General Update # 32

5:47 p.m. - Nurse's aide arrived to take Joyce's blood sugar level. Reading was 168. Joyce asked if that was good or bad and nurse's aide said "That's pretty high." Joyce's blood oxygen levels at 94%. After nurse's aide departed, Joyce asked if she had ordered prune juice. Dusty stated she had not. Joyce said she had been dreaming about it. Dusty let Joyce know he would ask room service for some prune juice when they brought her the broth and half banana, or that he would ask nurse Becky to bring some if she arrived before the room service hostess did. 

5:59 p.m. - Becky returned to check in on Joyce. Dusty relayed that Joyce wanted prune juice. Becky thought that was a good idea. 

6:01 p.m. - Joyce asked Dusty to inform her on what is going to happen to her tomorrow. Dusty reviewed plan that Dr. Keizur laid out for tomorrow. Joyce pressed call button to go to the bathroom soon afterward. Bed pad and diapers were changed due to incontinence issue. Nurse's aide, Stockton, put gait belt around Joyce and assisted her in reaching the bathroom and getting her cleaned up. Becky arrived shortly thereafter to assist.

6:08 p.m. - Room service arrived with broth, toast, and half a banana for Joyce. 

6:09 p.m. - Dusty asked Becky about urine culture that was collected from Joyce, as requested by Carol. Becky consulted mom's file and reported that there was no growth as of June 4. Antibiotics have been ordered for Joyce and will be starting tonight in preparation for procedure tomorrow morning, it will be a broad spectrum antibiotic so it should help cover preventing any urinary tract infection from developing.

6:13 p.m. - Joyce given the prune juice she requested by Becky while she was using the toilet. Becky not wanting to leave Joyce until she drinks the prune juice and gets the Tylenol into her. Becky asked Dusty if he was staying late, and after Dusty confirmed he was, she asked Dusty to ensure the Gritman night staff puts the Intermittent Pneumatic Compression (IPC) Devices onto her legs as she is at risk for blood clots. Becky was concerned that those have not been being re-attached to Joyce when she gets placed into bed. Dusty confirmed that Lucy set them up to run before he left Gritman last night. Confirmed that they have not been used on Joyce today as far as he knows. Becky got Joyce to take Tylenol while she was seated on the toilet. Becky was called away to different patient room so a nurse's aide (Callie) arrived to help Joyce finish in bathroom. Callie asked who put gait belt on Joyce, Dusty stated other nurse's aide must have needed it to help with getting Joyce up off of bed for trip into bathroom due to his build. Nurse's aide assisted Joyce out to her chair. 

6:21 p.m. - Becky introduced Amanda to Joyce as part of the shift change to evening staff. Becky relayed information onto shift change nurse (Amanda) out in hallway while walking back into room together about what has been given to Joyce (Tylenol, laxatives, a lidocaine patch for area pain relief, etc.) so Dusty missed most of conversation as it came into earshot. Dusty did catch Becky saying that the Norco (hydrocodone) was identified as causing nausea in Joyce, but Becky did not catch that when she took over caring for Joyce from Jill previously, and so had dosed Joyce with it continuously for pain relief and that had caused nausea yesterday. 

6:22 p.m. - David from ER arrived to get IV installed into Joyce. David noted that Joyce is "pretty battered." Becky explained that Joyce had fallen down some stairs. Dusty stated that not all of the bruises on Joyce's arms were from the fall, most were from previous IVs and injections and blood draws. Becky concurred. Becky told David that they would not have requested another IV to be setup except that Joyce will be going into surgery tomorrow morning and it is required for that procedure. David confirmed he would need the ultra-sound ("vein finder") machine to find a vein to use for the IV as he could not visually locate a suitable one in Joyce's current condition. Joyce was directed to eat her dinner by Amanda while they waited for David to return with the machine. 

Becky continued on with earlier conversation of shift change updates to Amanda, confirming that Joyce had no nausea at all today so the hydrocodone was most likely the culprit in causing the nausea and vomiting Joyce experienced yesterday. Becky stated that the assumption yesterday was that the constipation was the cause of the nausea and vomiting and so hydrocodone was continued to be used for pain relief in Joyce. The hydrocodone (Norco), Becky said, was still on the chart of okay medicines to use for Joyce to use as pain relief and so Becky kept dosing her with it. Amanda stated that she had been on duty when nurse Jill had first given Joyce the hydrocodone and Joyce vomited and experienced nausea and so Jill then had switched to giving Joyce the Tramadol which had less effectiveness at pain relief but didn't seem to cause the nausea and vomiting. Amanda stated she was surprised the hydrocodone was still on the chart as an option to give to Joyce yesterday. Amanda and Becky left room, preventing Dusty from tracking further discussion on the matter but it was about investigating what was listed on the chart for Joyce to verify it was showing correct information now.

6:27 p.m. - David returned with ultrasound machine to find vein to setup the IV, pulling Joyce's dinner tray away to get setup. Joyce had managed to get a mouthful of toast and a sip of broth in before this occurred. David made several attempts. IV was setup by ~6:52 p.m.

