General Update #170

Connie texted Dusty last night (9/24) ~9:13 p.m. to let Dusty know she thinks Joyce has Thrush in her mouth again, recommending that Dusty bring it to the nurse's attention tomorrow to see if a prescription for treating it could be obtained from Dr. Collins before the weekend. Connie will call Dusty tomorrow.

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Dusty arrived to farmhouse ~8:20 a.m. after picking up Kleenex, wound cleaner, and hand soap refill bottle from Walmart. Craig informed Dusty that Joyce had traveled to the bathroom on her own earlier in the morning and he had given Joyce a whole banana to tide her over until Dusty arrived to farmhouse.

Dusty found Joyce awake and alert in her chair with her opened whole banana sitting on a tray on her walker in front of her.

~8:40 a.m. - Breakfast. 1 slice of toast with butter, 1 hard boiled egg, 1/2 banana (cut whole banana Craig provided in half), Earl Grey tea. Morning medication administered (Carvedilol, Metformin, 2 Tylenol, Multivitamin, Iron, Potassium). 

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Connie called Dusty ~8:57 a.m. to provide update on Joyce from last evening's care. Connie planning to run out to farmhouse on her lunch break to drop off some Ensure and Efferdent for Joyce. Expressed concerns about Joyce's weight loss. Connie wanting to add Ensure for Joyce to have 1 in the morning and 1 in the evening with her meals to ensure she gets all the nutrients she needs.

Connie reported that Joyce had a hard time eating her dinner. Joyce ate ~3 bites of the spaghetti for dinner last night and that Joyce the tried to stop eating it, attempting to hide/toss it similar to what Dusty experienced the last time he served it to her. Connie asked Joyce about why she was not eating and Joyce stated the food was good but she was having trouble eating it. Connie gave Joyce alternate dinner option of chicken noodle soup which Joyce drank 1/2 mug of broth and ~4 bites of noodles. Connie reported that Joyce's mouth hurt too much to have her dentures in for meals. Joyce's mouth was inspected by Connie and gum irritation was noted (canker sore-like). Dusty will bring it up with the nurse today. 

During the final evening bathroom trip Connie was present for, Joyce had difficulty in walking back out to the recliner (due to her left knee). Joyce experienced immobility. Connie reported Joyce's knee issues have been ongoing for her and Carol with Joyce, usually during last bathroom trip of the evening. 

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9:19 a.m. - Joyce reported she was cold. Dusty provided her a second blanket. Joyce slept until ~11:20 a.m.

Dusty went to apply fresh Lidocaine patch to Joyce's back and discovered that the patch from yesterday and so removed it. Did not apply fresh patch as there needs to be 12 hours between patch applications.

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10:10 a.m. - Another individual calling the farmhouse landline to attempt to schedule a surgery at Gritman Medical Center. They both had a laugh about it and Dusty provided directions for them to contact the main Gritman desk, provide them their name and notify them about the error of Joyce's phone number having been assigned as the point of contact for the surgery scheduler's office. Caller thanked Dusty for his assistance. 

Dusty called Gritman administration office to report another individual has been given Joyce's home phone number instead of the surgery center's phone number. 

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10:42 a.m. - Scam phone call received on farmhouse landline (police officer support foundation refund being offered, asking for bank account information they possess to be verified). 

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Blood pressure 139/70, pulse 80; blood glucose level 93 at ~11:20 a.m.

Bathroom trip at ~11:30 a.m., Joyce thrilled her diaper and diaper pad insert were clean and dry. Bowel movement (type 6) and urine passed. Dusty assisted with cleaning Joyce's wounds and applying fresh barrier cream. 

Weight 164.2 lbs @ 11:38 a.m.

Joyce returned to her chair ~11:41 a.m. 

Dusty was sent to town to obtain lunch, given $45 cash from Joyce to replenish his "errand envelope." Dusty met Connie while in town, taking Ensure she purchased back out to farm with him.

Lunch @ 12:35 p.m. - 1/4 Humble burger and 1/2 small order of fries with Humble sauce eaten. 2 Tylenol for pain relief taken. 

Joyce napped until Kindred PT arrived.

2:16 p.m. - Jay (Kindred PT) arrived, Joyce stated she did not feel well enough to do a lot of PT. Joyce said that her goal was to eventually not be "confined to the chair." Jay confirmed and noted that Joyce would like to be more mobile in her daily living. Joyce reported no pain when asked. Jay asked if Joyce was able to walk, Joyce indicated that she could walk with the walker but only for a short distance. Joyce informed Jay that she has varying degrees of pain on varying days when asked. Joyce asked for assistance in making her life more productive again than it is now. Jay said that was a good desire to have as most people don't have that desire. Jay asked if Joyce has difficulty getting into and out of bed, Joyce informed him she usually sleeps in her chair. Jay asked why Joyce sleeps in the chair and Joyce stated that she likes her bed, but has been using her recliner out of comfort. Joyce not opposed to trying to go back to using her bed but prefers sleeping in her recliner. Jay asked if Joyce has any interest in sleeping in her bed again and Joyce said she would need to think on that. Jay said if Joyce wants to do that they can add that to the PT work for Joyce. Jay told Joyce that sleeping in a bed would be better for Joyce as it could remove the pressure points/sores on her body that might develop from her sleeping solely in the recliner. 

Jay reviewed pain Joyce experiences and Joyce explained about her left knee.

Jay reviewed Joyce's shower and use of shower and confirmed that she does not shower alone.

Jay checked Joyce's vitals, confirming 2 liter oxygen flow rate. Blood pressure 136/78.

Jay asked Joyce to review her day and activities as well as her hobbies. Dusty walked Jay through a typical day's routines and care plan administered by family care givers for Joyce. Jay told Joyce she was very lucky to have family to be with her all day as some of the people he works with don't have anyone to care for them and they struggle to remain independent at their homes without family care.

2:30 p.m. - Craig arrived to farmhouse, remaining briefly to look through newspaper before departing.

Jay worked through some leg exercises and range of motion calisthenics with Joyce as she sat in her recliner. Joyce reported that her legs felt stiff and sore after exercises completed. Jay asked if Joyce felt up to taking a walk with him and she agreed. Jay observed as he walked with Joyce to the living room and back, reminding her of proper breathing techniques and to keep the walker closer to her body instead of pushing it out so far ahead of her. Joyce had a moment where her elbow cramped and caused her to pause and step back into Jay. Joyce continued on and returned to her recliner without incident. Jay praised Joyce for walking better than he thought she would do. 

Jay stated that he would return next week to work with Joyce again. Jay joked with Joyce that he would arrive at 4 a.m. next time and they exchanged a laugh. Jay will coordinate with Dusty about appropriate time to arrive once schedule has been set among the other patients on his roster. Jay departed ~2:54 p.m.

Joyce soiled herself while seated in the recliner (Type 7) ~2:55 p.m. Dusty cleaned her up in the living room while she stood on a disposable mat before assisting her to the bathroom. Joyce traveled to bathroom, passing urine and remaining bowel movement. Dusty cleaned her wound and gave Joyce a shower, then changed her into fresh clothes and returned her to her recliner ~4 p.m.

~4:09 p.m. - Blood pressure was161/91, pulse 83. Blood glucose level at 139.

Dusty departing farmhouse ~4:30 p.m. to work at campus office and then travel to Palouse Anthropology meeting. Kindred nurse did not call to schedule arrival today before Dusty left farmhouse. Dusty called and left message with Tracy (nurse) at Kindred to provide update on no-show and information on what Joyce has been experiencing this week. 

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