Another busy day at the VA

I would like to start off today by praising all of the people I have had the good fortune to work with at the VA. Their patience and generosity in giving me so much of their valuable time has far exceeded my expectations. I only hope that everyone else is surrounded by such willing teachers.

The past two days have been crazy! There were a lot of new admits over the weekend and many of them were classified as moderate, and therefore must be assessed by the RD. I think the RD I was working with had about 16 patients to see and assess on Tuesday. Luckily only 2-3 new ones came in today. She also had to cover for someone else this morning, and both of us had meetings yesterday.

The RD I am with remained calm and cool through it all, but I must admit I was a little stressed out about getting everything done. On Tuesday she gave me 5-6 patients, and we didn’t really get working on them until 2pm. I knew I couldn’t finish by the end of the day. Neither of us finished, but we kept plugging away today, and hopefully we will get caught up tomorrow. The RD helped me through each assessment. We sat side by side at two computers so she would be right there to answer my questions while we both worked. It was a brilliant set-up in my opinion.

I had a tube feeder, and tomorrow I may have to work on a very complicated TPN patient, unless he is able to go home. We visited the pharmacist today and she talked to us about the case, which was a great learning experience! I was surprised to learn that he gets TPN at home. I have also been surprised by the number of EN patients that are seen by the out patient dietitian at the VA. The EN patient I assessed was interesting. He was already being tube fed when I started on him yesterday, but I wasn’t able to finish until today. When the RD and I looked at the order we were both surprised by the amount of fluid he was being given. This morning the doctor who ordered the tube feeding called the RD, and said he thought he might be over-hydrating the man due to some of his signs, symptoms and lab values, we agreed. I assessed the patient’s needs and adjusted his fluid. The doctor also decided to switch to a denser formula because the patient was not tolerating the formula well and had recently lost weight. So I calculated the amount and the rate of infusion with the new formula. I was excited that the RD agreed with what I suggested.

Yesterday when the RD and I visited patients I was a little overwhelmed by the number of patients and the fact that her visits were slightly different than the Diet Tech’s visits that I had become accustomed to. Today when we visited I felt like I got to know my patients a little more, and it was incredibly valuable to have a face and body to attach to the medical chart when I was evaluating them. There were a few I was concerned about after reading their medical file, but I couldn’t remember what they looked like or how they had acted. When we visited today I was pleased that some patients had improved, and others appeared healthier than I had expected after reading about their conditions. I found this very reassuring.