General Update #146

Craig attempted to call Dusty ~7:31 a.m. but Dusty missed the call as he was in the shower at his apartment in town. Dusty attempted to return Craig's call ~7:37 a.m. when he noticed the call had been missed.

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Craig made contact with Dusty ~7:40 a.m. to check in. He was calling from the farmhouse, having stopped by to check in on Joyce as he prepared to start his day of work for harvest. He wanted to know Dusty's planned arrival time and if he was all right to depart the farmhouse and leave Joyce on her own. Dusty confirmed that he and Jess were on the way out shortly and as long as Joyce was not needing immediate use of the bathroom they would help her upon arrival. Craig informed Dusty Joyce appears to have soiled herself. Dusty let Craig know he would get Joyce cleaned up once he got out to the farm.

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Dusty and Jess arrived to the farm ~8:10 a.m.

Joyce was found to be hunched forward in her recliner and took some rousing to restore her to an upright state that facilitated better breathing. Oxygen line was still in place. 

Jess visited with Joyce while Dusty prepared morning medication doses and breakfast (scrambled eggs flavored with onion & garlic powder). Jess and Dusty confirmed Joyce had soiled herself during the night or early morning hours as Craig had noted in earlier morning call. 

Dusty and Jess let Joyce know that they would get her cleaned up after they got her food and medication into her system as it would most likely take an hour or two. Joyce expressed resistance to taking a shower. Jess pressed the issue, with Joyce continuing to refuse. Jess and Dusty attempted to explore why Joyce was refusing the idea of taking a shower in her own home with assistance. Joyce finally stated that "it was a big production" and "a lot of work" to take showers. Jess and Dusty confirmed that it was, but they were glad to help her do it. They also cited that she was at home, in her own shower this time as opposed to having to shower at Gritman or Aspen Park, and that they would be present to help her with the process. Additional points were raised to Joyce by Jess and Dusty that part of her being able to be "independent" and have the doctors and home health people satisfied that Joyce was doing all right under 24/7 family care was that she had to keep her personal hygiene maintained. Also cited was the need for personal hygiene to help reduce risks of UTI or other infections. Joyce was scratching at her body and Jess pointed out that it would be good for Joyce to shower to help exfoliate the dead skin cells on her body and, jokingly, "to get the Aspen Park layers" off of Joyce. Joyce seemed to consent to the idea of a shower following Jess and Dusty's "sales pitch" after she ate her breakfast and got her medicine into her. 

Joyce requested some instant coffee. Dusty and Jess did not find anything in her file saying she could not have caffeine. Jess prepared a cup of coffee for Joyce to go with her breakfast. Joyce was slow to work at eating, citing that she was not hungry, but kept at attempting to get the eggs down as she acknowledged she needed food in her stomach to help with the medications.

Joyce stated that she was full after eating about half of her scrambled eggs.

Dusty administered the following medications to Joyce after she got about half of her scrambled eggs into her (~9:05 a.m.):

  • Carvedilol
  • Metformin
  • Multi-vitamin (Centrum)
  • Potassium Gluconate
Iron supplement could not be located and Dusty will plan to obtain a fresh supply later this morning or afternoon when making run to town for low-sodium diet friendly supplies for Joyce.

Lidocaine patch will be applied to Joyce's back post-shower.

Pain medication (tylenol) administered with morning medication and Joyce stated her pain levels were around a 5-6 (after some extreme effort in processing Dusty's question about where she felt her pain levels were at, severe delayed responses, Joyce experiencing severe difficulty in focusing even with Jess working with her for several minutes trying to suss out a response).

Blood pressure 153/88, Pulse 100 at 9:09 a.m.

Derrick arrived ~9:10 a.m. to use the bathroom. Jess and Dusty delayed getting Joyce cleaned up until he was out of the house.

Jess and Dusty initiated process of getting Joyce cleaned up and showered ~9:17 a.m.
Joyce requested that she be brought a gray tub container that Aspen Park had provided her (which contained some of her effects from her stay at the facility) for her to work on sorting. Jess let Joyce know she could sort it once the showering process was complete.

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Dusty and Jess working on developing a morning routine checklist for Joyce and building a medication/vitals record keeping sheet for family members to complete for providing to Dr. Collins.

Dusty and Jess will be purging out old and expired medicines (boxing up and storing in a location Joyce cannot access). Joyce's current medications have been consolidated into one place, for ease of locating, over to the kitchen counter beside the built-in cutting board. Dusty to call Joyce's pharmacy today and verify refill orders for items that appear to be needing refilled this coming week.

Participant Observation: Joyce wipes herself from back to front instead of front to back (due to her mobility impairments, it is the easiest method for her to self-clean) and could be a contributing cause for UTIs.

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