Staff relief at CMC Union

This week I'm doing staff relief. It worked out well for the dietitians because we are down 2 of our 4 dietitians this week. I kind of like being on my own. The patient that has been taking up the most of my time the last two days is a malnourished man on TPN. He also has two stage III pressure ulcers on his back that somehow grew together under his skin to form a tunnel under the skin. I started to feel queasy as the nurse explained it to me. He is still eating po, and I have also been doing a calorie count on him. Yesterday he got about 300 calories and 11 grams of protein. When I go and ask him how he's been eating, he says that he did a good job. I guess that just goes to show that patients might have a very skewed view of what they need to be eating. He is getting his needs met through the TPN, but he won't be able to stay on that once he goes home. I think the doctors might be placing a PEG tube soon. This all raises some of the same issues that Cassie mentioned in her blog. From what I've seen the patient does not seem to want the PEG tube or any of the supplements that I have sent to him, but the family is very insistant. It's hard to know what should be done, especially since the patient seems content to just not eat. In his pallative care report it says that he just wants to go home. It's a lot to think about.
Tomorrow should be a good day for lots of practice because one of the two dietitians we have this week will be seeing outpatients. It will be one dietitian and me for most of the day for the whole hospital - should be fun!