General Update #9

The Gritman physical therapy team arrived at 11 a.m. to prep Joyce for sitting upright and initial mobility work, setting up a chair for Joyce to the left-hand bedside. The physical therapists asked Joyce questions about her home, if she used a walker, became dizzy or lost her balance often, and how she fell down her stairs. Joyce stated that she doesn't recall being dizzy prior to falling down the stairs. They physical therapists confirmed they would not use a gait belt while working with Joyce due to her spinal fracture. They reviewed that the walker they will use in the hospital only has two wheels and not the four she is accustomed to using with her walker at home.

Initial plan from the physical therapists was for Joyce to sit upright on the right-hand side of her bed, stand up to a walker, and under their supervision walk around the foot of her bed using that walker to then sit in the chair they had brought in. Joyce was able to sit upright with little difficulty but encountered trouble standing up, failing to do so after several attempts. She may have been holding her breath while trying to stand up, causing her oxygen levels to drop with the exertion effort. The oxygen levels recovered quickly as physical therapists instructed her to breathe and take a deep breath before trying to stand. This caused minor muted coughing fits. After about 15 minutes of attempts to get Joyce to stand (~11:17 a.m.), the physical therapy team changed plans and moved the chair they'd brought in to the right hand side of Joyce's bed and had her stand up and move over to it. This was done relatively quickly over the short distance. The therapy team left Joyce seated in the chair with the intention to let her sit upright for a while to see how she feels (pain, discomfort, or if there is any onset of nausea or dizziness) as she has been laying down for almost 2 days. The physical therapists departed and stated they will return after checking in with Joyce's nurse and attempting to find a model of chair that is a recliner instead of just a plush upright model.

Joyce appeared to nap of and on until room service arrived at 11:39 a.m. to take Joyce's lunch order. Joyce started placing order with the hostess but then soon announced that she felt like she was going to vomit and did so shortly afterward. Hostess was able to obtain a container in time for Joyce to use. Room service departed, saying they will check back later and the nurse was summoned. 

Following deployment of vomit bag by nurse to replace initial container utilized and cleanup of Joyce, nurse speculated that the pain medications may have caused the nausea or potentially the change to a sitting position. Nurse asked if Joyce got sick during the night and Joyce indicated negative. Nurse had checked the logs and saw that Joyce was given anti-nausea medicine during the night. Joyce indicated that she wasn't sure. Nurse gave Joyce anti-nausea medication again at 11:48 a.m. Nurse asked Joyce if she was feeling dizzy and Joyce indicated negative. Joyce stated that she was feeling light-headed. Nurse took Joyce's blood pressure reading. Blood pressure and heart rate taken by nurse at 11:49 a.m. were showing as okay. Joyce reported pain levels at 6 out of 10 when asked. Joyce indicated that she was feeling "foggier than normal" at this time. Nurse expressed her concerns about Joyce's health given this turn. Nurse is questioning whether Joyce can be independently mobile at home, cook and care for herself, get to bathroom on her own, shower, etc. and will summon the discharge planner (Dana) to review options as Dana would know what kind of support Medicare might be able to provide as Joyce is still under observational care at the moment. Joyce does not look like she is bouncing back quickly from the vomiting. Joyce admitted that she can barely sit up but wants to continue trying to sit upright for a while if allowed. Nurse consented to leave Joyce in the chair with a vomit bag handy and departed room at 11:54 a.m. to request Dana. 

Message(s) from Joyce:

None.

Current location:

Gritman Medical Center, Room 226.

Current pain level:
5 out of 10 reported at 11:33 a.m. after she had been sitting in the chair for a few minutes.  

6 out of 10 as reported to the nurse at 11:48 a.m.

Visiting information:

No change from previous post.

Confirmed with nurse's station shift leader at 8:54 a.m. - 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).