Gabby Malisani

Capstone

Learning Objectives:

The first objective I am given for this camp is to make sure that proper

emergency boxes are set out across the entire campground, with proper treatments

placed in them. The emergency boxes that I am going to put together have glucose

tablets, glucose shots, juice boxes, granola bars, and crackers. Gluten-free bars need

to be offered because a couple of the campers have Celiac disease.

Fifteen grams of net carbs is considered one dose of treatment, so it is

important to make sure the food labels are written on each individual package. The

campers will be taught to use the treatments for low blood sugars only, and not to

be used as a snack. Also, it is important for them to understand that they should

turn to glucose tablets and juice first before other treatments. This way, excess

calorie intake can be avoided, and weight gain prevented.

If a camper experiences a low blood sugar, the proper procedure on how to

treat him or her will be explained. Here are the proper steps to take during

hypoglycemia:

1. Test the blood sugar to make sure the camper is low

2. If he or she has low blood sugar, give camper one treatment

3. Wait for fifteen minutes, and retest blood sugar

4. If still low, repeat steps two and three until blood sugar is above 70mg/dl.

This objective applies the Nutrition Care Process procedure. When assessing

the campers, it is important to know the signs and symptoms of hypoglycemia.

When a diabetic patient is feeling shaky, irritable, dizzy, weak, hungry, confused, or

has a personality change, it is important to take his or her blood sugar right away. If

it is below 70mg/dl, treatment is necessary.

An example of a nutrition diagnostic terminology statement for

hypoglycemia would be as follows:

Inadequate carbohydrate intake, related to type one diabetes, as evidenced

by a blood sugar of less than 65mg/dl, shakiness, mood change, irritability,

confusion, weakness, and hunger.

The intervention process would start out by giving the camper four glucose

tablets (they contain four grams of carbohydrates a piece), and then test his or her

blood sugar once fifteen minutes passes by to make sure they are above 70mg/dl. If

they are not, the intervention needs to be repeated until the ideal blood glucose

level is met.

The best way to monitor and evaluate the effectiveness of this intervention is

to continually test the camper’s blood sugar level by using a glucose meter. It is also

important to make sure the other signs and symptoms go away, but the number

displayed on the glucose meter is more tangible and reliable.

The second objective I have for this camp is to make sure all of the net

carbohydrates are displayed on posters and white boards. These are important

because it will help the campers, counselors, and medical staff determine how much

insulin each individual camper needs to take in at meal time and snack time. When

the net carbohydrates are properly calculated, a more stable and proper blood sugar

level is displayed in each individual. If there is ever a questionable amount of

carbohydrates in a certain food, it is always best to write down the lower number so

that too much insulin is not given to the campers.

In order to calculate net carbohydrates, the total fiber is subtracted from the

total amount of carbohydrates. I was informed that we will be counting

carbohydrates this way and we will not be worrying about the fat or protein content

in food. This way is easier, effective, and makes eating more fun. If any of the

campers have questions on how to count carbohydrates, I will answer those

questions and help educate them.

The last objective I was asked to complete was coming up with a nutrition

game that the campers could have fun with. I came up with a game where the

campers have to answer questions about diabetes, and if they answer the question

correctly, they get to roll down a hill and then run back up it. The first team that

completes this rely will win a prize.

This game seems like a good idea because it is both educational and physical.

Some examples of the questions that will be asked are:

How many carbohydrates are in one cup of fresh fruit?

What organ is responsible for making insulin?

What are the signs and symptoms of high blood sugar?

I really want to make sure the children know what is in the foods they are

consuming and have them understand their bodies more. I believe it is important

for them to realize that they can manage their diabetes while having fun and being

active.

