General Update #166
Dusty returned to the farmhouse ~8:15 p.m. (9/20) following conclusion of meeting in Moscow. Found Joyce awake, alert and responsive and she asked for an update on the meeting Dusty had in town as they were both excited about it. Joyce was taken to bathroom at ~8:49 p.m., soiled diaper (Type 6). Dusty helped clean Joyce up, applying fresh barrier cream. Joyce lamented her body failing her.
Joyce declined eating earlier in the evening when Dusty first arrived. Dusty continued to negotiate and got her to accept for sake of having something for her evening medication to digest with. Dinner at 9:16 p.m., 1 cup potato salad and 1/3 banana. Joyce continued to insist she was not very hungry but did eat her potato salad and banana. Evening medication given with meal (Carvedilol, Metformin, 2 Tylenol).
Joyce was quite awake and talkative, Dusty remained on site with her as she wished to continue their visit about his meeting earlier in the evening and some of her feelings about things.
~10:45 p.m. Dusty took Joyce to bathroom without incident.
~11:04 p.m. - Joyce settled into her recliner for the night. Dusty departed farmhouse ~11:10 p.m. for the night and will return tomorrow ~8 a.m. for next shift.
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~8:05 a.m. - Dusty arrived to farmhouse and found Joyce sitting in her walker out in the entryway hall. Joyce was responsive, stated that she did not know how long she had been sitting out in the hallway on her walker. Joyce's legs were asleep, Dusty worked to help her work them until they became functional enough to stand. Moved Joyce to bathroom ~8:10 a.m. and assisted in cleaning her up from a bowel movement that had occurred sometime in the early morning hours. Joyce reported that she had woken due to soiling herself "sometime when it was still dark" and took herself to the bathroom. Joyce stated that she cleaned herself up as well as she could by herself, as well as the bathroom floor and toilet riser, and had "probably worn [herself] out with the effort." Dusty sanitized Joyce's walker and then aided Joyce in changing into a fresh diaper and pad insert (as she had attempted to reuse the one he'd placed her in the night before, changing only her diaper pad insert) and applied fresh barrier cream. Joyce appears to have popped the blister that was on her buttocks at some point during her self cleanup process. Dusty gave Joyce fresh skirt and assisted her with walking back out to recliner, getting her seated ~8:40 a.m. Joyce stated that it felt good to sit on something soft as the walker seat had been quite hard.
Vitals taken ~8:44 a.m. with blood pressure 175/100, pulse 85 (assuming higher because of recent physical exertions and stress Joyce endured). Blood glucose level at 141.
8:45 a.m. - Kindred nurse, Carole (Sp?), called Dusty to confirm she would be arriving out to farm ~11 a.m. to check on Joyce. Dusty confirmed he would be present with Joyce all day and they would look forward to meeting her.
Joyce stated that she was not very hungry. Dusty convinced her that she needed to eat something for her medication, Joyce consented after some coaxing. Joyce stated she wanted only a slice of toast with butter, Dusty added 1/3 of a banana and mug of Earl Grey tea. Joyce served breakfast at ~8:50 a.m. along with morning medication (Carvedilol, Metformin, 2 Tylenol, Multivitamin, Potassium, Iron).
~8:55 a.m. - Kindred Carole called Dusty back, informing him of a schedule change with some patiens and that she would now be out at 1 p.m. instead of 11 a.m.
Joyce finished breakfast ~9:10 a.m. Dusty cleared her dishes and changed her a fresh shirt for the day.
~9:40 a.m. - Setup Joyce's feet for soak in warm water with Epsom salt, Joyce delayed soaking until after 9:55 a.m. "to let water cool down" for her feet. Joyce kept removing her oxygen line.
Derik stopped in to use the farmhouse bathroom and visited briefly with Joyce ~10:30 a.m. while Dusty was on teleconference call with his director in the family room.
Joyce taken to bathroom ~10:45 a.m. after Dusty got off teleconference call with his director. Joyce had soiled herself and required cleanup. Dusty changed Joyce's diaper and changed Joyce into fresh skirt and top. Joyce passed urine and had remainder of bowel movement (Type 6). Joyce had difficulty in standing up from toilet riser without assistance. Joyce returned to her recliner by ~11:35 a.m. During trip into bathroom Joyce shrieked, stepping backward and pointing to the floor saying that she saw a mouse run out from the bathroom and around the corner. Dusty had happened to have been watching the spot Joyce had indicated while assisting her into the bathroom and had seen no such mouse. Joyce insisted that it had run from the toilet and out into the hall along the edge of the doorframe.
Joyce kept removing her oxygen line as she watched Coco that Derik had put in for her to watch and needed reminders to put it back into place.
12:07 p.m. - Spam phone call to farmhouse landline.
12:33 p.m. - Carole (Kindred) arrived to farmhouse and took Joyce's vitals - temperature normal; confirmed 2 liter oxygen flowrate; oxygen level 96%; pulse 76; blood pressure 122/72.
Carole asked Joyce about neck pain or stiffness, Joyce reported sometimes. Carole asked if Joyce was in pain right now and Joyce reported that she was not. Carole asked Joyce if there were any open wounds that were being treated - Dusty brought up the wounds on Joyce's buttocks and how the family has been treating with barrier cream. Dusty and Carole assisted Joyce with standing and Carole examined afflicted area. Carole will visit with Tracy about plan for Joyce's wound care.
Carole asked Joyce if she got dizzy and Joyce stated "not really." Carole checked Joyce's legs. Dusty confirmed Joyce has been using compression stockings and he just soaked Joyce's feet.
Carole asked about Joyce's bowel movements and frequency. Dusty provided his logs with Carole. Joyce reported diarrhea incidents and Carole inquired about Joyce's diet to Dusty. Carole suspecting Metformin might be causing and Joyce will slowly adapt if it was not dietary related.
Carole reviewed what Joyce was taking for medications and Dusty confirmed Metformin and Carvedilol for main prescribed medications with Tylenol as pain reliever. Carole inquired if Joyce was still on blood thinning medication and Dusty confirmed the family is only giving what Dr. Collins has prescribed for medications as of Joyce's visit with her in August. Carole reviewed Joyce's orders from Dr. Collins and noted low end of blood sugar levels should be 60s-80s.
Carole listened to Joyce's heart, lungs and stomach with stethoscope and reported all sound fine.
Calendars reviewed with Dusty and confirmed that Carole or Tracy would be out on Friday, September 25 for next appointment with Joyce. Carole departed ~12:51 p.m.
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1 p.m. - Lunch. Joyce stated she was not very hungry. Dusty negotiated that she have a bowl of chicken noodle soup and 1/3 of banana. 2 Tylenol provided for pain relief.
Joyce taken to bathroom ~3:20 p.m. without incident. Joyce did a PT walk to family room and back to recliner. Requested to stretch out and potentially nap until Carol arrives. Dusty assisted Joyce with getting comfortable and laid back in recliner, setting up Pirates of the Carribean: Curse of the Black Pearl to play.
Dusty departing farmhouse ~4 p.m. to travel into Moscow to perform some work at his office on campus before evening meetings commence. Carol arriving for on-site care of Joyce from ~5 p.m. - 9 p.m. this evening. Dusty to return to farmhouse tomorrow ~8 a.m.
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