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...

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#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.

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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...