foods

Do regular exercise

Drink plenty of water

Use liquid cooking oil with low fat amount .

COMPLICATIONS OF DIABETES

Neuropathy - nerve damage

Nephropathy - kidney damage

Retinopathy - eye damage

Cardiovascular disease

Foot damage

Skin conditions

Hearing impairment

Alzheimer's disease

CHRONIC DISEASE MODEL

It is an outpatient clinic dealing with hypertension and diabetes

Did nutrition assessment using BMI

Nutrition intervention - nutrition counseling

NUTRITION COUNSELING ON DM PATIENT WITH CCF

Diet plan: CCF

Restrict sodium , caffeine and fat intake( saturated fat)

Encourage gradual weight loss where necessary

Adjust dietary fiber to avoid constipation

Counsel on weight reduction

Avoid alcohol and smoking

Complications of CCF:

Pulmonary oedema

Reduced blood flow to all organs

Enlarged heart and rapid heartbeat

Malnutrition due to high energy needs

Fluid retention hence stagnation of fluids in all organs.

MOTHER AND CHILD HEALTH CLINIC

Different sections: immunization :

BCG at birth

OPV 1 ,Rota 1 , pentavalent 1- 5 at 6 weeks

Oral polio 3 , pentavalent 3 , Inactivated polio vaccine at 14 weeks

Measle rubella 1 at 6 months

Dewormer , vitamin A at 1 year

Rubella 2 , vitamin A , dewormer at 18 months

Dewormer and vitamin A at 2 years

After every 6 months vitamin A and dewormer to 59 months

At 10 years girls are administered with HPV .

Family planning - family planning methods include:

Oral pills and condoms

Injections

Implants

Use of coil

PMTCT - prevention of mother to child transmission :

Activities done ....

Examine the mother from head to toe

Testing for HIV/AIDS and diagnosis

Prenatal treatment

Safe child birth

Sick child - monitoring of nutrition cases ;

Oedema

Kwashiorkor

Marasmus

Jaundice

Health talk to mother's on exclusive breastfeeding, hygiene , family planning , importance of

immunization and vitamin A supplement.

Nutrition anthropometric measurements height and weight

PEADIATRIC WARD

It deals with various conditions including SAM patients.

Children who are less than 15 years are admitted to this ward.

For malnourished children nutritinists are the ones who manage the patient.

Case study: pt x

Age: 7 yrs

Z- score -3SD
NDX Severe acute malnutrition

With bilateral pitting oedema ++

Dehydration

Mental changes

Severe wasting

Poor appetite

Dermatosis as evidenced by shedding of the skin and patches of the skin

Nutrition plan

Patient put on F75 ,135mls ,3hourly .

Weight monitoring .

How to calculate mls .

Formula F75

Wt × 100/8 - for poor appetite

Wt ×130 /8 - for good appetite

Formula 100

No oedema

The baby can be able to use both the formula and breastfeed at the same time

MATERNITY AND NBU WARD.

Maternity ward.

Health talk to mother's in kangaroo,ceaserian section ,post natal and antenatal rooms .

Kangaroo - mother's to put the children in kangaroo position to improve the attachment and
warmth . Done to babies who are below 2000 g and are stable .

Types of KMC

Those who are still at nursery and continuous who are put in kangaroo all day and night.

Ceaserian section- mother's to use warm fluids and proper position of the baby while breastfeeding
Postnatal clinic- mother's to ensure proper positioning ,good attachment and hygiene while
handling the baby.

Antenatal clinic- mother's to eat a healthy diet and do regular exercise.

New born unit .

Effects of preterm

Anaemia of prematurity

Rickets of prematurity

How to examine baby's stool:

Black - green - yellow/ brownish at date five of life if not so then breastfeeding is poor.

How do you know the baby is able to breastfeed well;

If the baby's skin is soft

If urine does not stain the diaper that's colourless

If the baby is able to pass stool or urine well.

NBU - It is where babies who are less than 2500g are being taken care of.

Most of the babies in the unit had jaundice .

Those who were less than 1500g were not able to breastfeed they are fed via cup or nasogastric tube

Nutritionists ensures that the baby is feed at the right time with the right amount.

Ensures the baby is progressing well ,if not then check if the mother has adequate milk by
expressing.

Before discharge nutritionist checks is both the mother and the baby are safe for discharge.

If the baby is well hydrated and is able to pass urine and stool well.

Causes of low birth

Prematurity

Smoking mothers

Poor maternal nutrition

Classification of low birth

Very low birth weight - less than 1500g

Extreme low birth weight - less than 1000g

Low birth weight - 1000 -2000g

SURGICAL WARD.

Top 10 conditions in surgical ward

Fractures

Burns

Appendicitis

Intestinal obstruction

Cellulitis

Hernia

Head injury

Soft tissue injury

Peritonitis

Leg ulcers

Came across different conditions

Pelvic inflammatory disease (PID)

Urea electrolyte cratinine (UEC)

Bone marrow aspirate ( BMA)

Road traffic accident (RTA)

Post and pre operation patients are being monitored.

For pre operation patients they are encouraged to stay for at least 48 hours before operation this
helps to prevent intestinal obstruction.

For post operation they are counselled on water only the first day after , thereafter for the next 2
days to take warm fluids then start on soft light food.

Those with wounds such as septic wound are counselled on high protein for fast wound healing

Case study.
Patient y

Age-- 45years

Dx : day 1 post operation

BMI _ 20kg/m2

Nutrition plan

Patient on water only ,oral sips

Monitor if the patient is able to pass stool.

CHAPTER THREE: CHALLENGES , CONCLUSIONS AND RECOMMENDATIONS.

3.1 CHALLENGES

During my attachment I encountered some few challenges these being.

In some sections I did not get to document files since the files were not easily being found.

During ward rounds in some section they did not recognize the work of nutritionist.

Language barrier to some clients they did not know how to communicate in kiswahili.

3.2 CONCLUSION

The attachment was a great time experience and I learned a lot.

I was able to apply what I learned in school practically.

The attachment was a success and I was able to nutritionally counsel a patient .

3.3 RECOMMENDATION

The hospital should be able to organize a nutrition day just like CME day.

Nutritionist in charge should organize easy access to patients files to be able to document .

Hospital should ensure there is variety of food in the kitchen to improve nutrition