BMT = BA

BMT = bone marrow transplant, and BA of course, is bad ass.

We have mini case-studies to present tomorrow on a patient we went and visited earlier this week. My patient was a woman who had just had a bone marrow transplant for her uterine cancer. She wasn't eating and the RD and I counseled her on ways to increase her intake while she isn't feeling well. Basically for this case-study is to start looking at patients, their charts, and most importantly, practicing our PES/NCP statements.

Short explanation, but the NCP is the Nutrition Care Process, and it's aimed at standardizing dietetic practices, so that they will be more highly regarded, respected, and perhaps even more covered by insurance. The nutrition diagnosis, which is different from a medical diagnosis, is aimed at quickly explaining the patients problem, etiology (cause), and the signs/symptoms (PES!). So, for my patient, her nutrition diagnosis (for that day) was...

Inadequate intake related to nausea and vomiting, as evidenced by food and menu refusal.

As for the rest of the week? BUSY! Lots of classes which cover/review bone marrow transplant, renal, cardiac surgery, gastrointestinal, estimating energy needs, enteral nutrition, and of course...dun dun dunnn....total parenteral nutrition, or TPN.

TPN is a type of nutrition that is basically elemental nutrients, such as basic dextrose, amino acids, and fat molecules that are given via IV. They give TPN to patients who may not have a functioning stomach, intestines, or bowel, and of course, these people still need their nutrients to survive. But giving a patient TPN is extremely more difficult than it sounds. If a patient with a certain, or any condition, is given the wrong formula, it could actually kill them.

So, we had our first of three TPN calculation classes on Tuesday. In this class, I learned about specific caloric values of the elements, how to calculate volumes, etc. etc. Perhaps it would be best explained with one of my homework questions...

****

#1: A pre-term infant weighs 3.5kg. The TPN order calls for 204mL at 8.5mL/hr of D18AA6 with 6g/day and 10gAA/day coinfused with 48mL 20% lipids/day at 2mL/hr. Total fluid order must include TPN + lipids + IVF = 14.5mL/hr.

Calculate total calories per day from dextose.

Calculate total calories per day from amino acids.

Calculate total calories per day from lipids.

Calculate total calories per day from TPN.

Calculate calories per kilogram in the TPN.

Calculate protein per kilogram in the TPN.

Calculate the dextrose infusion rate (DIR).

Calculate the lipid infusion rate (LIR).

Calculate the percentage of calories from protein in the TPN.

Calculate the percentage of calories from carbohydrate in the TPN.

Calculate the percentage of calories from fat in the TPN.

****

Yep...that's just one of the problems. Gotta love homework for clinical.

But, it's nice to finally be exercising my brain more and switching from a math/science/health approach versus a managerial approach. It's refreshing, and I love it. And finally, our holiday break begins tomorrow! About time...

Change? Yep.

That's about all I can say to explain today. A definite change from the last four months. I think I have had more things assigned today then I've had in a while. 

Today was a day full of class sessions that taught us about CareWeb, CareLink, policies and procedures, ABC's of dietary assessment, prealbumin measurements and uses, and many other topics. It was a lot of sitting and listening, but made me very excited to finally jump into the clinical portion of my internship.

But, I no longer like the snow. A drive back from work which usually takes about 30 minutes, took 2 hours today. It was ridiculous, and to be honest, brought me to tears. I have much to do tonight, including an online module which is taking about 2.5 hours, reviewing a PowerPoint with voice overlay, reading, and studying for a medical terminology exam that I have first thing in the morning. It definitely didn't help that I got home at 7pm.

As of today, it's a toss-up on whether or not the boyfriend and I will end up going to the Pistons game tomorrow, which makes me sad. With the roads the way they are, and our schedules, it might be more beneficial to wait and just go to another game. The seats I won are nosebleeds, and it's literally impossible to go up any higher in the arena. So, we might just wait, go when we're more relaxed and less rushed, and spend a little money on getting much better seats. Especially since great seats are only about $10-15. I did get lots of other fun, free stuff so it wont be a total bust. But still...

How many more days? 198.

Oh hey, snow

The first big snow of the season is here! Usually I am fully enjoying it by romping around outside or cuddling inside and watching it all fall, except today I had to drive back downstate in it. A two hour car ride turned into three hours tonight. But, while the trip was annoying and long, I made it all in one piece. I think Marge is being nice now because I got her fixed and ready for the winter. Marge is the name of my car, by the way.

This weekend was a fun weekend spent in Mount Pleasant for graduation! My sister and boyfriend both graduated, and I'm very proud of them both. We experienced graduation in the new CMU event center, which was extremely nice and super-new. It was nice and comfortable and temperature controlled. Not like my graduation. Which was outside. They meant it when they said, "rain or shine." Because on my graduation day, the sun did shine for a few short minutes, and the rain came...along with the snow, and sleet, and wind, and lightning, and thunder. To help us out, CMU gave us trash bags for ponchos. But yet nothing for our thousands of family members sitting in the stands, many of whom ended up getting sick afterward. But it was worth it...(right, Gram??).

