General Update #173 - September 28, 2020

Dusty arrived at farmhouse ~7:48 a.m., found Joyce in bathroom attempting to clean herself up after urinary incontinence issue. Joyce stated she was uncertain how long she had been in bathroom. Joyce passed urine and Type 5 bowel movement. Dusty assisted in getting Joyce changed into fresh clothes, cleaned wounds, and applied fresh barrier cream. Joyce taken for brief PT walk to living room before being returned to recliner ~8:17 a.m., citing her arms and knees were hurting and so she could not do the full PT walk. 

Dusty replaced lancet cartridge in Joyce's safety lancet. Blood glucose level 120 at 8:25 a.m.

Dusty applied lidocaine patch to Joyce's back. 

Blood pressure 169/99, pulse 82 at 8:35 a.m.

Breakfast (Oatmeal with peanut butter and 2 packets of Equal, 1 slice whole wheat toast with butter, 1/2 banana, 1 bottle strawberry Ensure). Morning medications (Carvedilol, Metformin, 2 Tylenol, Potassium, Iron, Multivitamin). 

Dusty sanitized bathroom floor and toilet seat riser.

Carole (Kindred nurse) called Dusty ~9:24 a.m. while he was on teleconference with his director. Carole planning to arrive ~1:30 p.m. to check on Joyce.

Joyce finished breakfast ~9:40 a.m.

9:47 a.m. - Tim called via phone to visit with Joyce. "That was good to hear from Tim," Joyce said at the end of their phone call ~10:03 a.m.

10:45 a.m. - Blood pressure 174/108, pulse 83.

10:47 a.m. - Bathroom trip without incident. Urine passed. Replaced diaper pad insert due to urinary incontinence. Wounds cleaned, fresh barrier cream applied. Weighed Joyce following toileting, 166.2 lbs. Joyce returned to chair ~11 a.m.

11:21 a.m. - Joyce soiled herself while seated in her recliner. Joyce refused to follow directions for cleanup in kitchen area and proceeded onto bathroom. Diaper contained everything. Dusty assisted with cleaning up Joyce who finished passing Type 6 bowel movement on toilet. New diaper and diaper pad insert given to Joyce, wounds cleaned and fresh barrier cream applied. Jay (Kindred PT) arrived ~11:30 a.m. while Dusty assisting Joyce with cleanup.

Jay began taking vitals on Joyce ~11:40 a.m. Blood pressure taken by Jay at 149/90, pulse 82. Oxygen level at 92%. ~11:45 a.m. Joyce not reported to be dizzy or light headed when asked by Jay. Joyce reported to Jay that she has tender arms/shoulders and pain in her left knee. Jay asked about the knee and Joyce reported it has been bothering her for some time and she cannot stand on it at times. Joyce reported pain level in the knee at a 7 out of 10 when asked. Jay asked Joyce how low the pain went, Joyce misunderstood the pain scale and reported "best" level of pain was a 8-9. Jay corrected her that higher numbers mean more pain. Joyce had difficulty in communicating pain levels to Jay.

Jay worked through some physical therapy leg exercises with Joyce as she was seated in her recliner without her wearing oxygen line. Jay had to remind Joyce to keep breathing during PT as she would hold her breath while performing movements. 

Jay asked Joyce how Joyce slept last night and Joyce reported she did not sleep well (even though she told Dusty that she had slept fine when he first arrived, Dusty reported the discrepancy to Jay). Jay asked Joyce about her appetite and food intake which Joyce directed to Dusty for answers. Dusty provided information on recent meals and logbook. Jay asked Joyce about what activities she did over the weekend. Joyce reported that she was had sorted out some items from a box and slept the rest of the time, but could not recall if she did much else. 

Jay continued lower body and extremity PT with Joyce, noting that the right leg moves better than the left leg. Joyce's oxygen levels (without being hooked up to oxygen) remained at a good level. Lower body and extremity PT continued with Jay reminding Joyce to breathe while working through the exercises. ~12:06 p.m. Joyce informed Jay she "quits" and did not want to perform anymore PT work. Jay said that was acceptable as they had completed their exercises for the day and he was pleased at how hard Joyce had pushed herself on what they had done. Jay negotiated with Joyce to do 2 laps of walking through the house and Joyce agreed. Jay coached Joyce on proper posture and use of her walker. Jay noted that Joyce tenses up her shoulders when she walks with her walker and that is most likely causing her shoulder and arm pain, and that she does not stand upright which may also contribute to her knee pain and other body pains as her body is compensating for the odd postures she takes while ambulatory. Joyce became irritated at Jay's recommendations, stating that "I'm trying to walk, you wanted me to walk and now all you're doing is criticizing me." Jay apologized to Joyce if she had interpreted his observations as criticism and spent time calming her. Joyce eventually accepted that Jay was attempting to help her do better and continued on with the walking exercise. Joyce attempted to follow Jay's instructions on correcting her posture while using the walker. Joyce returned to her recliner ~12:19 p.m. Jay departed ~12:23 p.m. after confirming he will coordinate with Dusty for scheduling his arrival for 2nd appointment later this week.

