Psych Floor

Today I went up to the Psych Floor by myself for the first time. I've been up there a couple times with the RD who normally works up there, but today she let me brave it alone. Mostly what is done is just to screen patients, since they have no electronic medical records, so we have to go to the floor to screen, and to see patients who have been there >7 days. There is one patient who is on the floor fairly frequently who is known for not only requesting to see an RD, but also for making his own referrals. He often comes up to the RD, asks to speak with her, and then when she starts talking to him, he starts telling her she has to see all these other patients because they need her advice too. He also apparently gives weight loss advice throughout the day to various other patients. When I looked at my patient list this morning, I was worried because he was on my list to see, since he has been in the hospital more than 7 days. The nurses have gotten so accustomed to him breaking the rules they don't even try to stop him anymore, so I knew they wouldn't come bail me out if he started referring other patients to me. The last time I had seen him was my 3rd day at the hospital, and he started instructing the RD on how to teach me. Needless to say, I wasn't looking forward to meeting with him. Luckily today he wasn't in a chatty mood, and all of the other patients were in a group session when I spoke to him, so he didn't have a chance to refer anyone to me. The RD was worried that he would be upset, since he denies having diabetes, even though he does, and the MD had changed his diet order to a diabetic diet. Luckily I don't think he noticed the change, and didn't hassle me at all about it.
I also found my case study late last week and started to do some work on it today. The man is 52yo alcoholic who has cirrhosis, had most of his stomach removed due to severe GI bleeding and has chronic pancreatitis, among other issues. Needless to say, he eats A LOT. He is on TPN at home, and eats pretty much anything he can get his hands on. He is in the hospital this time for altered mental status due to increased ammonia levels, but according to the other RDs he is in all the time, so there is a long chart history for me to look through. Tomorrow I am going to try and go in and talk to him about a diet appropriate for pancreatitis, since his wife reports that he follows no diet and eats whatever he wants. He is 69" 110#, so he could use any weight gain. The wife also doesn't know his TPN rate, so I'm hoping she can find that information out and see if he is getting enough calories that way.