General Update #154

Dusty put the new license tabs on Joyce's Subaru yesterday afternoon (9/13).

---

Traci (nurse from Kindred Home Health) attempted to contact Dusty while he was out of his cellphone's service area at Camp Grizzly sometime post 5 p.m. (9/13). She stated that she had been trying to call the farmhouse line but did not receive any answer there before noticing that Mary had placed a directive to call Dusty'c cell phone. 

Dusty returned to service area too late to call Traci back (post 10 p.m.) and will contact her tomorrow (9/14) around 8 a.m. upon arriving at the farmhouse.

---

Dusty arrived to farmhouse ~7:57 a.m., found Joyce hunched forward in her recliner with no oxygen tubing not in place and all lights in kitchen area were off, television off. Joyce was easily roused and was fairly coherent, stating that she had just taken herself to the bathroom (what she thought) was half an hour ago. Joyce stated that no one had been in the house and she figured Carol had turned off all the lights before she left for the night last night.

Dusty applied a fresh Lidocaine patch to Joyce's back ~8:05 a.m. and asked what she would like for breakfast. Joyce stated that she was not hungry. Dusty convinced her that taking in breakfast before her morning medications would be a good thing and Joyce agreed, deciding that she could get a slice of toast with butter and apricot jam down. Dusty made that and a fresh cup of Earl Grey tea, giving it to her ~8:16 a.m. Joyce and Dusty visited about the Potlatch Scout units he visited last night and how Jim McMillan knew Craig and Carol. Joyce praised Carol's efforts at cleaning the farmhouse, stating that she was very busy. Joyce expressed feeling bad that she was unable to assist in what she perceived as a meaningful way to Carol but gave assistance in helping direct where things went that she could recall had specific homes around the house.

Dusty asked Joyce what she had for dinner last night (after seeing the meatloaf Jess made was not cut into) and Joyce said she could not recall but assured Dusty that she had eaten. They joked that the family would not let her starve.

8:10 a.m. - Dusty contacted Traci (Kindred Home Health) after getting Joyce her breakfast and tea. Confirmed that Traci would arrive to the farmhouse ~1:30 p.m. this afternoon. Dusty confirmed he will be on-site till 4 p.m. today if Traci needed to have extended meeting time with family member beyond initial meeting with Joyce.

8:18 a.m. - Connie contacted Dusty via text to ask about when the Kindred Home Health team was going to come by to see Joyce, as she wanted to be present for their arrival. Dusty called Connie back, informing her that Traci (nurse) would arrive ~1:30 p.m. today. Dusty also asked Connie if she would be able to coordinate time to arrive to the farmhouse and go over the shared scheduling calendar, medications, locations of care items for Joyce, etc. at some point today or tomorrow now that she was back in Moscow. Connie informed Dusty that Carol had called her yesterday evening to request she arrive to begin adding her scheduling availability and restrictions onto the board. 

8:26 a.m. - Joyce finished her toast entirely. Dusty asked if she would like anything else, offering banana, cottage cheese, etc. and Joyce stated that she felt like she could eat 1/4 of a banana. Dusty provided it to her and she finished it off by 8:30 a.m.

8:35 a.m. - Dusty administered Joyce her morning medications (Carvedilol, Metformin, 2 Tylenol, Multivitamin, Iron Supplement, Potassium Supplement).

8:36 a.m. - Joyce opened the paper bag from Diane and Allen again to admire the butterfly hand towel set they had left for her when they stopped by when Joyce was at Aspen Park. Joyce spent time admiring it then stated that it was too pretty to remain in the bag and should be hung up. 

---

8:40 a.m. - Carol called Dusty's cell phone to provide update on Joyce last night. Carol reported that Joyce had one bowel movement, but was dry the rest of the day. Carol noted that the new diapers are a struggle for Joyce and are more likely useful for prone/non-ambulatory users. Carol recommends attempting to go back to the pull-up style Depends variant of diaper for ease of use for Mom as the toileting schedule Carol implemented (take Joyce to the bathroom every 1.5 hours whether she feels like going or not) appeared to work in reducing Joyce's incontinence and involuntary bowel movements. Recommending that family care providers keep Joyce on a 1.5 hour bathroom use schedule as no issues occurred during time Carol was present at farmhouse. 

