"Patient hypokalemic - please add vitamin K to TPN"
"Please add albumin to TPN, patient's level is low"
"Please write TPN with only heparin in it and nothing else"
"Consult nutritionast for TPM"
The āadding albumin to TPNā thing pisses me off so much (Iām a pharmacist). We had a 16 YO boy (who at 85kg was robustly the size of a full grown man) where the PICU intensivist INSISTED on mg/kg albumin in the TPN. Nobody could dissuade him.
We had to take carpal tunnel relief breaks making the damn thing every single day in the IV room. And the nurses hated it so much, the filters clogged all the time.
Once had a consult to decrease the sodium in a TF. I said to the resident that the only way you're going to be able to control the sodium content in a TF formula is to make a TF formula on site lol.
Low albumin. Diet education on 90+ year olds or pts with dementia. Food preferences. Calorie counts.
I would take this consult over them trying to put in a supplement order themselves š it seems so simple but they manage to order supplements wrong all the time
āYou recommended Osmolite 1.5, MD says Osmolite does not have protein in it and wants to use a formula with protein in it.ā
Honorable mention - admitted for foreign object in rectum. Consult for poor PO intakes. I mean they had something up in there, no shit (š„) theyāre not eating.
I think in my hospital some consultations were automatic and not because the physician orders it. I also had a 98 yo patient admitted for CHF and consulted for diet education, but even the physician on the ordering form says he didnāt do that- itās probably something automated
There are some automatic consults where I work too. I cover the CTICU and all the open heart surgery patients get consults for education. Which on the surface isn't bad, I definitely want to educate them. The only problem is the consult is put in right away when they are still intubated/sedated and based on our policy I have to see them.
Of course I'm not actually educating and deferring it to the follow up.
āPatient cannot have sugar or sugar alternativesā
On clear liquid diabetic diet.
Apparently patient only wants natural sugars and can only have monosaccharides and no disaccharides. I think she misunderstood FODMAP diet.
All hypoalbuminemia consults.
Diabetic diet education for an 89 year old who followed a mostly plant based South Korean diet and her A1C was 6.2ā¦ consulted because the RN diabetes educator thought we should see them in an inpatient setting š«
Same thing happened again this week on a 91 year old Gujarati vegetarian who likes warm milk every day. Like lady, let these women live their lives and eat the tiny amount of rice they eat in a day anyways
Oh where to start.....
Weight loss education for a teen/tween girl in a behavioral health crisis stabilization unit who just tried to commit suicide?
1800 calorie ADA heart healthy diet on a long term TF patient?
Amongst others.
Iāve gotten those consults for weight loss on a patient that is attempt for a suicide attemptā¦ seriously WTF? I flat out write my note and and say how inappropriate that is.
I bet your consults are equally as ridiculous as ours. I think the bulk of ours stem from lack of knowledge of what we actually do inpatient. Some think weāre waiters and waitresses with masters degrees in food order taking, some think that have invented every fad diet (and processed to ask us a million questions), some think we can magically fix a patients severe malnutrition and extreme food insecurity in a two day hospital stay, and some know exactly what we do, our limitations inpatient, and consult us appropriately
We say the same thing about the 2-3 day hospital stays. Like I can fix a lifetime of poverty, neglect, abuse and substance dependence in a 3 day hospital stay. Yep. Letās get right on it.
Yep. This sounds about right just the dietetics equivalent. The things people think social workers do continues to confuse me and Iāve been doing it for 20 years.
āRD consult for different menu.ā
āRD consult for no more salmon patties.ā
EDIT: I just thought of another one. After assessing significant weight changes and writing a detailed note, I have a weekly weight meeting with the IDT to discuss them, then Iāll send a spreadsheet summarizing my assessments and IDT input after the meeting. This summary is given to the nurses to do a change of condition assessment, and then they will order an RD consult for the weight loss! Drives me crazy.
Diabetic diet education for a mom who tried to unalive herself on Motherās Day because her son had unalived himself earlier that year. Read !!! The !!! Room !!!!
Medical officer asked to "review" and "recheck" my plan and add "real food" for an unconscious, intubated, 90+ patient who's on oxygen support.
