A long but satisfactory Friday

When I got to the hospital today, I discovered that on the floor where I am doing my staffing, there were 19 patients to see. Hmmm... Fortunately several were discharged and one had been seen by someone else yesterday, so I had 13, which was a load for me. I was supposed to go running after work, but I took a nap instead.

My longest case of the day was a gentleman I saw earlier this week who has some sort of vocal cord paralysis/esophagitis/something where he can't swallow correctly so he has to be tube fed for the time being. However, they got him up to Jevity 1.2@30 and he started having residuals of 80-90cc, so they stopped him at that rate. I had recommended Vivonex@85 as a goal rate in case they wanted to try something else that maybe he would tolerate better (I mean, 80-90cc isn't too bad, but they were worried about it, so I did what I could). They kept him on Jevity@30 the whole week. However, today they wanted to send him home, so I got a consult for recommending bolus feedings (which I hadn't done before really), but I looked at his chart and Vivonex@85 was written all over it. Apparently the MD read my note and assumed that was my rec for him at home (which I had made before I knew he was even going home...). So two problems arose. #1 His continuous feeding was not high enough to meet his needs at the moment, so how could we send him home with bolus feedings (which would be 7 cans a day to meet his needs) which he may not tolerate? #2 Would he do better with Vivonex or Jevity at home? He had never been on Vivonex, so how could we send him home with something that he had never tried before with a bolus feeding that he had never tried before either? So I called the doctor (my first time to do that... I'm terrible with trying to figure out the phone system at the hospital...) and voiced my concerns and asked if we could just do a little test bolus of Jevity at the hospital just to see if he would be ok with that. The RD I consulted with told me that Jevity would be a little easier to come by, so we went with that. So the doctor ordered the nurse to feed the patient with 1 can of Jevity (which I watched her do... I had never seen a feeding before, which sounds kind of ridiculous), and the patient did fine. His little wife was in there learning how to do it. So cute. The patient asked me (in his partially vocal-cord-paralyzed voice) if he could use Ensure instead of Jevity, because he likes Ensure because of all the different flavors. He likes strawberry. I'm not really sure where he was going with that. Maybe his stomach has some sort of special taste sensation... Anyways. So the doctor ordered for the pt to get 7 cans of Jevity a day. The doc asked me how to spread them out in the day ("2 in the morning and 5 at night?" was his question... Please. Quite the bolus for a man who has been on slow continuous for a while...). So I shared my recs about spreading them out every couple hours and starting with a few cans a day and work up to 7 just to make sure he can handle it. The little wife was just so grateful for my help and gave me a big hug. I told her I hoped I'd never see her again. (Meaning of course that she would not have to come back to the hospital again....). So a success. I felt my position was an important one in the care of this patient.

Sorry the story was so long. Kind of measures up to my Friday. Have a great weekend, all!