Hospital Craziness

This is my second week in the ICU. These past few days I have been working in the neurosurgery and trauma ICUs. Quite interesting and sad. The stories are unreal, and I continue to be amazed. Most of the patients are on a vent and enterally or parenterally fed. Perative seems to be the formula of choice in these units. Patients come in all shapes, sizes, ages and genders... although I must admit the majority of the trauma patients seem to be men. Hmm. Maybe their wild sides could not be restrained any longer?

I learn more and more each day. In fact, on a completely different note, I was working on my case study earlier and found out some unexpected info. My patient is s/p Roux-en-y gastric bypass surgery (in 2002) and arrived at WFUBMC with a perforated marginal ulcer (x2). Well, I originally estimated her needs using her ABW because she was 150% of her IBW. However, after speaking with the Bariatric RD, she said she would have used the gastric bypass standards of care to estimate her needs --> 14-22 kcal/kg IBW and 1.5-2.0 gm protein/kg IBW. The results were quite different than mine. However, my patient had been eating a higher calorie diet prior to admission and also had additional energy needs due to her recovery following 2 operations, etc.... it made me think she needed more than the meager 763-1200 kcal estimated using the gastric bypass standards. The Bariatric RD did say that each case is different and independent variables must be considered for each patient. Complicated I tell you.

Cannot believe we only have 3+ weeks remaining. Time flies.

Hope all is well,
Rachael