Universitas Hospital Day 1

Universitas Hospital (Bloemfontein, South Africa)

Today was my first day at the University Hospital (one of Bloemfontein's tertiary government hospitals) and it certainly started out as quite an adventure. The dietetics department is hidden in the back of the hospital and through a gate (which you need a card or chip to get through...which I don't have) and so I got lost before I even started making rounds with the senior dieticians. Luckily, after I finagled my way to their offices, the rest of the day was very interesting and educational.

I began the day in the neurological ICU where patients are normally admitted with head trauma (due to fighting when under the influence of alcohol or car accidents) or brain aneurysms. Those patients with brain aneurysms typically also have hypertension, which is often times a contributing factor to the aneurysm. The dietician told me that one of the biggest problems in the ICU is infections. Patients on a ventilator are at a higher risk of contracting an infection than those who are not ventilated, and so those who are eventually able to be taken off ventilation have a better chance of survival.

Patients in the neurological ICU at Universitas feed for 18 hours a day and rest for the remaining 6 and are fed within the first 24 hours of admittance to the hospital. However, diabetic patients are fed 24 hours a day. It is important the the dieticians indicate the method of food consumption (i.e. via the mouth, a feeding tube, intravenously  etc) and that all formulas prescribed come from the same company. Dieticians do not restrict energy (caloric) intake for overweight and obese patients in this work and it is important that they look at the patient's urine for diagnostic purposes. The color of the urine helps the dieticians to assess if there is an infection in the kidneys or if medication is causing the discoloration.

I was quite surprised to see that even though this was an ICU, there were empty beds lining/blocking the hallways and the so called "isolation" rooms weren't exactly completely isolated. For example, one of the patients was isolated from the remainder of the ward, but the door between his room and the hallway (which was filled with nurses, doctors, stray beds, etc) was wide open the entire time we were making rounds. The nurses who cared for him we careful to wear smocks (not them I'm entirely sure that did anything for them), but did not utilize gloves or a face mask.

After visiting the neurological ICU, we moved forward to the neurology and neuro-surgical wards. The majority of the patients admitted in to this ward arrive malnourished and have poor dental hygiene, which causes them to struggle with eating solid foods. Therefore, they are given what are known as sip feeds, which is simply the oral intake of a liquid dietary supplement. The only restriction we discussed in this ward was the restriction of protein when a patient is in a coma or is severely disoriented.

It is also quite common for these patients to have co-morbidities and sometimes even auto-immune diseases. They are sometimes fastened to their beds (i.e. hands tied to the bed rails) so that they can not pull out their tubes.

Next was the high-care ward. High-care is a level of care between ICU and general wards. The nurse to patient ratio is 1:1 in high-care and these patients are too healthy for ICU and too sick for general wards. They are typically given pureed foods because it decreases the risk of asphyxiation.

The last thing I did today at Universitas was sit in on a couple of nutrition consultations and learn a little about the nutrition care process. Nutrition consultations are given when requested by a doctor for a patient that is struggling to eat the food being given to them or for those patients who will be discharged soon. They are typically done to help with a supplementation regimen or to help develop an at-home diet plan. If a patient is not being discharged immediately, then they require daily follow-up consultations. There are set menus for diabetic patients. Each plate will look exactly the same, but portion sizes are dependent on caloric restriction and intake levels. Otherwise, dieticians will work with the patients to help develop a diet plan that is right for them.

The Nutritional Care Process