ICU

Yesterday was my first day at the ICU. It's a whole different world up here! (ICU is on the top floor at the VA). The day started slow, with only 5 patients. The RD suggested that I could go cover other floors, but she spoke too soon. By the end of the day, there were 15 patients on that white board at the nurse's station. Crazy!

One of which was a home tube-feeder, coming from a city in Northern CA 4 hours away from the SF VA. When we got to calculations, he was only receiving 1500ml of Promote w/ Fiber daily @ 125 ml/hour, with no po intake at all. I was surprised that he wasn't losing weight, since it doesn't meet his caloric needs. And 125 ml/hr seemed too high a rate to be tolerated well. What's amazing is that his albumin is 20, and his skin has no signs of ulcers whatsoever. Confusing. But hey, if he's healthy, then that's good (and he is pretty healthy; he was at the hospital to get a Baclofen pump replacement). So we changed the TF recs to 70 ml/hr x 24 hours, and updated his wife on changes and additional instructions on how to check for gastric residuals.

On Carolyn's post, I've seen a lot of patients with C. diff at this hospital (maybe because they're mostly older men?). The RD I was working with at the time gave C. diff patients some Activia for probiotics as an MNT, but that's about it.

I also saw a modified barium swallow today. It was neat!