General Update #163

Dusty arrived to farmhouse ~7:47 a.m., found Joyce sitting hunched forward in her recliner without her oxygen line in place and somewhat incoherent. Dusty asked if anyone had been in to visit with her today and Joyce indicated no. Dusty asked if Joyce had gotten up to take herself to the bathroom and she indicated no. Dusty replaced Joyce's oxygen tubing and went through some breathing exercises to get her perked up.  

Joyce traveled to bathroom ~8 a.m., a little unsteady on her feet but made transition from standing to sitting on toilet riser. Urine passed. Urinary incontinence occurred sometime during night or early morning. Diaper and diaper pad insert replaced, fresh barrier cream applied. Joyce changed into clean skirt and fresh top for the day.

Joyce given breakfast at 8:25 a.m. (toast slice with apricot jam & butter, 1/3 banana, V8 juice, and Earl Grey tea). Morning medication given to Joyce (Carvedilol, Metformin, 2 Tylenol, Iron, Potassium, Multivitamin) before Dusty departed farmhouse for his medical appointment.

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Tracy, nurse from Kindred, called Dusty ~9 a.m. while he was at his doctor's office to confirm she could arrive today to check on Joyce around noon. Dusty confirmed he would be out all day and into early evening at the farmhouse.

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Dusty returned to farmhouse ~10:40 a.m., finding Joyce hunched forward in her recliner without her oxygen line in place. 

Joyce taken to bathroom ~10:42 a.m., diaper pad insert replaced due to urinary incontinence. Only urine passed. Applied fresh barrier cream. 

10:53 a.m. - Dusty and Joyce worked on her physical therapy and performed back posture exercises. Joyce walked with some difficulty from bathroom into family room, then into kitchen to main window, then over to garage stair doorway before returning to sit in recliner. Dusty gave Joyce the magazines he and Jess had ordered for Joyce to read through. Joyce was excited and began to process them. 

11:46 a.m. - Received a scam call to the farm's land line claiming to be the social security administration, stating that "your social security number has been compromised and all associated services would be suspended," etc. 

11:58 a.m. - Tracy called Dusty, notifying him that she was running late and would arrive out to farmhouse to check on Joyce later this afternoon.

12 p.m. - Dusty and Joyce worked on her physical therapy and back posture exercises. 

12:40 p.m. - Bathroom trip, no issues. PT walk from bathroom to family room to kitchen and back to recliner. Joyce attempted to drag her walker sideways as she walked alongside her recliner as she moved to get into position for sitting, which nearly toppled her. Dusty caught Joyce before she fell sideways into counter. Joyce transitioned to recliner and got her oxygen line into place.

12:50 p.m. - Tracy arrived to farmhouse. Reviewed PT and OT plans with Dusty and plan for PT/OT that Dusty will work on with Joyce on days physical or occupational therapist are not out. 

Tracy reviewed Joyce's current condition. Asked Joyce if she wears dentures, Joyce stated "no." Dusty corrected to remind Tracy that she upper dentures. Tracy asked if Joyce was experiencing pain, Joyce stated "no." Dusty commented that Joyce had stated she had pain in her hip during their recent PT walk around the house. Joyce then spoke up and reported she was experiencing pain in her right shoulder. Tracy asked where Joyce's overall pain levels were on a scale of 1-10. Joyce unable to report her pain level. Tracy attempted to use descriptors to get Joyce to identify the type of pain she was experiencing. Joyce appeared unable to process before finally indicating "dull" pain. Tracy asked if it was a "dull ache" and Joyce stated she didn't know what "ache" meant. 

Tracy reviewed Joyce's sores/rash on her inner thigh and buttocks with Dusty. Recommended if Joyce experiencing pain in that area while seated to use a pillow to keep her "off to one side" as she sits to help take direct pressure off. Dusty provided directions about pillow placement and time runs.

Tracy asked Joyce if she had gotten the compression stockings she was wearing new or if she had them. Joyce could not recall, Dusty confirmed that Joyce has had them and been using them.

Tracy checked Joyce's heart and lungs with stethoscope. Lungs sound good, heart has "a little murmur." Joyce stated that she has had that for years. Confirmed 2 liter oxygen rate flow. Joyce reported no shortness of breath while resting in the recliner. Joyce stated that she feels like she is sleeping well. Joyce did not report any burning sensation when urinating, no constipation or diarrhea. Tracy asked if Joyce had a bowel movement today, Dusty confirmed no bowel movement for today. Tracy asked Joyce if she was having any incontinence issues, Dusty 

Tracy noted Joyce has dry mouth, recommended attempting to get Joyce to take more fluids throughout the day for that and to help her avoid dehydration. 

