NICU and the phantom illness

I got to see the NICU for the first time today. The peds/oncology RD only goes to NICU 3x per week since it's isolated from the other units and requires a special access code, fingerprint ID and lots of hand washing. The neonatologists and pharmacists actually take care of calculating TPN's and determining EN needs, so my preceptor is basically just another set of eyes on the calculations. Kind of disappointing, but that's just the division of labor at Rex. My preceptor is certified for peds and she really prefers oncology, so I guess it works out for everyone. The babies were so cute though! And I got to see one get prepped for photo-therapy to treat hyperbili.

I assessed a 78 yo pt with a frustrating phantom illness today. He lost his appetite ~1 month ago due to severe abdominal pain and a hacking cough, and he and has lost ~30 lbs. He says he was pretty active and healthy up until then. He's undergone a slew of tests in the past two days, but they haven't been able to explain his illness. I could really sympathize with him, having experienced less severe recurring bouts of seemingly inexplicable abdominal pain myself. He was on clear liquids preparing for yet another test, but I assured him that I would work with him to help keep him strong even if I couldn't diagnose him. So I'll be following up with sooner than I normally would.

Oh, and I had a small confrontation with the wound care nurse today. Apparently she was disappointed that my patient "suffering from vapors" didn't understand the importance of protein in treating her pressure ulcer. I admit, I could have done more to educate everyone involved in her care about the importance of drinking the Boost. However, it's really hard to round up an entire family that's coming and going, and the patient is not always feeling well enough to talk. Moreover, she had more issues than just protein (poor appetite, thrush, out-of-control blood glucose levels, concerns about weight gain). Like I said yesterday, it's really hard to balance all of these problems, especially in already-overwhelmed cancer patients!