History/ Wanting the uncertain Future to be History

I got a history lesson from one of my patients today. He told me about opening the gates of a concentration camp in WWII. It sounded pretty amazing.

I finally got the information about the wounds I needed (discussed in previous blog) and fortunately they are healing. However, as I was writing up the patient’s assessment I began to doubt how I had decided to classify him, and I will need to speak to the RD tomorrow. I enjoy getting to know the patients in long-term care, but I am finding it difficult to let go, and to accept that I will not be around to reassess them, nor will I be around to check on them between assessments. The latter makes me a bit nervous. The moderates are re-evaluated every 30 days, but I think the mild pts are reassessed every 90 days. That is why I am doubting my initial impulse to change this patient from moderate to mild. The issues that made him moderate before, albumin and wounds, have significantly improved, but as I looked a bit deeper his DM is very uncontrolled and his renal function is quite poor. He is overweight, but the classification of his weight status is a bit nebulous depending on whether BMI or target body weight is used. Normally BMI is used, but I believe I was told at one time to use TBW when assessing patients with an amputation, and another time I believe I was told you could consider both and then use clinical judgment. Anyways, I am a bit preoccupied with this patient at the moment, and I will be glad to talk with the RD and get him finished tomorrow!!!

I have to remind myself that many other health professionals are monitoring these patients, and that the dietitian will be told if a patient’s health status changes. Also, the Diet Tech and RD DO check on the patients regularly at meal rounds, so even though there is a lot of time between formal assessments the patients are being watched in the interim.