General Update #148

Joyce woke up from her nap ~12:17 p.m. but stated that she didn't quite feel like having her eyes open yet. Dusty and Jess reviewed the need to get Joyce cleaned up and showered, asking if she felt like she would be able to stand and do that. Joyce consented but asked for a few minutes to gather and orient herself. Joyce asked about the waterproof mat that had been placed on the floor in front of her and Jess explained that is part of the cleanup process they were attempting to do on Joyce earlier in the morning.

12:23 p.m. - Joyce discussed "motivation" with Jess and Dusty. If she cooperates with Jess and Dusty for cleaning up herself she requested a hamburger for lunch. Dusty stated that would probably be all right to do today, he'd need to find a correct hamburger to get (or make) for Joyce that fit within the dietary plan. Joyce asked who gave Dusty that dietary plan. Dusty informed Joyce it was most likely Dr. Collins. Joyce stated that she would have to talk to Dr. Collins and "get her straightened out." Joyce expressed dislike of being on a dietary plan. Jess explained that it was for her health and to help keep her out at the farm longer and around with the family longer. Jess reviewed that Joyce was malnourished when she was admitted to Gritman back in June.

Joyce struggled to remain upright in her chair while visiting with Jess and Dusty.

Joyce provided "story" about the places she had been staying at, claiming that they all told her they would give her a shower and that she didn't have any showers at all. She expressed concerns over why they would tell her they would give her showers and then did not give her showers. Jess and Dusty explored that line of thought with Joyce, explaining that maybe she missed some showers due to her lethargy (missing her designated shower schedules) or the staff was short on some days, or that Joyce may have been given showers but forgot she had them.

Joyce quaffed some cold coffee, commenting that she was okay with cold coffee after Jess offered to get her fresh warm coffee.

Jess and Dusty moved to get Joyce cleaned up from soiling herself.

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Joyce's cleanup and shower completed by 2 p.m.

Joyce's stool was Type 6-7, quite tarry and mucous-like in nature. Cleanup effort definitely required 2 adults to assist and should not be attempted solo. Joyce lost control of her bladder while cleanup effort was under way but Jess and Dusty had deployed a disposable waterproof mat below Joyce as part of the plan so minimal issue arose from this. 

Joyce had some additional bowel movement (Type 6-7) and urinary output when Jess and Dusty seated her on the toilet pre-shower. 

Showering for Joyce will take 2 adult assistants for safety and to help coordinate/expedite the process. Jess got into shower with Joyce after Dusty dialed in correct and comfortable water temperature, focusing on cleaning front areas of Joyce's body while Dusty managed the shower head, shower curtain liner, and cleaning Joyce's back, legs and soiled areas from bowel movement. Jess and Dusty assisted and in some instances took over scrubbing out areas on Joyce's body. Most problem areas appear to have been in recesses and folds of skin that may have been repeatedly missed during prior hygiene events. 

Joyce has rash on her buttocks which will need to be monitored and will need barrier cream applied by family members providing care for her.

Joyce has swollen legs. Jess and Dusty assisted Joyce in getting fresh compression stockings pulled on. Joyce was given a blanket and oxygen line back into place once she was returned to her recliner. Jess assisted Joyce with taming her long hair and confirmed with Joyce that plans will be put into place to schedule a haircut for Joyce either from Nichole or Jess if Nichole is unavailable. In the mean time Jess aided Joyce with hair control using hair clips previously procured by Jess and Dusty and some hair spray.

Joyce stated that she had bargained for hamburgers and Dusty confirmed that he was now obligated to get her a hamburger. Joyce laughed.

Dusty departed farmhouse for Moscow to obtain hamburger for Joyce and dry change of clothes for Jess. Jess remained on-site to monitor Joyce and provide her support. Jess managed to convince Joyce to try reclining her chair back into a more prone position to help reduce the swelling in her legs. Joyce accepted being laid further back with Jess working the recliner's controls.

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