Introductory Letter:

Gabby Malisani716 25th Ave. N.E.Great Falls, MT 5940408/11/2013

Elise Morris1627 W. Main St, Ste. 295Bozeman, MT 59715

Dear Mrs. Elise Morris:

Thank you for giving me the opportunity to volunteer at the diabetes camp this year. Camp is quickly approaching, and I thought I should inform you about my objectives for the campers. My first objective is to set up and distribute emergency boxes around the campsite. This way, the campers have access to emergency treatments, no matter where they are. The safety of our campers is very important, and preventing or treating low blood sugars at this camp is crucial to the health and safety of our campers. The emergency boxes will be stocked with glucose tablets, juice, granola bars, gluten-free granola bars, and crackers. They will be picked up and restocked daily so that the treatments never run out.Along with the emergency boxes, I will be counting out the amount of carbohydrates in each food for all the meals and snacks. Having an accurate carbohydrate count is going to help these campers when they are dosing for insulin, and help prevent high and low blood sugar levels. I would like these campers to have a great camp experience, and it would be hard to accomplish this without proper carbohydrate counts. So, having a white board and poster board up at each meal will help the medical staff, campers, and counselors dose the correct amount of insulin.Lastly, I came up with an interactive nutrition game that should be fun for the campers. The campers will be split up into two relay teams. They have to answer a nutrition question related to diabetes correctly; if they answer the question correctly, they get to roll down a hill and run back up it. The first team that reaches the finish line wins a little prize. I am hoping that the campers either learn something new or brush up on old information, while having a blast being active.Again, I really appreciate the opportunity to volunteer at camp this year. Thank you so much. I am looking forward to seeing everyone again.

Sincerely,Gabby Malisani

Thank You Letter:

Gabby Malisani716 25th Ave. N.EGreat Falls, MT 59404gabriella.malisani@gmail.com

Elise Morris1627 W. Main St, Ste. 295Bozeman, MT 59715

Dear Mrs. Elise Morris:

Thank you so much for letting me be involved in camp again this year. It was great getting to see plenty of familiar faces, along with meeting new people. It was also a great learning experience for me. Not only did I get brushed up on carbohydrate counting and emergency boxes; I also had more of an opportunity to hang out with the campers and learn about the challenges and struggles involved with diabetes. I love the atmosphere and getting to see how strong these children and young adults are. You can learn about diabetes in textbooks, but you cannot really get a good grasp of it unless you experience it first hand. Again, thank you so much! Hopefully I will be able to attend next year, and the years to come.

Sincerely,Gabby Malisani

Daily Journal

Day 1

Saturday, July 20, 2013

11:30am-5:00pm

Today, I arrived in Fishtail, Montana, for the annual diabetic camp for

children and teenagers. As soon as I arrived, I went to the dining hall and checked in

with Elise, the camp supervisor. She gave me a nametag, camp shirt, and schedule

for the week.

Soon after checking in, the training session started. Two ladies that were

part of the medical staff team went through a couple PowerPoint presentations. The

presentations were about different terminology used with diabetes, like

hypoglycemia, hyperglycemia, A1c, ketones, etc. The second presentation refreshed

my mind about the signs and symptoms of both hyperglycemia and hypoglycemia,

along with how to treat each one. They gave us a group quiz at the end of the second

PowerPoint to make sure we were ready for the next part of training.

After a little snack break, we jumped back into the second part of training

that had to deal with how to use a glucose meter. I vaguely remembered how to use

one from last year, so it was a good review for me. First, I started up the meter by

putting a strip in the slot on the meter. Then, I pricked my finger and once I got

enough blood, I put my finger on the strip. The glucose meter then gave me my

blood sugar level number.

At the end of the training session, I met up with Carla Cox to help set up

emergency boxes for the cabins and campsite. The emergency boxes consisted of

granola bars (both regular and gluten-free), raisins, juice, glucose tablet, glucose

shots, and crackers. There were seven boxes, so we looked at a map of the campsite

to decide where they should be placed. Emergency boxes and bags were also placed

in each cabin used for the diabetic campers. We also counted up the carbohydrates

for tonight’s dinner, and tomorrow’s breakfast.

Once I was done with my daily duties, I decided to hang out and play

volleyball with the other volunteers. It was a lot of fun, but we all decided to head to

bed early. The campers are going to be here early tomorrow morning!

Day 2

Sunday, July 21, 2013

7:45am-9:30pm

Before I started volunteering today, Kristin, Nikki, and I decided to go for a

run at 6:30am. We ran up the hill that overlooks the campsite. The best part about

the run today was that we had Lucy, the camp goose, follow us the whole way up

and some of the way down. After our run, I showered and got ready for the rest of

my day.

