tube feedings and TPN

For the past week at CMC Union I've been practicing more tube feedings and TPN's. I got to practice writing the TPN's for my case study, an alcoholic patient with acute pancreatitis who had his gallbladder removed and then had a hemorrhage in his abdominal cavity and went into respiratory failure. I got to transition him to TF and then see him progress to solid foods. It was a very fast progression! For me the hardest part of TPN is knowing what to do with all the electrolytes. It's also hard to figure out exactly how many grams of macronutrients to give when the patient has multiple conditions to consider. I enjoy working on the TPNs though. For tube feedings, the hardest part is again figuring the needs if multiple conditions are present and determining which formula off of the formulary is the most appropriate.
Two other exciting things have happened recently. First, Amanda came to visit last week, and we had a good visit. I enjoyed getting to share everything I've learned :) Second, we were short staffed yesterday, so I got to do third floor medical (excluding the progressive care unit) by myself. Somebody came by to check on me about once an hour and answer any questions I had, but it made me realize how far I had come to be able to take care of my patients without much help. I felt pretty comfortable with everything that was on my list, including two patients that we got a consult on because they were admitted on a tube feed. I definitely ran everything I did by the dietitian for the tube feed patients, but it gave me confidence when she approved of what I did!
Today I gave a "chat session," or mini-lecture on safety to the nutrition and food service department. It went pretty well, except I had an extremely hard time talking loud enough. We held it in the kitchen with all the ovens and fans running, so if you've heard me talk before (which you all have), you know it was a challenge for me!