Wow, what a rotation! Honestly, I've been a little anxious about this rotation all year. The preceptor is a very well-respected staff member among the clinical nutrition team and throughout the hospital. She covers the Surgical Intensive Care Unit and works with some of the most critically ill patients in the hospital. We spent the majority of our time in the SICU seeing patients as well but did work on a few patients in outside units. This was the first rotation where we worked with patients who required TPN for nutrition support (also explained in one of my January rotations here). This rotation wore me out with a 7:30 am rounds start time in the unit, but I really learned a lot and enjoyed my time working with the preceptor.
Some of the patients we saw: necrotizing pancreatitis, surgical cancer patients, liver transplants, gastrointestinal surgical patients (like colostomies, ileostomies, colectomies, gastrectomies, Nissen fundoplications, esophogectomies, paraesophogeal hernia repairs, and others), ulcerative colitis, intestinal and esophogeal perforations, etc.
Similar to the Medical ICU where I did my enteral rotation, the Surgical ICU is a unit where some of the sickest patients are treated. It was not uncommon to have patients code on a regular basis and to have patients in the unit die, including two of my patients.
Some learning experiences from the rotation:
- Post-op GI patients have a return of bowel function in the following order: small bowel, gastric, then large bowel. To determine when we should start feeding a patient again after surgery we check for bowel sounds, suctioned gastric contents (most patients come out of the OR with a tube from their nose to their stomach just for the purpose of suctioning the secretions back out of their stomach until function returns), then the passing of flatus or stool production.
-Patients can develop an ileus after surgery where portions of their bowel dilate and don't function for an extended period of time.
Quick overview of a paraesophageal hernia:
Paraesophogeal hernia: image showing the stomach herniated through the hiatal covering and sitting next to the esophagus. The stomach is not the only organ that can push up through a hernia opening, intestines and other organs can pop through too. A major issue occurs with a volvulus, or twisting, of the contents in the hernia leading the necrosis of the tissue. One of my patients had this issue and ended up with a gastrectomy, hemicolectomy and partial esophagectomy (so no stomach, part of his intestines removed and part of his esophagus removed). In patients like this the intestines can be directly connected to the esophagus for continued oral feeding.
Up Next: Trauma, 2 Weeks then SPRING BREAK IN COSTA RICA!! I can't wait!
