Rehab thoughts!

So after my week in rehab, I thought I would share some of the things that I thought would be most helpful if any of you end up going to rehab during your rotations. So here are some of my thoughts about what I spent a lot of time assessing-
1) Albumin and prealbumin as many of these people have had recent inadequate intakes/are NPO/have a mechanical soft or pureed diet..etc. We used these values to decide whether they are protein-deficient (don't really look at BUN or Cr unless they are also a renal/dialysis patient since those values are more variable according to my preceptor)
2) We looked at the RN/NA charts where they log what % of their diet they are eating (<25%,>75%) so that we knew whether they were getting adequate nutrition.
If they weren't eating a lot, or their lab values were really low then we talked to them about whether or not they would be willing to try an Ensure, and I emphasized to them eating the protein foods on their trays.
3) If it's an initial assessment, we always calculated their CAL/protein needs.
4) If they were using a supplement (Ensure, etc.) then we made sure to include the CAL/protein in the supplement in the note.
5) We looked at their MRA to make sure that they werent on Coumadin (a LOT are in rehab) and if they were then we put in their diet to be consistent K.
6) We looked at their pressure ulcer staging according to the NA, if they have one.
7) We looked for the record of their last BM
8) If on TF, then we looked to see if they were getting it.
9) We started most of them on a multivitamin if they weren't already on one, since most of them have high nutritional needs.
10) Most of the PES statements in the notes that I had the chance to write delt with increased protein needs, inadequate oral food/beverage intake, and swallowing difficulty, and then it was usually related to their CVA, spinal cord injury, trauma, or whatever they were in there for, and then we used the lab values, the report of their % of food intake, or their TF/mechanical soft diet as the evidence.

I hope that's helpful to you all if you spend some time in Rehab. I found it fascinating, and all of the staff in that building got along SO well and it was really cool to see the interactions. I also got to meet some really interesting patients, as rehab really runs the gammot in terms of how old the patients are and what state they are in, mentally and physically.

Have a great weekend, everyone!

Elizabeth