Thursday was less overwhelming. I had 2 reassessments to do, and I got to spend some time with patients, alone!! I was also allowed more independence in my note writing. I had some amazing experiences visiting my patients.
1. I visited one of my TPN pts who was lying with his stomach exposed. His wife was there and she offered to explain what I was looking at. This man has been on TPN since November, he has a fistula and I saw the fistula bag over the small intestine. The bag was clear so I actually saw the small intestine! The woman said that there are two holes in the intestine that drain into the bag. The fluid is a yellowish color. He also has a colostomy bag, and brown stuff was draining into that. It was pretty amazing to see.
2. I also saw a nurse disconnect one of my tube feeders and give him some drugs through the PEG tube. This was the man who got mad at me the first time I visited and so I thought I had made an enemy, but now he greets me warmly and seems very glad to have visitors.
3. I had to run and find a nurse when my other TPN patient was having a conversation with me and then all of a sudden said he needed a nurse because he was leaking. I ran and got a nurse, but didn’t feel it was appropriate to stay and gawk at his unfortunate situation, so I am not exactly sure what happened. He actually only gets TPN at night and then can eat during the day.
4. Another one of my patients is probably going to die very soon. This will be my first loss since arriving at the VA.
I visited my TPN patients on Friday morning and was disappointed that one of them was in pain and the other had diarrhea and seemed subdued. I wish I could make everyone happy.
Monday I start working with a different RD in long term care.
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