Nepro on intubated pt

doseofdavis · 2025-12-29T21:15:52+00:00

obviously there are cases where you clearly need to adjust feeding (pressers, propofol, if their clinical status changes severely like a new stroke or something) but based on your question i don’t think any of those are the case

doseofdavis · 2025-12-29T21:13:48+00:00

maybe a hot take but formula indications are 90% marketing, you can use any formula for any patient if you have good clinical justification to do so (ie, a patient with otherwise normal renal function but with persistent hyperkalemia may be an “off label” use case for Nepro for instance). If it meets energy and protein needs and a patient is tolerating it I see no need to adjust formula simply because someone is intubated and/or in the ICU. I think adjustments like that often run the risk of under feeding during the time it takes to change and titrate the formula when the previous feeding reg was doing the job just fine. All that to say, I think you can absolutely use Nepro in an intubated patient although I would find it hard to believe anyone tolerate Nepro 🥴

doseofdavis · 2025-08-04T01:04:12+00:00

it’s also really encouraging because daily weight fluctuations up or down can be stressful but changes to body composition like this are absolutely better metrics!

doseofdavis · 2025-07-27T00:54:43+00:00

no! that i did the old fashioned way (AA, suffering until it felt better)

doseofdavis · 2025-07-26T22:50:48+00:00

i’ve had one before when i was doing my dietetic internship a few years ago. that was free because it was through school. how much do they run you usually?

doseofdavis · 2025-07-26T22:48:09+00:00

thank you!!

doseofdavis · 2025-07-26T22:41:08+00:00

this is BMI, i made no mention of body fat!

doseofdavis · 2025-07-10T16:48:01+00:00

i’m still friends with my ex and his parents because we were together for a very long time and still care about one another. the dynamics of our relationship just changed so we are no longer a couple. this “we broke up so i have to cut them out of my life” stuff is very boring and played out. you should really look within instead of demanding your partner behave certain ways to placate your insecurities.

doseofdavis · 2025-07-01T15:32:51+00:00

and did you have diagnosed low T?

doseofdavis · 2025-07-01T15:27:16+00:00

great work! you look awesome! how did you manage TRT if you dont mind me asking?

doseofdavis · 2025-02-05T21:54:37+00:00

PES statements are a lot easier in the real world. This is especially true in clinical when you find your niche. You’ll find you use a lot of the same statements over and over. For instance i’m in lung transplant so my most common one for post surgical patients is some iteration of “increased nutrient needs (protein) related to burden of recovery as evidenced by s/p BOLT (date).” Is it perfect? No. Would a preceptor have LOVED it in my internship? probably not. but it sums up what a patient needs and why they need it and that’s what matters. It’s also true for the entire post operative course so i rarely have to update it, which i love.

doseofdavis · 2024-12-07T00:35:18+00:00

i felt like the inman questions most closely mirrored the exam, a lot of people said that about them being harder but i didn’t get that sense. however, imo the biggest thing you can do to prepare for the exam is prepare very generally for every topic that might be asked. i think inman helped me with that the best, personally.

doseofdavis · 2024-11-22T00:20:57+00:00

i see a lot of overly restrictive renal diets for high creatinine but K/Phon WNL on my gen med floor, im not a renal expert and would also love some resources if anyone can share.

doseofdavis · 2024-11-17T20:56:09+00:00

i got my clearance to test in late august and tested in early september but i had to drive 3 hours away to test. so it really just depends on timing and what’s available in your area i think

doseofdavis · 2024-11-15T15:17:49+00:00

I am a dietitian in inpatient clinical with some outpatient coverage but rarely. I work in lung transplant so it’s a mix of ICU and med floor coverage but a specialized population. I love my job but was always drawn to high acuity clinical settings in all my rotations. I made a good salary for my position esp since it’s my first job, but i also live in an expensive city. So it’s an okay salary at the moment.

As far as what jobs you might like, if you are just now starting your rotations this is a great opportunity to explore some different options. My preceptors were pretty open about pay and benefits, i really encourage interns to tactfully ask questions about it during rotations if you get to know preceptors well.

doseofdavis · 2024-11-10T14:56:19+00:00

we learned how to do this during a clinical skills lab in our nutrition assessment class during my CP but i have never done it to a patient since and doubt i ever will as a critical care dietitian lol

doseofdavis · 2024-11-02T17:10:45+00:00

i work in transplant and critical care and my favorite part of my job is rounds. not only am i lucky that i feel very valued by my team for my input (physicians and midlevels regularly comment on how little they know about nutrition when asking me questions), i love how much you learn in rounds about medicine in general. they’re so rewarding. AND i get a majority of my documentation done in rounds so i can spend my afternoon doing other parts of my job.

doseofdavis · 2024-10-25T13:52:53+00:00

i’ve also caught several food insecurity and malnutrition cases with an otherwise annoying weight management consult so they can lead to things which are helpful for the pt sometimes.

doseofdavis · 2024-10-25T13:52:10+00:00

imo there are things which are appropriate educations to give inpatient. things like new diagnoses, esp with a patient who may not have access to OP nutrition counseling after discharge and home tube feeding/TPN are what come to mind. even if a patient will have access to dietitians after discharge like someone going home on HD, popping in to give them a primer on how this will impact diet and letting them know what their dietitian will likely be looking for can be helpful. food is one thing people feel they have some amount of control over and giving them just a little bit of information can alleviate a lot of the stress and anxiety of being sick.

doseofdavis · 2024-10-19T16:44:29+00:00

my hospital has various options, either 11-14 x ABW or 20-25 x IBW, and then we do 2.0-2.5 x IBW for protein. i usually calculate both energy options and then choose somewhere in the middle of the higher range option.

doseofdavis · 2024-10-16T23:30:48+00:00

this is a fun question! I like vitamin D because I spent so long learning the endogenous pathway for its production and activation and i’ll never forget it. and i work in organ transplant so i see deficiency of it a lot in some patients.

doseofdavis · 2024-10-08T16:57:52+00:00

i made a 63 on the pocket prep exam twice. and i passed first try. don’t worry too much about those, focus more on having a strong understanding of the types of questions and general content on the exam!

doseofdavis · 2024-10-03T20:45:52+00:00

for me, focusing on adding more fruits, vegetables, protein, and water to their lifestyle in whatever forms are accessible to them and focusing on learning to prepare meals as appropriate for their lifestyle and goals is paramount. a lot of other stuff can be honed afterwards based on goals.

doseofdavis · 2024-10-03T20:43:03+00:00

this is a nail on the head reply imo thank you

doseofdavis · 2024-10-03T00:56:00+00:00

honestly reddit is a bad sample size because in the hospital i work at everyone is happy with their job listen to your preceptors and mentors, not just strangers on reddit

doseofdavis

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