While it did stink to drive home for three hours, I love the fact that I can get back to a normal schedule again! I love that I can work out before I have to go into work and actually shower before I go into work and feel presentable. I did love my PSE, though. I learned so much and loved all of my staff. As days went on, while I may have had more problems come up, I felt comfortable enough to handle them on my own and staff began coming to me with their issues, which was really neat. I'm sad that my foodservice experience is officially over (still can't believe it!), but I'm more than elated to start my clinical rotation. 

And, in five days is my winter break! Two weeks where I can do whatever I want, including sleeping in, finally...

Oh, and guess what?! 199 days...

2 more days!

Until I'm done with my PSE. Very exciting. Today started off great - as I won Detroit Pistons tickets on the radio at 5:30am! So, it looks like getting up and going to work so early has it's perks. I'm very grateful and I look forward to next Tuesday to watch them play the Atlanta Hawks!

And, by some stroke of wonder, no one called in this morning and the day kept on going smooth. Except for the stupid copy machine, which was giving me trouble and "jamming" all up for the second day in a row. Wonderful. My QA phone and pager went off a ton as usual, and I had to help pass trays, remind staff to stock their fridges, and do rounds...overall a good day.

I also got to do some more administrative duties, but because of confidentiality, I can't say. But, I will say that it definitely gave me a challenge and saw how something really happens versus practice scenarios and metaphorical situations. Same situations, but big difference in the way I felt practicing in practice sessions versus when it really happens. But, it gave me great exposure to what being a manager is really like. And I love being a manager, I love my staff, and I'm sad that Friday is my last day!

While I am sad that Friday is the official last day of my entire foodservice rotation, I am extremely pumped and ready for my clinical rotation to begin. We got the packet of information and PowerPoints that we will be going over next week, and it's about 2" thick, back to back paper. I'm really happy that we're doing a week of refreshers for ABC's of clinical practice, renal/cardiac/BMT/etc.etc. diets, and writing notes and doing all that fun stuff.

Bring.It.On.

PSE? Psshhhh...

Today = all by myself! I took over as the QA, answering all staff questions, keeping patients happy, and basically just making sure everything is running like clock work. It was a good Monday, no call-ins, only two patients to talk to regarding accuracy of meal trays, and other small issues. I think the most exciting thing that happened was that the Fire Marshals decided to drop in for a surprise inspection, and I just had to make sure that all the logistic rooms and the soiled tray carts were not in front of doors or anything. Which they never are. But, it gave me something to do.

Besides that, just getting excited for the holiday season. This includes scraping snow off my car, bundling up in my winter gear, and decorating with hand-made paper snowflakes (impressive, right??). 

I'm almost sad that my foodservice rotation is over. I'm going to miss the awesome/amazing preceptors and the fun and outgoing staff. I now know tons more than I did when I started. I had an undergrad class that was meant to prepare us for a managerial position, but I think I've learned more in the past 6 days as a (well, pretty much) manager than I did in a 16-week course. 

One thing I'm not going to miss? Shifts that start at 6am.

Week 1...check.

Week one of my professional staff experience is officially over. And I survived! Yesterday wasn't nearly as bad as Thursday, I must have paid my dues. We still  had a few staffing things to take care of with call-ins and such, but overall, not bad at all. I got more pages than Thursday, but they were for easy stuff like delivering formulas for discharge and just making sure that patients are happy. I also had to deal with a disciplinary issue so that was "exciting" to see. Not exciting about what happened, but exciting in the fact that I got to see a real case scenario of what it's like...versus the counseling practice experience we did where we had the worse case scenarios and were videotaped trying to solve them.

Week two starts on Monday and I will officially be done with my entire foodservice rotation on Friday. Next Monday begins with a week of clinical classes to get us refreshed with all of our clinical information. I also have my medical terminology exam that week so I've been brushing up on that. My life has been pretty mundane besides that. Yep.


207 days...

Eh.

Such a long week. I leave home at 5am and sometimes don't get home until 6pm. I'm so tired. Things are SO crazy. 

The PSE is nuts. For the first three days, I was with three different supervisors, which was really frustrating, as they all had different schedules and ways of doing things. I never knew what tasks needed to be done on a daily basis. But, today I was with the same person again and I got the hang of things.

Basically, the QA Supervisor does a lot with staffing, making sure the galleys on the floor are stocked and clean, making sure staff are doing OK on the floors and aren't having any problems, talking with patients who have had accuracy issues for their trays, and stepping in for positions when needed. This isn't only for galley staff on the floors, but also the B2 galley which does a lot of the call-backs for trays and making trays for last minute diet changes.

The first three days, I wasn't the supervisor 100%. Today, I was. I was handed the phone and the pager and had a pretty smooth day throughout. When 1pm hit? It never stopped. The phone was constantly ringing and my pager was constantly going off. RD's needing formula. People needing to go to meetings. Nourishments not getting there on time. People calling in and not coming to work. Trying to find a replacement. Unhappy patients. 

Extremely happy tomorrow is Friday.

Pros of having a blog:

*Remembering what I've done, kind of like keeping a diary

*Sharing my experiences with those who might be applying to a DI

*Keeping in touch

Cons of having a blog:

*Too tired to write sometimes, especially after 13 hours at the hospital

*Sometimes not much to say

*Friends/family reading the blog and not calling or writing instead

...how many days left?