Tuesday- day 2

I found out knowing meds that can affect nutritional status (which meds don't, right?!) is very important. You have to add that to nutritional assessment. The kicker is that our lab coat pockets are too narrow for the food-drug interaction book to fit into :( keeps your hands busy while walking down the hallways to other floors, I suppose ;)

Another tricky thing is learning to read other people's scribbles. I am really hoping the electronic record will become a reality soon.

Always read progress notes (which are often scribbled)! There may be a DNR order and in this case we can't start a tube feed/TPN.

Always look at Intake and Output to catch any signs of edema- it will affect what you can do with a TPN order.

I found out it may be possible to taste formulas, but not to get my hopes up- apparently they are as awful as they get. No wonder patients dislike them. The hospital uses 7 types of formulas (now, it may change) Pulmocare is the most commonly used, for patients on a ventilator, the other ones are Oxepa (septic pt), Nepro (renal failure), Nutrihep (liver failure), Jevity (stable pt with low PO) which has fiber and apparently tastes eeky, and Osmolite which is like Juven but has no fiber. there is also a ProPass- protein supplement that must be taken with food and something else which I forgot the name of but it's accessible through pharmacy department.

I sat on a couple of ICU rounds where the nursing staff presented case studies of current patients to other RNs, RD, and therapists: occupational, speech, physical, social worker, pharmacist and a pulmonologist. These rounds are helpful at catching small things because patients are given a real teamwork rundown. Often new consults are picked up by RDs thanks to this approach. At the end the patient (or attending caretaker) will be presented with the finished chart to sign. It helps the patients see they are being cared for.

Also, remember the name Diprivan or Propofol. It's a sedative/anesthetic that uses 10% lipid as base. It counts the same way as a lipid piggyback (1.1 kcal/ml) and you shouldn't use it in patients with elevated triglycerides or cholesterol.