Georgetown Week 3

This week I'm in the ICU focusing on nutrition support and critical care. It has been very different from GenMed/Endo because most of these pts are intubated, so you can't really speak to or education them. I've been writing TF recommendations, which has been pretty straightforward for me, as well as TPN recs, which are a bit more complicated. The TPNs are not calculated the way we learned in class; we have to specify the % concentration (they are not given to us) and the total volume of each nutrient. The RDs use trial and error, kind of weird. I'm trying to figure out if there is a methodical way to do this. What is everyone else doing for TPN?

As far as emotional experiences, again, the ICU is very different. A lot of people are passing :( Actually, I was following and interacted with one pt, Mr. B, while I was in the GenMed unit. He had jaundice with excessive bile drainage, and was off and on NPO for an antipated procedure that kept getting postponed. Earlier this week, I was told to assess the pt in room 9, based on our see within 72hrs of ICU admission protocol. I happened to look over and notice no one was in that room. I looked asked the RN what happened, she said he passed away. Then, I went to our "pts to see" list to check it off and noticed it was Mr. B! It was sad because I had just talked to him the previous week and I thought he was stable. I have yet to find out what brought him to the ICU.

As a f/u to my favorite pt, Mrs. G from last week (she's the one who wouldn't eat because she didn't like the food, and was therefore under consideration for a PEG), I just found out she's was put on TPN. Unbelievable! I know she didn't want TF's, so she probably refused. Her calorie counts over 6-7 days averaged ~44% intake. I think this is a great example of when TPN is not appropriate; the gut is working. The RD following this pt was pretty annoyed about this as well. On the other hand, her low PO intake was probably affecting her progress.

We also have journal club here, and one of the RD's presented a case study this week. In general, I've noticed the dietitians reference studies and research for various topics and issues such as feeding obese pts. I think it's great that they are keeping up with the literature!

Sarah O - I also learned the same thing today about Propofol. A lot of pts are on it in the ICU.