I arrived in the dining hall at 7:45am. Kristin and I put the poster board up on

a stand, and copied down the food and carbohydrate content of each food on the

white board. Breakfast was served at 8:00am, and lasted for about an hour. Once

breakfast was over, we went to the cabin that had the emergency boxes in it, picked

them up, and dropped them off at the designated locations.

The campers started checking in around ten o’clock. As they checked in, we

got the carbohydrate boards ready for lunch. We ended up having to help all the

campers make sandwiches for lunch because the kitchen was running behind

schedule. This was quiet challenging for me because it was very chaotic, and all the

campers were very hungry. Soon after lunch, the campers had their first activity,

and we dropped their snacks off to them.

Then, it was time for Kristin and I to show off our new game to the campers.

The young girls were the first to try it out. We went to a hill and separated them

into two teams. We asked them questions about diabetes, and if they got the answer

right, they got to roll down the hill and run back up it. The first team that won got

to pick out a prize. I was nervous if our game was going to please the young girls,

but they seemed to enjoy it.

After the game, we prepared the carbohydrate boards for dinner and snack

time later that night. Dinner was followed by a presentation from the Beartooth

Mountain Christian Ranch staff. They talked about the rules for about a half hour.

Soon after, we went outside and took our camp pictures. The last activity we did

was go to the campfire pit and sing campfire songs until about nine at night. Kristin,

Carla, and I then handed out snacks to all the campers and staff and picked up the

emergency boxes for the night.

Day 3

Monday, July 22, 2013

7:45am-9:30pm

After our morning run, Kristin and I got ready and then preceded to set up

the breakfast and morning snack board. We ate breakfast, and set out the

emergency boxes again. As soon as we were done with the emergency boxes, we cut

up and measured out a cup of fruit for each camper, and then set up for our game

with the middle girls. The middle girls didn’t like our game as much as the younger

girls. They seemed too embarrassed to roll down the hill. Next time I think it would

be best to design a different kind of game for this age group. It was difficult to get

them excited about it, and some of the girls didn’t participate at all.

Then, it was time to make the carbohydrate boards for lunch and afternoon

snack. We started to notice a few struggles that occurred with these boards. First of

all, some of the food items that the kitchen made for us were not on the original

menu, so we had to consistently add these items to the board when we were eating.

Also, the homemade food was more difficult to calculate the carbohydrate count

because there was no food labels to go off of. It made me feel bad for these young

adults and children that have diabetes. I feel like it would be so stressful to always

have to calculate and sometimes guess the carbohydrates in food. It made me

realize how much I appreciate my pancreas and how fortunate I am because it

works properly.

After lunch, we got the boards ready for dinner and the late night snack. We

then set out to distribute the afternoon snack to the campers. Each day at camp,

there will be three meals and three snacks that we need to make boards for and

distribute. We gathered up the young boys and had them play our game. They all

really loved it! You can really see the difference in boys and girls in how they like to

play. It was great to watch them have so much fun. After our game, I decided to roll

down the hill with them and we played dodgeball.

Kristin and I went to the dining hall after dodgeball and made the board for

dinner, night snack, and breakfast for tomorrow. We picked up most of the

emergency boxes, but left one out by the campfire and one by the volleyball court.

We all sang campfire songs again tonight. Later we brought out the late night snack

out to the campfire for everyone. After campfire, we picked up the rest of the

emergency boxes.

Day 4

Tuesday, July 23, 2013

7:45am-9:30pm

When I woke up this morning, I went for another run, got ready, then set up

the breakfast carbohydrate boards. Kristin and I also got the boards ready for the

morning snack. After breakfast, we restocked the emergency boxes and brought

them to their spots. Kris Freeman, the professional cross-country skier, arrived at

camp to talk and play with the children. He was very inspiring. It was awesome to

hear his story and realize that no matter what life throws at you, nothing is

impossible. Diabetes doesn’t have to be treated as a disability because people with

diabetes can follow their dreams and become whoever they want to be.