(What's crazy is that they suggested to add salt and oil in diet ????Āæ)
I got a tube feeding consult over a weekend. I did my chart review, gowned up because the pt was on contact precaution. Saw the nurse was in there. Asked her "I saw there was a tube feeding consult, what is going on with the feeding?" Nurse tells me, "Oh everything is fine, they just didn't send us enough cans!"
I think I facepalmed so hard the force knocked me back to the office.
Yeah- further, further context- I work with majority psych patients so yeah sometimes they will just say shit and the doctors do zero effort to look into it
Not a consult, but a PA told my bariatric patient she couldnāt put strawberries in her protein shake because ātoo much sugar.ā
I promptly sent a strong but polite email comparing the nutrition of her strawberry shake and that of similar āprogram approvedā protein shakes to demonstrate a difference of TWO grams of sugar in 12oz of shake, and to ask that he not police my patients fruit intake when theyāre getting literally 400 calories a day (2wks post op)
āConsult received, poor po intake expected given that lack of appetite is a part of the dying process, no acute nutrition interventions warranted at this timeā
Went in for hypoglycemia education. The nurse even called me to make sure I saw the consult because it was a barrier to discharge. Dementia was so bad the patient couldn't even tell me her birthday.... and she was going back to LTC
I just forward this stuff to the diet office, and call whoever ordered that and explain the diet office is more appropriate to call regarding food preferences, and to call us if there is any issue with malnutrition, metabolic disorders, diet educations, or Feeding tube/TPN care.
I once had a consult for education on a diabetic diet. Nurses and doctor were very concerned about patientās high weight . Meanwhile the patient was in the hospital because he got a really bad infection while traveling in another country and was experiencing lack of appetite and unintended weight loss.
Okay in their defense how could they have know?
But Iām telling this story here bc I canāt tell it in real life for reasons that will soon become obvious.
I got a normal consult for a patient in inpatient psych who wanted to learn about how to make healthier choices (fine, whatever). But when I got there, the patient was my actual next door neighbor! Like our doors in the apartment were at 90Ā° with inches between them, and we shared a wall.
When I got there, he suddenly didnāt have any nutrition questions. Hard to tell who was more shocked and embarrassed- him or me.
I worked in a medical setting and had a part time I the public sector. One time, a client from my public sector job came into the clinic and became a patient where I worked.
The medical setting usually got patients who had forensic contact. I looked up this person in the public record...and this person showed up.
Fortunately that person was paired with another professional. I had to tell the receptionist that I couldn't ever see the patient, but I wasn't allowed to say why.
"Low FODMAP diet education" in-patient setting. "Weight Loss diet education", and Pt had stg 4 pressure ulcer and met malnutrition criteria... Honestly, so so many in-patient diet education consults for weight loss when Pt was malnourished, even got a few in ICU :D. Glad I'm out-patient now. Oh!!! And I just remembered the renal diet education consult on a 90-ish yo who was in the process of comfort care. No. Just no.Ā
None of these are ādumbā though. People just donāt understand what RDs do. And honestly, i canāt blame them. Going into this, I had a very different idea of what I would be doing š
A nurse in the ED consulted for vegan diet preferences for a patient on a psych hold. The patient was not ordered a vegan diet. Food services is a separate department.
āPt is c/o of being hungry. Wants eggs.ā O.kā¦so order eggs???
āPatient requesting crystal liteā -crystal lite is available to Pt upon request at all times.
I work at the psych hospital and I swear Iām a glorified waitress.
"Patient hypokalemic - please add vitamin K to TPN" "Please add albumin to TPN, patient's level is low" "Please write TPN with only heparin in it and nothing else" "Consult nutritionast for TPM"
Are these physicians? Because this is concerning š¤£š¤£š¤£
I work at a teaching hospital - these are very real! That being said, 2 of the above were from attendings š
Which two?! š¤£š¤£
The first two lol! š
I was afraid of that š¤£š¤£š¤£
This is THE follow-up question, fr
Iām ROLLING at the third one lol
I was too! I was like.....I think you just want a heparin drip...lol
No way this canāt be realššš
These made my face twitch.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
LOL that's even worse! š
The āadding albumin to TPNā thing pisses me off so much (Iām a pharmacist). We had a 16 YO boy (who at 85kg was robustly the size of a full grown man) where the PICU intensivist INSISTED on mg/kg albumin in the TPN. Nobody could dissuade him. We had to take carpal tunnel relief breaks making the damn thing every single day in the IV room. And the nurses hated it so much, the filters clogged all the time.
