This week has been very busy.  My focus has shifted more to critically ill patients and those needing enteral feedings, which are formula feedings through the nose or through a tube connecting to the stomach/small intestine.  I’ve had to pick out which formula to use, their daily needs for calories and protein, and how much they need to be given per hour.  Its using a few algebra skills as well as clinical judgement.

One lady I wrote an order for has a jejunostomy tube, which is a tube that connects from the skin to the jejunum, a part of the small bowel.  She is on enteral feedings at home, and uses a particular formula that is pumped into her during the night.  However, she is post-op from surgery, which automatically  increases her nutrition needs- mainly protein!  Extra protein will help her body to heal better.  I went in to speak to her about starting her tube feeding and she was worried about switching formula; sometimes with different formula compositions, some side effects such as diarrhea could occur.  I assured her that we would be following her very closely to make sure she was tolerating it ok, and that her body needed the high-protein formula.  She and her husband were glad I took the time to speak to them, and I was too!

A lot of the other enteral feedings I ordered were for people who were unable to speak to me- and visiting with patients is one of my favorite parts of dietetics- so I was glad to have this interaction.

Having the ability to order tube feedings is pretty awesome, if I do say so myself.  It’s nice to have a definite impact on a patient’s plan of care.  With interviews and recommendations, you never know if the patient is really going to be impacted by what you say or if the doctors are actually going to listen to you.  Tube feedings are another story- once the doctor gives the word, it’s all up to me!


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