After his speech, we had our morning snack while Kris signed autographs for

the campers. Then we all went outside and played games and ate lunch together

with Kris until it was time for him to leave. A few hours later, we brought the

afternoon snack out to the campers. We picked up the snacks when they were done

and disposed of them in the garbage. The snack was yogurt, so we wanted to make

sure the extras got back into the refrigerator. Then, we picked up most of the

emergency boxes and got the board ready for dinner.

After dinner, the campers had the opportunity to perform in the talent show.

A lot of the campers danced and singed. One kid performed a magic show and

another performed as a ventriloquist. It was awesome, and the kids all had a lot of

fun. We handed out the night snack to the campers, picked up the rest of the

emergency boxes, and prepared the breakfast board for tomorrow.

Day 5

Wednesday, July 24, 2013

7:45am-9:30pm

Instead of going for a run today, I decided to sleep in. As soon as I got ready, I

headed down to the dining hall and put up the breakfast board for everyone.

Following breakfast, Kristin and I picked up the emergency boxes from the cabin,

and dropped them off. We made the snack and lunch board after that. Then, I

helped the kitchen crew put together fresh fruit bags for the campers and staff.

Once the snacks were ready to go, I walked around the campsite with Kristin. We

dropped them off to each age group because they were all at different activities. We

had a little extra time to kill, so I went and played with the campers.

Right before lunch, I helped put the carbohydrate board up. After lunch,

Kristin and I made the boards for snack time and dinner, and soon after that, we

brought the snacks out again. We had more time to hang out and play with the

campers. After I played with the campers, I observed the medical staff checking the

blood sugars of the campers before dinner.

After dinner, I got to give a shot of insulin to a counselor who is not on the

pump because she likes to take shots instead. It was great to be able to get the

hands on experience like that. The needle isn’t as big as I thought it was going to be.

It looks like the finger prick would hurt more than the actual insulin shot. My friend,

Nathan, and I decided to go for a run while the campers watched Balto. He has

diabetes, so he decided to take off his pump and take an apple juice with him.

During our run, he started feeling low so he drank his juice. It is interesting that

diabetics know their bodies so well and have an idea of when they are high or low

before they check with a meter. After Balto, Kristin and I picked up the emergency

boxes and put them away. Then, it was bedtime.

Day 6

Thursday, July 25, 2013

6:30am-10:00pm

This morning, I decided to go on a run with a registered dietician from

Billing. Her name is Jodi, and she told me how hard it is for her to see her patients at

this camp without their parents, because you learn new things you didn’t know.

According to her, some of these kids opened up to her, confessing that their parents

yell at them for having too high of blood sugars. It was very sad to hear. A lot of

parents do not understand what is going on with their children. I feel like there

needs to be more education classes for parents with diabetic children. After our

run, I got ready and helped out with early morning fishing at 6:30am. Only one

camper caught a fish, but it was very exciting. They were all stoked about his catch.

After fishing, Kristin and I made and put up the board for breakfast. The day

ended up being very similar to yesterday. We put the emergency boxes out, made

posters and white boards with the net carbohydrates on them, distributed snacks,

and enjoyed the company of the campers. Instead of watching a movie though, there

was a dance. All of the girls and guys got dressed up for it, and we all danced until

about nine o’clock. The campers also got to eat ice cream.

After the dance, I decided to stay up with some of the counselors and help the

write out awards for all their campers. I was a little sad that this was my last night

here, but it was fun while it lasted.

Day 7

Friday, July 26, 2013

8:00am-10:00am

Today was a shorter day. After Kristin and I woke up and got ready, we went

to the dining hall and wrote out the poster boards for breakfast, snack, and lunch.

These were the last boards we had to make before leaving camp. After breakfast, all

we did was pack up and help the campers pack up if they needed our help. Then, the

sad part came. We had to say good-bye to everyone. It was definitely a great

experience. I am happy I was a part of it. If time permits me to go next year, I am

coming back for sure.

