With only 1 week left before Staff Relief, I am amazed at how much I have learned in the last 13 weeks of clinical nutrition (Long Term Care 5 weeks and Acute Care for the past 8 weeks). I spent my last 2 interning days in the ICU, CCU and rehab and I have 6 more days to overload my brain with tube feeding calculations. I don't think I have ever used my calculator so much in my life!
(for any future RD's/Students, this website is really helpful: http://www.csun.edu/~cjh78264/tubefeeding/introduction.html)
Never have I realized the importance of knowing my medications until I was placed into the ICU and told to put a pt on nutrition support/tube feeding and to figure out the rate and formula. I still have a little trouble finding the best formula because you have to take so many things into consideration such as labs, wt and meds.
Most of the patients in the ICU are on Propofol (anesthetic) and many are ventilated. Many pt's are also intubated. The propofol rate given to the pt for sedation really throws things off because propofol is a fat-based medication and can bring a lot of calories to a person. So when figuring out the correct rate for TPN feedings, it is important to take this medication into consideration so that you don't provide more than 60% fat.
Many of the patients in the ICU aren't eating, can't eat or have something wrong with the GI system, so needless to say, there are a lot of recs being made for tube feedings/nutrition support and my brain is filed with numbers by the end of the day.
Once again, 3 years ago I never realized what I was getting myself into when wanting to get the "RD" behind my name. I'm amazed at the knowledge of clinical dietitians and what they are responsible for in an acute care setting.
The other day Karel was craving fruit so I decided to have a fruit-filled dinner. I made yummy crepes with a Quaker Oatmeal Pancake batter. Super simple.
1 egg white
Splash of milk
About 1/4 cup - 1/3 cup batter
Enough water to make the batter soupy (dripping off the fork when you mix it)
Wheat Germ (honey)
1. On a non-stick pan, on low heat, with a little non stick spray, pour a laddle full of batter, just enough to cover the pan (the batter should be thin, like a thin pancake).
2. Flip after a minute or two, when the edges start to curl up.
3. Spread a little yogurt on the crepe and sprinkle with honey wheat germ and chopped walnuts.
4. Add fruit and fold
(Fruit: oranges, pineapple, nectarine, strawberries, blueberries, kiwi, peach)