General Update #109

One of Joyce's nurses, Andrea, saw the note to contact Dusty and returned Dusty's phone call from 11:15 a.m. around 11:43 a.m. 

Andrea had been present all weekend, checking in on Joyce and overseeing her care. Joyce was reported to be doing well so far into today's day shift - no hallucinations, doing all her own care, is alert, and responsive when interacting with staff. 

Joyce did have some toilet issues over the weekend with 3 bowel movements on Saturday and one yesterday. Nothing to worry about overall, increased bowel movements are a known side affect of the antibiotic Joyce is taking. There was no diarrhea, just pretty soft stools and the urgency to go to the bathroom for the bowel movements came on quicker for Joyce than she anticipated resulting in some accidents requiring assistance in cleaning. Andrea passing information onto family in case Joyce takes antibiotics in the future while at home (so they can factor in planning to provide assistance in cleanup which may be needed). 

Joyce had no incontinence issues over the weekend, so small gains have been made in this regard.

Joyce's blood sugars are good and vitals are good.

Aspen Park nursing staff have reached out to Joyce's primary care provider, Dr. Collins, informing her that culture results from the second urinalysis collected from Joyce also show no growth, so no UTI present in Joyce - Andrea is waiting for confirmation from Dr. Collins to move toward discontinuing antibiotics treatment.

From strictly a nursing standpoint, Andrea notes that the hallucinations seem to indicate something has been going on with Joyce's urinary tract, as when antibiotics are administered they cease and there is noticeable change in Joyce's alertness and energy levels. Antibiotic use seems to help Joyce, preventing hallucinations and aiding in her overall health which leads to the question from the nursing staff as to what is going on? Potentially something related to possible cancer?

Andrea asked if cancer testing was scheduled for Joyce. Dusty stated that he was under the impression that would be worked out with Dr. Collins - he has not been able to participate in discussion with Dr. Collins and Joyce's telehealth visits and was uncertain as to the overall schedule of things, especially given the recent delay to Joyce's discharge timelines. Dusty stated that he thought that information might have been scheduled by Aspen Park team and be shared/worked out with Dusty direct when re-initiation of Joyce's discharge plan gets back underway. Andrea agreed that would most likely be the case, noting it was above her pay grade and was not able to provide information in that regard. Having seen Dusty's message left from earlier in the morning, Andrea wanted to provide general update to Dusty from the weekend and what she knew from today so far for Joyce given the rapport they'd built. Dusty thanked her for her care and communication.

Dusty's message requesting information on Joyce will be forwarded to Sue to discuss care plan, discharge, cancer testing, etc. Andrea will follow up with Dusty if any new information arrives before end of her shift today, time permitting.


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Maggie called Dusty ~12:34 p.m., acknowledging that Dusty previously discussed information about Joyce with Andrea. Maggie confirmed that Joyce appears "back to baseline normal" when she checked in on her today. 

Joyce is reporting some discomfort in her abdomen area. When Maggie requested clarification from Joyce, Joyce stated that it was in her stomach region.

Maggie expressed concerns on re-initiating the discharge process for Joyce at this time, as the Aspen Park staff can't tell what happened to cause Joyce's decline from baseline normal behavior, why it happened, or how to prevent it from happening again. Dusty confirmed there is no rush to get Joyce out of Aspen Park if she is still being treated for ailments, noting only the September 16 full coverage end date. Maggie confirmed Joyce was covered in full to that date but did not believe that Joyce would remain at Aspen Park that long. 

Maggie confirmed they are still waiting on Dr. Collins and what the Aspen park team should pursue for Joyce - example, do they need to get Joyce to see the urologist and/or oncologist to help determine what is causing Joyce's change in mental behaviors and energy levels.

Maggie will keep Dusty updated with the care of Joyce and information on her treatment as it becomes available. 

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