Making more work for myself

It's my staff relief week at Rex, and I choose to work on 5W, the unit with the most interesting hodge-podge of cases (cancer, FTT, fungicemia, drug OD's, etc.). Since that's not enough to keep one person busy, I was also assigned the other hodge-podge floor, which has apparently become the DM wing. Every morning, I get several consult orders to clarify the MNT order for DM patients (i.e. determine how many gms of CHO they should get at each meal). Several have turned out to have ESRD and other significant health problems. So 2-3 times, I've gone on to do a full assessment: getting a full PMH, speaking with the patient, carefully determining protein, potassium, sodium and CHO needs, making extensive recommendations in my notes, etc. Today, the RD who's signing my notes told me that she changed them to just a clarification of the CHO needs. If the MD doesn't order a renal MNT, she said, she usually won't order it since she assumes there's a reason for it - and usually they aren't eating well enough to exceed a limit anyway, so it could hurt them more than help them to restrict something. I've come a long way in 12 weeks, but it also means it's been a long time since my renal rotation! I guess this is why I had never done an assessment for a renal pt based on this kind of consult before this week...