Georgetown End of Week 8

I started Oncology on Thursday of last week. It is definitely a different atmosphere. We hear alot about hospice care and code status - some pts are DNI/DNR. The RD mentioned that it is tough on this unit because she really talks to her pts and gets to know them, and then some of them die. We were working on one pt and the RD got really frustrated because this pt was barely getting any nutrition currently, and generally hasn't been eating very well since he was diagnosed. She was like, "Now they consult me? When it's too late!" She really feels, and I agree, that nutrition needs to be addressed ASAP with cancer pts. It surprised me that MDs can forget this, some of these pts are clearly wasting away, we need to feed them!
The energy needs depend on the type of cancer, stage and mets, but its seems like in most cases we give about 30-35 kcal/kg, and 1.2-1.5 g pro/kg.

I've been working on more TPNs and talking with pts on PO diets. They use a lot of supplements in these units and we try to sneak in calories however we can. Everything from Beneprotein in soups to peanut butter. One pt said he liked soft, soothing foods, so we called down to the diet office and asked for ice cream and puddings.

I'll be in Oncology all this week.