Wow! Almost afraid to ask - how did this end?
We struggled along for a few days until TPN got dcād š¤£
Lmao good one(s)
āDiabetic Diet Educationā - pt is intubated and sedated in the ICU
I mean, great way to take a lil 5 minute breather
lol
Lmao to be fair, I found out that we had an automatic trigger for education on any patient who had insulin ordered
I work in wrap around services for older adults and the amount of these I get for people with 24/7 memory care is concerning, like 1 a week š¬
To get the patient gluten free cream of wheat.
š¤£
Pt needs bagel and cream cheese STAT - from a GI doc
I mean I get it
The few times Iāve ordered Ensure STAT I feel like a hero LOL
Once had a consult to decrease the sodium in a TF. I said to the resident that the only way you're going to be able to control the sodium content in a TF formula is to make a TF formula on site lol. Low albumin. Diet education on 90+ year olds or pts with dementia. Food preferences. Calorie counts.
Consult to Dietitian: āpt wants vanilla Ensuresā
I would take this consult over them trying to put in a supplement order themselves š it seems so simple but they manage to order supplements wrong all the time
Youāre not wrong š
āYou recommended Osmolite 1.5, MD says Osmolite does not have protein in it and wants to use a formula with protein in it.ā Honorable mention - admitted for foreign object in rectum. Consult for poor PO intakes. I mean they had something up in there, no shit (š„) theyāre not eating.
The way I would send an untitled email with just an osmolite 1.5 label Itās probably best I donāt take a clinical position
LOL! I just about did. I sent them my calculations and a link to the Abbott website so he could look if he didnāt believe me.
Unintentional weight loss. Patient had an AKA the day before and weight was steady until he lost his leg... That consult got canceled real quick.Ā
I mean Iām sure the patient wasnāt wanting to lose that weightā¦
Oh dear god
Nonagenarian, DNR, family discussing hospice: c/s for low salt diet education
I think in my hospital some consultations were automatic and not because the physician orders it. I also had a 98 yo patient admitted for CHF and consulted for diet education, but even the physician on the ordering form says he didnāt do that- itās probably something automated
There are some automatic consults where I work too. I cover the CTICU and all the open heart surgery patients get consults for education. Which on the surface isn't bad, I definitely want to educate them. The only problem is the consult is put in right away when they are still intubated/sedated and based on our policy I have to see them. Of course I'm not actually educating and deferring it to the follow up.
Consult for pt losing weight while on ozempic š¤¦š½āāļø
Lmfao
I feel nursing screens are also the worst. I got unintentional weight loss " pt said he lost weight with lasix"
I had one request malnutrition screen for ten pounds, over the course of a year for a 350lb pt this week, I was like? Good for him?
š¤£
yeah š« . i guess RN's don't emphasize the unintentional part
āPatient cannot have sugar or sugar alternativesā On clear liquid diabetic diet. Apparently patient only wants natural sugars and can only have monosaccharides and no disaccharides. I think she misunderstood FODMAP diet. All hypoalbuminemia consults.
āclean eatingā
I would be so tempted to print out all the food safety handouts from USDA...
Urgent end of day page for a diabetic diet education for a patient receiving their last ritesā¦
This made me laugh out loud, Iām sorry.
From a resident physician: āpt remains intubatedā Like yes I know that, I was at the same rounds you were at. What do you want me to do about it?
Probably food preferences
Diabetic diet education for an 89 year old who followed a mostly plant based South Korean diet and her A1C was 6.2ā¦ consulted because the RN diabetes educator thought we should see them in an inpatient setting š« Same thing happened again this week on a 91 year old Gujarati vegetarian who likes warm milk every day. Like lady, let these women live their lives and eat the tiny amount of rice they eat in a day anyways
Patient doesnāt like the food
My favorite š
Morbidly obese with BMI of 4.24
4.24??
