CMC Week 2

Hi everyone,

I've really enjoyed keeping up with your blogs! I'm mostly in General Medicine this week, but something that I have learned is that the dietitians here all really do everything- so while my weeks are divided into rotations, they do a ton of cross-coverage. The dietitian that I am with this week sees a lot of patients with random problems (I saw a lady today with a crazy spider bite, a patient with what they have now identified as liver cancer, a pre-heart transplant patient, and the list goes on). It keeps it interesting. The dietitians also write all of the TPN orders so that is a rush to get those in to the pharmacy in the morning. I haven't written any myself yet, but today I helped look at labs and watched the dietitian make a few changes to a few TPN orders based on the individual's labs.

A few things that I wanted to share-

-I went to "Grand Rounds" this morning with the transplant dietitian, the other intern (in her internship at Winthrop who will be here for the first part of my summer), and the Clinical Nutrition Manager. Grand Rounds, from what I gathered, are for mostly residents and doctors interested in the topic, but they went and invited us because the topic was Liver disease, and the MD speaking was from UNC school of medicine! He had a little test for fun to help the MD's start thinking about liver diseases, and the first one was "23 yo woman with history of hemolytic anemia at age 16 and you see Kayser-Fleischer rings." Thanks to Dr. Beck, I knew that was Wilson's disease...620 pays off already!

-In looking at PN, something that I learned for adjusting K was that for every 10 mEq of K that you add to the order, it should increase lab by about 0.1. So that's helpful if any of you will be manipulating PN orders.

-I got a handout from my preceptor because they use PES statements here, so this handout was concerning if there is no nutrition problem what do you do (because every patient's note starts off with a PES statement, no matter what." I thought this would be helpful for you all in case you come accross this: "Nutritional parameters within normal limits as evidenced by (then include evidence such as BMI, % intake, indicator of visceral protein status, and knowledge of diet)." There's no etiology in there, but I guess you could say something about sufficient appetite, etc. Anyways...just wanted to share that. The note also says that if this is the case, be sure to mention when the unit RD will rescreen in case of nutrition risk arising.

I'm going to watch an open heart surgery on Thursday. I'm excited/a little nervous, so I'll try to report in after that!

Hope you all continue to enjoy your sites!
Elizabeth