Salisbury VA, not a simple first case

I hope everyone is doing well!

I forgot to mention that all notes at the VA are done on the computer, and trying to learn their multiple systems is a bit overwhelming. Another interesting thing about their documentation is that the dietitian I am working with uses a modified SOAP note; they have not switched to the NCP.

Today I was asked to attempt a follow-up assessment of a patient. The patient is diabetic, has renal failure, is intubated (I think with COPD and maybe pneumonia), and on EN. There may have been other medical diagnosis as well, and it was definitely not a simple case to start on! I did not end up writing the note because I had to go do my last orientation activity, but I did get to discuss and work through the case with the dietitian orally, and I found it very exciting. We had to change to a different formula, adjust the rate, and add water boluses. At the end of the day I was able to read that note and another one that she had written-up, and I was very glad to see the examples before actually doing it myself. Fortunately, she uses a template that I will be able to use as well.

We evaluated the regular lunch tray this morning. They use the re-thermalization carts that we talked about in Food Service and Management. The dietitian measured the temperature of each item on the tray, and then we tasted each item and rated it. The food was better than I had expected it to be.

At lunchtime we visited the patients, got feedback about their meals, and asked them if anything needed to be changed. We saw many of the same ones we had seen yesterday. One man who looked really good yesterday was not doing very well today. The sudden change caught me off guard and I felt disappointed. Another man seemed eager to learn about controlling his diabetes, and I wanted to jump in and teach him all that I knew about diabetes and exchanges. The dietitian gave him a little guidance, but I was surprised that she did not provide more education. I think she may work with him on it more in the future, but I will just have to wait and see. Had I been allowed to educate him at that moment I probably would have overwhelmed him with too much information. I need to be careful not to do that!