Joyce refused lunch when Dusty offered it to her at 12:25 p.m. Dusty negotiated that he would attempt to give her something light to eat later on.

12:29 p.m. - Telemarketing scam phone call to farmhouse's landline was intercepted by Dusty.

12:40 p.m. - Dusty departed farmhouse to travel to his office on campus and drop off his FMLA paperwork with Dr. Collins.

1:23 p.m. - Lunch. Chicken strips from Rosauers (diced up), 1/2 cup rice pudding, 1/2 banana. 2 Tylenol provided for pain relief. 

1:46 p.m. - Lunch paused while Carole (Kindred nurse) arrived to visit Joyce. Carole took vitals on Joyce and confirmed oxygen for Joyce at a 2 liter flow rate. Blood pressure was 132/82 (okay). Carole asked Joyce how physical therapy was going and if it was going all right for Joyce. Joyce stated "I guess so."

Carole asked Joyce if she was having any headaches or dizziness and Joyce answered negative. Joyce was asked about her pain levels and Joyce said she had no pain. Dusty updated Carole on Joyce's pain levels 

Carole asked if anyone had come out last Friday to inspect Joyce's wounds on her buttocks and Dusty stated that no one arrived on Friday. Carole investigated and discovered that Joyce's orders were decreased to one visit per week for nursing check-ins. Might have been queued in the system before the Friday visit order for wound inspection was submitted. Carole will follow up with the wound nurse to ensure they come out to inspect Joyce's wounds.

Slight swelling in Joyce's legs noted by Carole, Dusty confirmed that Joyce has and uses compression stockings and family care providers work on elevating Joyce's legs throughout the day. Dusty attempting to get Joyce an Epsom salt foot bath every other day at the least.

Carole asked about Joyce's bowel movements. Dusty provided updates from the logbook from what he has specifically tracked. Carole enquired about Joyce's appetite and Dusty reported that Joyce informs him she is not hungry but does eat when given food, acknowledging she needs to eat even if she does not feel hungry. 

Dusty reviewed list of items that the family had put together to ask the nurse to look at with Carole. Carole looked at Joyce's left knee, asking what PT said when informed that they had been made aware of the reported pain this morning during Jay's visit. Carole asked Joyce if the left knee pain was new pain or old pain. Joyce unable to answer. Dusty noted that it (left leg becoming immobile) was documented as having happened at Aspen Park as well at least once. Might be result of fall down stairs or just general degradation of the joint/bone? Carole will notify Dr. Collins so it can be monitored.

Carole checked Joyce's reported tenderness and mouth sores. Checked Joyce for Thrush at Connie's request. No open wounds noticed, no signs of severe irritation noted. Salt water wash/rinse plan is recommended for Joyce after every meal to see if that helps clear up the pain/discomfort that she is experiencing. Recommend family caregivers continue to monitor. If white specks appear in Joyce's mouth/throat then please follow up with nurse.

Joyce's incontinence and bowel movement issues (loose stool; soiling incidents). Dusty asked if all right to try providing an anti-diarrhea medication or increase in fibre for Joyce but noted concerns about causing constipation. Carole asked if Joyce was on antibiotics and Dusty reported negative. Suspecting Metformin causing issues with Joyce's loose bowel movements. Carole will check in with Dr. Collins' about sores on buttocks and loose stool and will follow up with Dusty. The wound nurse will contact Dusty to schedule appointment to inspect and treat Joyce's buttocks.

Carole departed ~2:10 p.m.

Joyce requested Earl Grey tea at 3:40 p.m. Dusty asked Joyce why she did not drink all of her Ensure from breakfast as she had agreed to do throughout the day. Joyce pointed at the nutrition label and told Dusty "You see this? This tells me I don't have to drink it!" Dusty got Joyce to agree to finish it with her dinner, placing it on her evening meal tray he prepped for use at dinner time.

Joyce removed the Lidocaine patch from her back on her own ~4 p.m. while Dusty was out of the room taking out the trash and moving her laundry over to the dryer. Joyce taken to bathroom. Urinary incontinence requiring diaper pad insert change out. Joyce released her bladder as she seated herself on the toilet riser. Dusty cleaned and sanitized toilet riser and bathroom floor. 

Dusty departing farmhouse to work on projects at his office on campus ~4:45 p.m. 

Carol arriving ~5:30 p.m. to cover evening care of Joyce.