Nothing too crazy happened at the hospital today. So, I will just list a few things that I saw/learned. Most patients have the Ryles tube, the tube for enteral/tube feedings, inserted through their nose down to their stomach or intestines. One patient I saw today had the tube coming out of her mouth. Because she is unconscious, her movements sometimes yank on the Ryles tube. They have straps to hold patients' arms down if a particular patient has several mishaps like this. For some reason, no one secured this patient's arms to prevent her from yanking on the tube. Several times, the patient pulled the tube nearly all the way out of her nose. When the tube is pulled out, a new one must be put in. Because she did this so many times, in a jerking fashion, she irritated her nose to a great degree. She developed a nasal infection, so they had to put the new tube into her mouth instead. This brought up the ER patient I saw last week whose caretaker took her home with an enteral feed. This caretaker will be preparing and administering all of the food. However, my suspicions were confirmed, today. Many patients who go home like this accidentally pull the tube out. In these cases, a doctor visits the home to install a new one, or the patient comes back in for one to be installed. Infections are common for patients who go home with tube feedings. Additionally, my other fear was confirmed that many caretakers do not make food of the correct consistency, and they end up clogging the tube. The dietitian informed me that cost is not a problem for most of these patients; it is merely the matter of not wanting to be at the hospital.
Another patient showed dislike for being in the hospital. This patient hated the tube and always begged for it to be taken out. When his condition allowed it, he then started complaining that all of the food he receives is nasty. Because he is not accepting the enteral feed or oral diet, he is not eating enough! This is deadly for a patient in the IMCU because their calorie and protein needs are already very high, and muscle wasting is common. He demanded food made from his home. The only problem is that there were no good hospitals near his home town/village, and KMC is famous, so he drove eight hours to get to Trichy. Without ice or refrigeration, which is expensive, there is no possible way that this man can have food made at home and brought to him without it spoiling. The total use of restaurant food that I mentioned in yesterday's post exacerbates this issue because the food is always the same. Many hospitals at home have rotating menus, but he is served the same, bland foods every day. No wonder he does not want to eat! Luckily, his neighbor is in town this week and, with coordination with the dietitian, will start making and bringing food to him. After the neighbor leaves town, I do not know how this difficult patient will get any nourishment. I also found out personally why patients are served bland foods, even if they do not like the taste. Every time I eat very spicy foods at lunch with the dietitians, I cough every so often after the meal. I notice that mucus production increases. This would be bad for a patient lying on their back all the time!
Today, I saw a patient prescribed 2.1 grams of protein per kilogram of bodyweight. Normal people need 0.8 to 1.0 grams per kilogram. This is the highest prescription I have seen, and, today, I saw why. This man had been in a RTA, road traffic accident, and had a severe HI, head injury. Today, I saw him for the first time without bandaging. There was a huge dent/impression in the left side of his head. At first I thought it was the sunken look of severe malnutrition, but, when I walked on to his right side, there was no dent. It looked like a bowling bowl sized impression. No wonder he needs so much protein; his brain and skull need to heal! He also cannot do very much activity with that much trauma, so muscle wastage is a huge issue for him.
In the PICU, many children are admitted for common things like fever or vomiting. These patients will receive breastmilk if they are young or a normal diet if they are older. However, babies in critical care, like the ones on ventilators, cannot nurse. These patients are given artificial milk through a Ryles tube. The nephrotic syndrome case that I saw a few days ago had made no improvement. Because his eyes kept falling open and he needs to rest, his eyes were taped shut. This was on top of all of the tubes and machines hooked up to him. This is a sad case.
I found out we are going to Mudumalai and Ooty this weekend, two places with many forests, wildlife reserves, safaris, elephant camps, and shopping. Tea is only 300 rupees per kilogram because there are many tea farms in the area. In the US, I have paid the rate of 8,500 rupees per kilogram. Because the rate was so high, I only bought a few ounces. Here, I can buy several kilograms! Hopefully, I can fit it into my luggage. I am so excited to see elephants and tigers and sloth bears! Oh, my!
One last note: I feel as if I suggested that nurses are incompetent in my post, yesterday. My point was that they make many mistakes when it comes to feeding patients. Despite these mistakes, the hospital would not run without them. They are a huge workforce, and patients would receive no care if there were only doctors, therapists, and dietitians to prescribe care that they could not carry out on their own! Nurses are very necessary and perform many skilled tasks that are critical for patient care. Thank you to all of you nurses out there!
Another patient showed dislike for being in the hospital. This patient hated the tube and always begged for it to be taken out. When his condition allowed it, he then started complaining that all of the food he receives is nasty. Because he is not accepting the enteral feed or oral diet, he is not eating enough! This is deadly for a patient in the IMCU because their calorie and protein needs are already very high, and muscle wasting is common. He demanded food made from his home. The only problem is that there were no good hospitals near his home town/village, and KMC is famous, so he drove eight hours to get to Trichy. Without ice or refrigeration, which is expensive, there is no possible way that this man can have food made at home and brought to him without it spoiling. The total use of restaurant food that I mentioned in yesterday's post exacerbates this issue because the food is always the same. Many hospitals at home have rotating menus, but he is served the same, bland foods every day. No wonder he does not want to eat! Luckily, his neighbor is in town this week and, with coordination with the dietitian, will start making and bringing food to him. After the neighbor leaves town, I do not know how this difficult patient will get any nourishment. I also found out personally why patients are served bland foods, even if they do not like the taste. Every time I eat very spicy foods at lunch with the dietitians, I cough every so often after the meal. I notice that mucus production increases. This would be bad for a patient lying on their back all the time!
Today, I saw a patient prescribed 2.1 grams of protein per kilogram of bodyweight. Normal people need 0.8 to 1.0 grams per kilogram. This is the highest prescription I have seen, and, today, I saw why. This man had been in a RTA, road traffic accident, and had a severe HI, head injury. Today, I saw him for the first time without bandaging. There was a huge dent/impression in the left side of his head. At first I thought it was the sunken look of severe malnutrition, but, when I walked on to his right side, there was no dent. It looked like a bowling bowl sized impression. No wonder he needs so much protein; his brain and skull need to heal! He also cannot do very much activity with that much trauma, so muscle wastage is a huge issue for him.
In the PICU, many children are admitted for common things like fever or vomiting. These patients will receive breastmilk if they are young or a normal diet if they are older. However, babies in critical care, like the ones on ventilators, cannot nurse. These patients are given artificial milk through a Ryles tube. The nephrotic syndrome case that I saw a few days ago had made no improvement. Because his eyes kept falling open and he needs to rest, his eyes were taped shut. This was on top of all of the tubes and machines hooked up to him. This is a sad case.
I found out we are going to Mudumalai and Ooty this weekend, two places with many forests, wildlife reserves, safaris, elephant camps, and shopping. Tea is only 300 rupees per kilogram because there are many tea farms in the area. In the US, I have paid the rate of 8,500 rupees per kilogram. Because the rate was so high, I only bought a few ounces. Here, I can buy several kilograms! Hopefully, I can fit it into my luggage. I am so excited to see elephants and tigers and sloth bears! Oh, my!
One last note: I feel as if I suggested that nurses are incompetent in my post, yesterday. My point was that they make many mistakes when it comes to feeding patients. Despite these mistakes, the hospital would not run without them. They are a huge workforce, and patients would receive no care if there were only doctors, therapists, and dietitians to prescribe care that they could not carry out on their own! Nurses are very necessary and perform many skilled tasks that are critical for patient care. Thank you to all of you nurses out there!
No comments:
Post a Comment