A week of observations

I squeezed in a lot of observations this past week: a PEG placement, a g-tube being exchanged for a low-profile PEG, a dressing change on a deep wound with surrounding bedsores, TPN compounding, and indirect calorimetry. In between all of that, I helped the nutrition support RD to do lab checks on all of the TPN patients, write and change TPN orders, and assess ICU patients.

I like the environment in the ICU - it seems like the care is coordinated a little better due to the severity of the cases, and nutrition is viewed as an important part of patient care. The MD called us out for being 5-10 minutes late for rounds and proceeded to catch us up on the patients we needed to see. One patient we had already been following - he has been inpatient since early May but was moved to ICU this week. It's a sad case: an 70-something man got severe N/V on the day of his late wife's memorial service. They discovered he had metastatic gastric cancer, and he's been in the hospital ever since. He has coded 3 times, but he and his daughter still want everything done. He is mentally with it, but his body is just about gone. His albumin was 0.9 after his last lab draw, and he's even been getting TPN for weeks. The MD said his chances of leaving ICU with alb that low are just about zero, but this pt has surprised him before. In the words of the MD, he must be a cat because he seems to have nine lives.