Rude nurse and nutritionist

[glitter]

   My husband is having his carpal tunnel corrected March 6.Today the nurse at the out-patient surgury center called and asked me if he was a dialysis patient, because his labs looked ‘pretty funny’,I said yes he is,and will you please mark it in big letters on his paperwork that he is on a severe fluid restriction,and to please try to give him as little as possible during the procedure. I said it nice as can be….he reply to me was,”I am a registered nurse,I think I realize that.”  The arrogance just floored me…so I had to tell her, ‘It has nothing to do with your competence as a registered nurse,my husband has had procedures before where they were told over and over not to do it and they still do.It has nothing to do with you being a registered nurse,it has to do with mistakes being made by humans,and as my husbands caregiver,it would be remiss of me not to bring it to your attention at every opportunity. ‘ She was quiet for about three seconds then she mumbled some inane comment about possibly redoing the labs if the anesthesiologists wanted and hung-up.

I give him a protein drink to take to dialysis ..
Today the night shift nurse walked up to him and said the nutritionist left this for you.  It was his labs, and it shows a high phosphorus level, there was a handwritten sheet of paper with it where she had written that the drink I give him was 1200mg of phos. based on a RDA of 4000mg per day. The drink is 30% of the Daily Value. Now I just spent 2 hours on the US RDA,The FDA,and The National Kidney Foundation websites-ALL of which put the daily allowance at 700mg to 1000mg. Doing the math means his drink is 300 mg. NOT 1200mg. You know what sucks the most? They do not want to hear this,and they will probably just blow us off.

We are scared if we make too much of a stink they will ask him to find another place and its the only place that does it in the evenings,can they do that? kick someone out?


EDITED: Thread moved to proper section: "Dialysis: Workers" - Bajanne, Moderator

[jbeany]

Wait, where did the nutritionist get the 1200 mg number?  Did she look up the info on the drink itself?  Your daily limits for phos should be set individually by your neph, depending on how your labs are - what the "normal" daily allowance is shouldn't make any difference, so the % part doesn't really matter.  If the label on the drink tells you a % of phos instead of an actual mg. number, it should also tell you what daily allowance they are basing it on.  Read the label yourself.  The programs the nutritionists use may not have the brand name of protein drink you are buying, so her numbers may all be estimates.  Mine just did an estimate of calories, phos, potassium on a 3 day list of my foods, and she asked me for brand names on everything, but had to estimate on a lot of things since her computer program didn't have everything I buy.

Yes, they can kick someone out.  I think it would have to be for a lot more than complaining about rude treatment, though! 
Good for you for standing up to the RN!  I had fluid restriction warnings all over my charts for the last fistulagram I had done.  They managed the microdrip IV okay, but when my blood sugar dropped after the procedure, they fed me a giant glass of apple juice while I was still too groggy and out of it to object.  I sucked the whole thing down - must have been at least 1/2 a liter.  I didn't realize what I'd done until after the anesthetic wore off.  I paid for it the next day at dialysis, too.

All that fluid in one gulp, and I wasn't even conscious enough to remember and enjoy it!

[glitter]

Wait, where did the nutritionist get the 1200 mg number?  Did she look up the info on the drink itself?  Your daily limits for phos should be set individually by your neph, depending on how your labs are - what the "normal" daily allowance is shouldn't make any difference, so the % part doesn't really matter.  If the label on the drink tells you a % of phos instead of an actual mg. number, it should also tell you what daily allowance they are basing it on.  Read the label yourself.  The programs the nutritionists use may not have the brand name of protein drink you are buying, so her numbers may all be estimates.  Mine just did an estimate of calories, phos, potassium on a 3 day list of my foods, and she asked me for brand names on everything, but had to estimate on a lot of things since her computer program didn't have everything I buy.

I did do the math myself-(with advice on how to figure it from Zach)

Quote from: glitter on January 13, 2007, 12:21:25 AM
if you look at the phosphorus it says 35%-how do you figure out what that is?can this be taken during dialysis with a binder?

Zach's answer
The % of phosphorus on most food labels usually refers to the Daily Allowance (DA), which for phosphorus (PO4) is 1,000 mg.  So if the listed PO4 is 35%, then the amount is 350 mg.  That's about 3 PhosLo gel caps, depending on your own situation.  You can drink it during dialysis (with your binders), but remember to add it to your fluid-loss rate.

But just in case he was wrong I also went and looked it up myself-the RDA for a normal healthy male is 1000mg  with an upper tolerance of 4000 mg. Percentages on most labels (including this one) are based on a 2000 calorie diet and normal RDA's.
He is allowed 1000mg per day with binders of course so she came back and said his drink was actually 1200mg because it is 35% percent of the RDA ... She quoted the USRDA, which if you go to there site says 700mg to 1000mg.and so does the FDA,and the NKF.
  See,I think they were po'ed because we didn't buy their product...and the head nurse has been refusing to believe it was in guidelines.these people are the most closeminded I have ever met,all but one or two resent any questions.

[glitter]

I couldn't stand it,i called the nutritionist and she was very nice,I sent her all the information I had,and she emailed me back that she was entirely wrong and stood corrected,so at least they will stop fussing at his drink.....I am just flabbergasted that she didn't know the RDA's...

[jbeany]

One down. . .

 

[thegrammalady]

the nurse at my center said they won't kick anyone out unless you continually skip treatments and don't show up for weeks at a time.