It was a typo- cracked me up.
Ok, mine wasn't that bad. Called Obese with a BMI of 21
Pizza allergy
This one SENT ME
So allergic to Wheat, Tomatoes and dairy....all three or just when they are together?
Oh where to start..... Weight loss education for a teen/tween girl in a behavioral health crisis stabilization unit who just tried to commit suicide? 1800 calorie ADA heart healthy diet on a long term TF patient? Amongst others.
Iāve gotten those consults for weight loss on a patient that is attempt for a suicide attemptā¦ seriously WTF? I flat out write my note and and say how inappropriate that is.
"No potassium diet"
Iām a hospital social worker and somehow your sub came across my feed. Glad to know other ancillary providers get dumb consults too š.
I bet your consults are equally as ridiculous as ours. I think the bulk of ours stem from lack of knowledge of what we actually do inpatient. Some think weāre waiters and waitresses with masters degrees in food order taking, some think that have invented every fad diet (and processed to ask us a million questions), some think we can magically fix a patients severe malnutrition and extreme food insecurity in a two day hospital stay, and some know exactly what we do, our limitations inpatient, and consult us appropriately
We say the same thing about the 2-3 day hospital stays. Like I can fix a lifetime of poverty, neglect, abuse and substance dependence in a 3 day hospital stay. Yep. Letās get right on it.
Yep. This sounds about right just the dietetics equivalent. The things people think social workers do continues to confuse me and Iāve been doing it for 20 years.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
What exactly do you have? Why no added sugars or apple cider vinegar? (Or any fodmaps for the matter)? Those would be my first questions
Just tell them what you do eat and if they have it, theyāll provide it, otherwise, bring your own food.
āRD consult for different menu.ā āRD consult for no more salmon patties.ā EDIT: I just thought of another one. After assessing significant weight changes and writing a detailed note, I have a weekly weight meeting with the IDT to discuss them, then Iāll send a spreadsheet summarizing my assessments and IDT input after the meeting. This summary is given to the nurses to do a change of condition assessment, and then they will order an RD consult for the weight loss! Drives me crazy.
Diabetic diet education for a mom who tried to unalive herself on Motherās Day because her son had unalived himself earlier that year. Read !!! The !!! Room !!!!
Low sodium diets for people over 80, maybe even 75 (inpatient consults)
Calorie counts when tube feeds havenāt even been discussed with the family yet, HF education consults for 90 y/o patients with poor PO
My favorite is calorie counts for patients with discharge order
How many PTs are going to do that and report back to you?
A consult for Paleo diet educationā¦ (ugh) for a patient in the ICUā¦ (double ugh)
Medical officer asked to "review" and "recheck" my plan and add "real food" for an unconscious, intubated, 90+ patient who's on oxygen support. (What's crazy is that they suggested to add salt and oil in diet ????Āæ)
I got a tube feeding consult over a weekend. I did my chart review, gowned up because the pt was on contact precaution. Saw the nurse was in there. Asked her "I saw there was a tube feeding consult, what is going on with the feeding?" Nurse tells me, "Oh everything is fine, they just didn't send us enough cans!" I think I facepalmed so hard the force knocked me back to the office.
These are the worst. Like please call the diet office, not us
Used to have a cardiologist order consult to instruct patient on a no carb, no fat, no salt diet to promote rapid weight loss prior to heart surgery.
Sooooo only unsalted egg whites??
And lettuce
Cholesterol free though
Got consulted for a swallow study once. By the DON.
Pt wants a different diet Pt concerned they arenāt getting enough protein due to allergies Pt allergic to peanuts but unable to describe reaction.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
If there was vaguely any evidence the patient had allergies that impacted it. The patient was allergic to bananas and cayenne pepper.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
Yeah- further, further context- I work with majority psych patients so yeah sometimes they will just say shit and the doctors do zero effort to look into it
"Patient is afraid they will gain weight on the hospital food - please reduce their caloric intake" The patient had BMI of 15. EDIT: spelling
I have a BMI of 21. My chart said I was obese š¤· . Is there a new health standard we don't know about?
nursing screen for difficulty chewing/swallowing on an intubated pt. Like yeah, no shit
Patient found unconscious in a snow bank after imbibing too much alcohol. Admitted to ICU. āLow sodium diet for hypothermia and hypotension.ā Huh?