Total hours: 78

Self Evaluation and Summary:

As stated earlier, I had three objectives for this camp. The first objective was

to make emergency boxes with appropriate treatments in in them and disperse

them in reasonable spots. My second objective was to make poster boards and

white boards that had all the foods listed out with the amount of net carbohydrates

found in each food. My last objective was to come up with a game that deals with

diabetic nutrition that was educational and fun. All three of my objectives were

successfully met. The emergency boxes were always full and available to the

campers, the poster boards were always accurate and up in time, and the game was

fun and interactive.

This experience at camp helped out with my professional development as

well. I got to experience the effects of diabetes in many different kinds of

individuals. This experience taught me more about diabetes then any textbook I

have had to read. I also got to interact and communicate with professionals in the

medical field. I feel that my communication skills have improved. It was nice being

able to practice being a young professional among the staff.

I gained a lot of memories during this camp. Most of them were wonderful,

but others were stressful. The most unexpected experience for me was being able to

give shots of insulin to my friend. It was new for me, and it wasn’t as bad or difficult

as I thought it was going to be. I was so grateful that she was willing to let me

practice on her. Now, I am more aware about how to give an insulin shot. The

easiest thing to do was stock up emergency boxes and put them in the right spot.

Since the food we used was the same every day, it was easy to know the amount of

treatments needed in each box. The hardest part was communicating with the

kitchen to make sure our menus were the same, and determine if the foods were

gluten-free or not. Some of the homemade food was more difficult to count

carbohydrates for, and sometimes we forgot to write gluten-free food items on the

board. I definitely need to practice looking at a food label and determining if it is

gluten-free or not.

All in all, I was prepared for a lot of the activities that went on during camp.

I knew this week was going to be very busy and demanding, so I would say I came

into the camp being mentally and physically ready. The part of camp I was the least

prepared for was being knowledgeable enough in gluten-free foods and being able

to spot gluten on food labels. I had to ask Carla if the foods were gluten-free. Next

year, I hope to go back to camp and be able to determine if a food is gluten-free on

my own.

The experience I loved the most was getting to play and interact with the

campers and staff. They were all very welcoming, and I feel like I fit in with them. I

got to hang out with a new group of people, and I am now more aware about what

these campers have to deal with on a daily basis. They are so strong, and it amazes

me how normal their lives are. They are just like me, except they have to check their

blood sugars often, and then treat themselves if necessary. This would be a

community that I would love to work with.

This camp helped me realize that I am on the right path when it comes to the

career I want. I can picture myself becoming a registered dietician more than ever

because it is very rewarding. Also, each individual is so different, so being able to

take care of each one is like solving a new puzzle. I always knew I wanted a career

where I can interact and help people. I don’t know where I will end up in the future,

but I am enjoying what I am learning right now, and I am so passionate about good

nutrition. I know that becoming a registered dietician is the right place for me to

begin my professional career.

Samples of Work:

The first example I have involving the nutrition care process has to deal with

my friend taking insulin after a meal. After we ate dinner, we looked at the

carbohydrate board that Kristin and I made and we added up the total amount of

carbohydrates she consumed. She then told me how much insulin to put in the

syringe before I I injected her with it. After a little while she checked her blood

sugar to make sure it was within normal range. It wasn’t, so she consumed a few

glucose tablets and checked it again after a little while. At that point, she was within

normal range.

Another sample of the work I did was the nutrition board. Carla, the

registered dietician, put together a meal plan for breakfast, lunch, dinner, and snack

every day we were at camp. For every meal, Kristin and I went into the kitchen and

counted the carbohydrates in each food item. Below is an example of what this

looked like.

Saturday, July 20 2013 Dinner

Grilled chicken 0 grams

Brown rice 34 grams/1 cup

Peas 8 grams/1 cup

Green salad trace

Ranch dressing 0 grams

The last sample of work I did had to deal with educating the campers. With the

nutrition game, we asked questions that had to deal with diabetes. A couple of

the questions that were asked had to deal with the organs that make insulin and

make glucose. Other questions asked about how many carbohydrates are in

certain foods. Since everybody in the target population had diabetes, we felt it

was important that they knew what was going on with their bodies. It was also

important to keep them interested and engaged because the age group was

between five and thirteen years of age, so we felt that a learning game would be

better then a lecture. The campers had a blast and some of them learned more

about their diabetes. So, all in all it was a success.