Joyce was able to confirm her birthdate, location (at her farmhouse and its address), current year. Joyce was unable to tell Tracy who the president of the U.S. was. Tracy asked Joyce if she was depressed, Joyce stated that she was not depressed and felt pretty happy.  

Tracy checked with Dusty about Joyce's diabetes, reviewing directions received from Aspen Park/Dr. Collins. Dusty directed to do what Dr. Collins informs family to do in regard to Joyce's diabetes control. Tracy confirmed that Dusty knows how to treat a low blood sugar incident with Joyce, walking through steps on how to identify symptoms/behaviors in Joyce and how to treat them. Tracy asked Dusty if the family has been helping Joyce follow the low-sodium and diabetic diet plans. Dusty confirmed that they are following the low-sodium plan (2000 mg sodium per day limit) but probably were not effectively following the diabetic plan. Dusty asked if they need to be following a diabetic plan and Tracy confirmed they should be to provide Joyce best chances of not needing to continue on with self-administered insulin use. Recommending to keep Joyce away from "white" foods (sugar, flour, pasta). Dusty confirmed he will start reviewing diabetic meal planning information to combine with low-sodium plan already in effect for Joyce.

Tracy requesting daily weight measurement information be collected on Joyce. Attempt to weigh Joyce around the same time each day with the same amount of clothes on at each weighing. If a change greater than 3 lb variance occurs, notify Tracy or Dr. Collins, as it could potentially indicate water building up around Joyce's heart or some other condition which should be checked. 

Tracy checked Joyce's blood pressure. 147/88 (still within the good range), pulse 74, at 1:22 p.m. 
Dusty instructed to report to Tracy any time blood pressure exceeds 170/90 or falls below 90/50.  
Joyce's oxygen saturation at 95%.

Tracy (or her alternate) will arrive next week on Monday to check in on Joyce again. Tracy departed ~1:30 p.m.

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Joyce given lunch ~1:36 p.m. (1/2 peanut butter sandwich, 3/4 cup cottage cheese, 1 cup potato salad, iced tea). 2 Tylenol caplets taken with lunch for pain control.

3:20 p.m. - Bathroom trip, no issues. Applied fresh barrier cream. PT walk from bathroom to family room to kitchen and back to recliner. 

4:05 p.m. - Joyce had a sudden large bowel movement (Type 6) while seated in her recliner, pull-up diaper and pad insert caught it all. Joyce muscle control and limited mobility proved to be a hinderance to her successfully cleaning up herself. Dusty brought in pair of scissors from kitchen to keep on hand in the bathroom to aid family caregivers in removing future soiled pull-up style diapers. Dusty cleaned up Joyce with some effort and got her into a new diaper and pad, applied fresh barrier cream, and changed her long sleeve shirt. Returned Joyce to rest in her recliner ~4:30 p.m. 

Joyce napped from ~4:50 p.m. to 6 p.m., leaning back in recliner with feet elevated. Frequently removed oxygen line and had to be reminded to restore it to proper position. Dusty asked if Joyce would like to get up and go to the bathroom. Joyce refused.

Joyce given dinner ~6:15 p.m. (leftover KFC bowl, iced tea leftover from lunch) and evening medication (Carvedilol, Metformin, 2 Tylenol). Joyce stated that she was not very hungry and the leftover KFC bowl sounded like the best option to her for the evening. Joyce stated she was feeling very tired. ~6:20 p.m. Joyce dumped her iced tea down the front of her blanket. Dusty cleaned up mess, getting Joyce fresh iced tea and a new blanket. Joyce finished her dinner ~6:47 p.m. 

Joyce requested 1/3 of a banana ~6:53 p.m. Dusty asked if Joyce would like to get up and use the bathroom. Joyce refused.

8 p.m. - Bathroom trip. Diaper pad insert replaced due to urinary incontinence. Only urine passed. Applied fresh barrier cream. Joyce returned to recliner, replacing oxygen line with some encouragement.

8:30 p.m. - Dusty discovered Joyce had not taken her evening medication with her dinner (she had set the Dixie cup aside when the iced tea had spilled). Dusty gave Joyce 1/3 of a banana and Joyce took her evening medication. Craig stopped by to visit mom, informing her that harvest for 2020 was now finished. 

Craig departed farmhouse ~9 p.m., Dusty departing for the evening ~9:30 p.m. (after taking Joyce to the bathroom once more before bedtime) and will return tomorrow around 1 p.m. after his late morning training session for Scouts concludes. Connie arriving tomorrow morning to be with Joyce. Zac, Nichole, and their new baby Miranda accompanying to visit Joyce. Nichole planning to cut Joyce's hair. Joyce very excited about seeing her great-grandchild.  

Joyce wishes everyone a goodnight.