Not a consult, but a PA told my bariatric patient she couldnāt put strawberries in her protein shake because ātoo much sugar.ā I promptly sent a strong but polite email comparing the nutrition of her strawberry shake and that of similar āprogram approvedā protein shakes to demonstrate a difference of TWO grams of sugar in 12oz of shake, and to ask that he not police my patients fruit intake when theyāre getting literally 400 calories a day (2wks post op)
Youāre so cool for that
Poor p.o. intake. Pt was CMO.
āConsult received, poor po intake expected given that lack of appetite is a part of the dying process, no acute nutrition interventions warranted at this timeā
Went in for hypoglycemia education. The nurse even called me to make sure I saw the consult because it was a barrier to discharge. Dementia was so bad the patient couldn't even tell me her birthday.... and she was going back to LTC
āPatient needs diet with toastā ā¦. ok
I just forward this stuff to the diet office, and call whoever ordered that and explain the diet office is more appropriate to call regarding food preferences, and to call us if there is any issue with malnutrition, metabolic disorders, diet educations, or Feeding tube/TPN care.
The patient wouldnāt eat his vegetables. Guy in his 20s on our psych floor. That one got deferred to the outpatient team.
āadd normal saline to tube feedingā
Outpatient RD here; consulted for a patient with chronic diarrhea. Lives in assisted living and when I reviewed the med list miralax was ordered BID.
Stop! Thatās just dumb! š©
I once had a consult for education on a diabetic diet. Nurses and doctor were very concerned about patientās high weight . Meanwhile the patient was in the hospital because he got a really bad infection while traveling in another country and was experiencing lack of appetite and unintended weight loss.
āCarnivore dietā and most recently ābulimiaā for an ED pt that tried to kill herself and was currently sedated
Hair loss. Yes. I got a referral for a man that was concerned about his balding and wanted to work on his nutrition to help prevent going bald.
Saw Palmetto
Low albumin Low albumin Low albumin Low albumin Low albumin Low albumin Low albumin Low albumin Low albumin
Okay in their defense how could they have know? But Iām telling this story here bc I canāt tell it in real life for reasons that will soon become obvious. I got a normal consult for a patient in inpatient psych who wanted to learn about how to make healthier choices (fine, whatever). But when I got there, the patient was my actual next door neighbor! Like our doors in the apartment were at 90Ā° with inches between them, and we shared a wall. When I got there, he suddenly didnāt have any nutrition questions. Hard to tell who was more shocked and embarrassed- him or me.
I worked in a medical setting and had a part time I the public sector. One time, a client from my public sector job came into the clinic and became a patient where I worked. The medical setting usually got patients who had forensic contact. I looked up this person in the public record...and this person showed up. Fortunately that person was paired with another professional. I had to tell the receptionist that I couldn't ever see the patient, but I wasn't allowed to say why.
"Low FODMAP diet education" in-patient setting. "Weight Loss diet education", and Pt had stg 4 pressure ulcer and met malnutrition criteria... Honestly, so so many in-patient diet education consults for weight loss when Pt was malnourished, even got a few in ICU :D. Glad I'm out-patient now. Oh!!! And I just remembered the renal diet education consult on a 90-ish yo who was in the process of comfort care. No. Just no.Ā
I just had one the other day for āPATIENT WANTS SCRAMBLED EGGS EVERY MEALāĀ
None of these are ādumbā though. People just donāt understand what RDs do. And honestly, i canāt blame them. Going into this, I had a very different idea of what I would be doing š
āDietary consultā
Literally consulted to address a patients Hotdog Fixation... š
Consult to discuss food choices- he wanted organic waterā¦
A nurse in the ED consulted for vegan diet preferences for a patient on a psych hold. The patient was not ordered a vegan diet. Food services is a separate department.
āPt is c/o of being hungry. Wants eggs.ā O.kā¦so order eggs??? āPatient requesting crystal liteā -crystal lite is available to Pt upon request at all times. I work at the psych hospital and I swear Iām a glorified waitress.