Today's Patients

I had a few interesting patients today. One gentleman is on palliative care and he has taken a turn for the worst recently. His blood pressure has been very low. After reading all of the chart notes I was expecting to find someone completely uncommunicative. When I walked into the man’s room his wife and daughter were with him. I realized he was a patient I had visited several weeks ago and that I had had a fairly extensive conversation with him and his family. It shocked me to realize that this was the gentleman I had been reading about. It also shocked me that he looked as good as he did and seemed cheerful. He has hardly been eating anything, but said he wanted lasagna, and since we couldn’t provide it for him his family said they would go get some. The nurse offered to heat microwavable lasagna if the family provided it. This patient is also given soda and ice cream, I know he drinks the soda, but I am not sure about the ice cream. Fortunately, I think he does still drink some of the Ensure he is given.

Another patient I had today had recently returned from a short stay in the hospital because of sepsis from a UTI. He also has dementia, so when I went to talk to him it was hard to know how much he understood and how reliable his information was. The other interesting thing about this man is that he is NDD1 and on honey thick liquids. I find it a bit frustrating when I have patients like this because the available supplements are limited. We have a honey thick milkshake that I added to his meals, but you can’t just add an Ensure to provide the additional calories and protein needed with sepsis. He was on IV fluids due to poor hydration status, and his albumin had plummeted from its previous value several months ago, but the sepsis probably had a lot to do with that.

The last patient I worked on today was a tubefeeder. It was a reassessment, as are most of the assessments I do in LTC. He seems fairly stable, but unfortunately he has not been weighed in over a month, which significantly hinders my ability to assess him. I will have to go visit him tomorrow before I complete the assessment.