Joyce had a good dinner, but would not take Tylenol. 

Derrick finished watching a movie with Carol and Joyce during the evening. Joyce expressed that she was in no pain and refused Tylenol. Derrick remained on-site with Joyce to watch another film after Carol departed for the evening. Derrick stated that he would offer Tylenol to Joyce once more before he would depart farmhouse for the evening. 

Joyce was able to run her recliner's remote on her own last night without assistance.

Carol really pleased with Mom's progress, thinking things were much worse based on Dusty's blog entries of the previous days. 

---

8:46 a.m. - Dusty called Moscow Medical to verify the day and time for the 2-week appointment follow up for Joyce with Dr. Collins had been scheduled. Spoke with Tanya. No record exists at this time for Joyce, Tanya citing that they'd just seen Joyce last month. Dusty confirmed, citing Joyce's recent discharge from Aspen Park facility and discharge directives. Dusty will call Aspen Park social worker to review 2-week appointment scheduling (Aspen Park was to have handled or if Dusty was to setup on Monday vs. just confirm it had been done).

---

Joyce's blood pressure 147/72, pulse 83 at 8:58 a.m.

---

Dusty took Joyce to bathroom at 9 a.m.

Joyce initially became distracted with trying to pick lint off her skirt but was eventually was focused enough to work on getting up and heading into bathroom. Joyce moved to bathroom unassisted with Dusty following close behind. Joyce transitioned from standing position to sitting on toilet riser without loss of bladder control. Joyce's diaper appeared dry and clean, with only potential remnants from yesterday's bowel movement Carol reported. 

Joyce passed urine and had a small bowel movement (Type 4-5 on the Bristol Stool Chart). Dusty assisted with cleanup of buttocks and applied fresh barrier cream. Dusty swapped heavy-duty side-tab diapers out for pull-up style diapers for Joyce to use today. Joyce was pleased, saying she hated the side-tab ones. Joyce able to pull on and pull up the pull-up style diapers with some difficulty but managed well overall (skirt kept falling down and getting between body and diaper's rear area so Joyce's post-bowel movement hygienic practices will need to be monitored by family care providers to reduce chances of soiling). 

Joyce was returned to her recliner ~9:22 a.m. Joyce required reminding to put her oxygen tubing into place and seat her chair off of it's forward incline position. Joyce got oxygen into place after 3 verbal reminders from Dusty to focus on that task. 

Swelling in Joyce's legs reduced. Recommending to family care providers that compression stocking use and elevation of legs continue.

Joyce began "looking for things to do" around her recliner area after becoming settled. Dusty asked if he could bring Joyce something to work on. Joyce said that she would like to work on her coloring book, but couldn't focus on finding one in her book rack. Dusty assisted and helped locate her coloring book. Joyce became distracted with an empty kleenex box. Dusty asked if he could break it down and put it in the recycling bin for her. Joyce waved him off stating that she wanted to just "fiddle with it" and that she would break it down and make a box out of it with some glue (Joyce often recycles empty kleenex boxes by remaking them into notepad/pencil holder containers). Joyce proceeded to get her scissors out and work on cutting up the box.

---

Dusty called Aspen Park ~9:26 a.m., requesting to speak with Rachael to confirm information about Joyce's follow up visit to Dr. Collins. Rachael was in morning staff meeting, Dusty transferred to her voicemail account.

---

Dusty called Palouse Foot & Ankle Clinic ~9:35 a.m. to schedule appointment for Joyce with Dr. Capawana to have her toenails trimmed. Spoke with Blaine. Dr. Capawana will meet with Joyce at 10:50 a.m. tomorrow in the Moscow office for routine care of her toenails. Dusty to take Joyce to the appointment using Joyce's Subaru.

Joyce was excited to learn she will have her toenails trimmed, stating that they have been bothering her. Dusty confirmed and stated that it would make wearing all of her different shoes much nicer for her again.