Georgetown Week 10

This week I am on my last rotation - GI/Surgery. I like GI. I've seen pts with bowel resections and even a pt with a DIEP facial graft, etc.

One of the pts had exploratory laparotomy and an OSH which resulted in a stomach perforation. She was transfered to Georgetown, and her abd has been huge, round, and distended since she came in. She was started on TPN because of the perf. After it was fixed, she was started on trickle feeds. We attended medical rounds, and the teams said she was handling the TF well, so we asked to slowly increase TFs and DC the TPN. Well, 3 days later, the pt was STILL on TPN, even though we very clearly discussed it with the team. Apparently, one of the new residents was worried that the pts albumin was a little low, so he decided TF and TPN together (both providing full nutrition) would be a good idea. OMG, crazy. Sometimes they really just don't get it. I checked again today, and I saw the pt was NPO for some procedures. There was no TPN running today, but that same resident ordered TPN for tonight. When I asked him about it, he said it was just for the meantime since she's having procedures today. I tried to explain that we normally don't order TPN for just one day. And, even if we do order it, by the time it gets here (we put orders in by 11am, and they come in at 8pm that evening) her procedures will be over. I still don't think he understands!

A lot of the dietitians are in and out of the office, using vacation time, so I've been seeing pts on my own and helping out.