7:02 p.m. - Joyce asked Dusty to explain what her schedule is for tomorrow. Dusty stated that Joyce is going to have a procedure to remove her kidney stone at 9 a.m. and that is all he knows right now as far as timelines go. Joyce then stated, "Well that's more than I knew."

7:10 p.m. - Joyce has finished her half banana, all her toast (left the crusts), and entire cup of broth. Managed to eat her dinner without falling asleep, spitting out her food, or vomiting. 

7:25 p.m. - Nurse Amanda arrived to setup Levaquin (antibiotic) IV bag for Joyce. Amanda asked how Joyce's pain levels were now. Joyce reported upper back pain "not too great" but otherwise she is surviving. Amanda asked if the lidocaine patches were helping Joyce and Joyce confirmed she thought they were helping but still had pain. Amanda checked Joyce's charts to see if she could administer pain relief medicine now, saw that Becky had administered Tylenol not too long ago. Amanda will plan to give Joyce Tramadol soon and Tylenol again when the dose Becky gave Joyce earlier wears off at midnight. Joyce's oxygen level at 94%.

7:35 p.m. - Amanda returned to dose Joyce with Tramadol. Joyce reported her pain level at a 6 out of 10 prior to dosage being given. Amanda asked to confirm if the commode was being used for Joyce or if Joyce was now walking to the bathroom. Joyce confirmed that she was now walking into the bathroom. Amanda stated that Joyce is now doing even better than the last time she saw her on Thursday. Amanda asked if Joyce was experiencing numbness or tingling in her fingers or toes. Joyce confirmed she did not have numbness or tingling in her toes. Amanda asked about Joyce's appetite.  Amanda said current plan for the evening is that Joyce will be allowed to rest and give the Tramadol a chance to work. 

Joyce will receive a shower this evening with antimicrobial soap before being bundled into bed for the night. Joyce will have one more antimicrobial shower tomorrow morning before her procedure. Joyce will have the IPC device setup to run overnight on her as she sleeps. Dusty asked Amanda about the Norco (hydrocodone) and Amanda confirmed that it is now removed from the list of pain relievers to administer to Joyce. She will even go and triple check it once she leaves Joyce's room just to be certain. Amanda told Dusty that the hospital went from four patients to seventeen rather quickly and that situation most likely contributed to communication issues about the Norco's affects on Joyce not being relayed correctly as they were understaffed through the day yesterday and today (due to COVID-19 cutbacks).

The plan for tomorrow that Amanda knows about right now is that Joyce will be taken out of Room 202 and down to the operation theater around 8:30 a.m. and procedure will occur at 9 a.m. Dusty is welcome to return either before Joyce is taken to the surgical theater or can arrive after 9 a.m. to Gritman. Dr. Keizur will come and report on operation to Dusty once it finishes. Dusty informed Amanda he will arrive before 9 a.m. to wait for Dr. Keizur's report.

8:04 p.m. - Nurse's aide, Lucy, arrived to take Joyce's vitals. Oxygen levels were at 93%. Temperature was 98.5 degrees. Blood pressure was 132/80. Verified that Joyce is going into NPO status again starting at midnight. Lucy asked if Joyce was wanting to go back to bed or stay in the recliner a while longer, Dusty stated that Joyce needed to get her shower before bed in preparation for procedure tomorrow. Joyce chose to stay in chair. Lucy asked when the procedure would be, Dusty relayed that it is currently set for 9 a.m. Lucy noted that down so she gets Joyce her shower in the morning scheduled.

8:11 p.m. - Joyce stated that it is hard for her to shower and now she has to do it twice (tonight and tomorrow morning), expressing her lament that she hurts and hurts trying to shower. Dusty assured her she is improving and when she showers tonight she'll be much better off than she was this morning.

8:12 p.m. - Joyce asked Dusty what she was having done to her tomorrow. Dusty informed her she was having her kidney stone removed.

Dusty departing Gritman for the night.

Message(s) from Joyce:

"Goodnight, I love you all."

Participant observation:

A rude and high maintenance patient in this wing that Joyce has been moved into was noticed by Dusty to have been verbally abusing the nursing staff all day. Behavior was so bad the doctors were summoned at least twice to confront them about their behavior. This may have caused some of the staff's high stress levels and been a source for distraction in getting information relayed or posted across shifts and among team members if that patient had been present yesterday as well and causing the same interruptions to nurse's duties? 

Current location:

Gritman Medical Center, Room 202.

Current pain level:
6 out of 10 at 7:35 p.m.

Visiting information:

No change from previous post.

Confirmed with nurse's station shift leader at 11:05 a.m. (on 6/6/2020) - currently only 1 visitor per day for Joyce, no exceptions. Once current visitor departs Joyce's room, no further visits for the rest of the day. No swapping out visitors (example, Dusty cannot remain on hospital grounds while Craig goes to sit with Joyce for an hour and then Dusty returns to room).