General Update #175 - September 30, 2020

Dusty arrived at farmhouse ~8:15 a.m. after stopping by his office to unlock it for his work study student and dropping off documents at Moscow Medical. Found Joyce asleep in her recliner, curled forward, with oxygen line in place. Joyce was fairly alert and reported that she had a wonderful dinner with Connie last night when asked but could not recall what they had to eat. 

Joyce was able to stand and travel to the bathroom ~8:50 a.m., disposable chair pad was wet - Dusty replaced it. Joyce's skirt showed signs of urinary incontinence but diaper was dry. Skirt replaced. Dusty assuming that Joyce must've had an accident overnight/earlier in the morning and either didn't notice she had wet her skirt or had released her bladder when sitting on toilet riser and not noticed. Urine passed, wounds cleaned, fresh barrier cream applied. Joyce did a PT walk with Dusty to living room and returned to recliner ~9:12 a.m. Changed Joyce into fresh clothes for the day at her request. Lidocaine patch applied to Joyce's back.

Vitals taken ~9:20 a.m., BP 144/83, pulse 84. Blood glucose level at 131. 

Breakfast at 9:25 a.m. - Oatmeal with 1 tablespoon peanut butter, 1 chocolate Ensure, 1/2 banana. Morning medication (Carvedilol, Metformin, 2 Tylenol, Potassium, Iron, Multivitamin).

~9:34 a.m. Carol called farmhouse to check in with Dusty. Carol provided update that Joyce had been awake and using the bathroom ~7 a.m. on her own this morning when Carol dropped Craig off at the farm on her way into Moscow. 

~10:34 a.m. - Trish called Dusty and scheduled a social visit to come see Joyce for Tuesday, October 6. She will be joined by Arleen. Both of Joyce's old H&R Block colleagues are looking forward to seeing Joyce. Dusty informed Joyce and she stated that it would be nice to see them. 

11:26 a.m. - Joyce soiled herself while seated in her recliner. Joyce became frustrated at herself and her body's malfunctions. Dusty helped calm her down and worked through her feelings. Dusty assisted in getting Joyce moved to bathroom, removed her soiled clothing and assisted her with removing diaper before aiding with transitioning onto toilet riser. Joyce passed urine and remainder of Type 6 bowel movement. Joyce had extreme difficulty in standing up from the toilet. Dusty assisted her and then aided her in cleaning up remainder of fecal matter from her buttocks. Dusty cleaned Joyce's wounds and applied fresh barrier cream. Joyce was unable to move/walk following toileting process and handwashing, claiming that her left knee would not function for her without causing extreme pain and imbalance. 

~12:03 p.m. Joyce was seated onto her walker (after nearly tipping backward as she tried to walk under her own power using walker) and Dusty rolled her out to the kitchen. Dusty sanitized toilet riser, sink, and bathroom floor. 

~12:06 p.m. Tracy (Kindred nurse) arrived into farmhouse accompanied by Craig. Tracy had apparently attempted to notify Dusty yesterday and earlier today that she would be arriving today at noon but was unable to reach him. Dusty discovered that he had no calls from Tracy. It was determined that she had been attempting to call Joyce's cell phone instead of Dusty's cell phone, somehow it had been reset to the default number away from Dusty's number in their database system. Tracy corrected the information in the contact database.

Tracy reviewed the health concerns Dusty spoke with Carole (Kindred nurse) on Monday when she visited Joyce. As the loose stool/diarrhea issues have been going on for more than a week for Joyce Tracy recommends bringing it up with Dr. Collins tomorrow during Joyce's follow up appointment and Dr. Collins will most likely ask for a stool sample to be collected for testing. Tracy suspects that the loose stool/diarrhea might be due to antibiotics Joyce was administered while at Aspen Park. Tracy thinks that Dr. Collins will most likely recommend adding a fiber supplement (Metamucil crackers recommended) to Joyce's diet but family should wait to begin administering that until Collins confirms it should be initiated. If a fiber supplement is added to Joyce's diet, the family caregivers will need to ensure that Joyce increases her fluid intake throughout the day to prevent constipation from occurring. 

Tracy reviewed the logged urine/bowel movement, blood pressure, blood glucose level, and weight logs that Dusty has been keeping. Food intake and PT/OT exercise logs reviewed. Tracy confirmed that Joyce appears to be doing well overall from the collected data and recommended that family caregivers should continue collecting data to provide best information to health care providers about Joyce. 

Joyce was stood upright with assistance from Dusty and Tracy. Tracy inspected Joyce's wounds on buttocks. Wounds are healing well, wound care should continue on as family is currently doing. Family should continue to assist Joyce with toileting hygiene, wound care, barrier cream application and regular inspection of skin that is in contact with diaper or diaper pads to help with prevention or mitigation of recurrence of skin breakdown. Joyce was transitioned to her recliner ~12:17 p.m. once Tracy done inspecting wounds. Tracy supplied updated guidelines about pillow use under Joyce's buttocks to relieve pressure sores - move pillow to alternate side of chair each time Joyce gets up to use the bathroom. Goal should be to have it adjusted to opposite side every 2 hours if possible.

Tracy provided updated guidelines for Joyce's weight monitoring: 3 lb. increase within a day; or 5 lb. gain within a week are warning signs to be watched for and if they occur then family care providers should call Kindred nurse or Dr. Collins' office. Weight monitoring is key in watching for warning signs about water buildup around Joyce's heart.

Tracy reviewed Joyce's reported mouth sores and confirmed it is not Thrush. Tracy suspects it could be from antibiotics that were administered at Aspen park as well, recommending that Dusty have Dr. Collins inspect at tomorrow's appointment.

Tracy took vitals on Joyce @ 12:26 p.m. - temperature 98.1 (normal). BP 117/77.  Joyce has a heart murmur, lungs functioning okay but Joyce noted to not be breathing deeply. Tracy departed ~12:39 p.m.

12:40 p.m. - Scam phone call to farmhouse's landline intercepted by Dusty.

1:25 p.m. - Joyce stated that she was not very hungry but Dusty convinced her to eat. Lunch served (1 hard boiled egg, 1 cup rice pudding, 1/2 banana, V8). 2 Tylenol for pain relief.

2:13 p.m. - Victoria at Moscow Medical called to confirm Joyce's appointment with Dr. Collins tomorrow at 11:20 a.m. Dusty confirmed he would be bringing Joyce into town for it. 

~3:31 p.m. - Carol called Dusty and informed him that Wendy (Dr. Collins' assistant) had been contacted by Carole (Kindred) about Joyce's bowel movements. Wendy apparently unable to reach Dusty.

3:32 p.m. - Dusty called Wendy at Moscow Medical. It was determined that someone at Moscow Medical had entered an incorrect phone number for Dusty's contact information (numbers had been transposed). Wendy submitted update of Dusty's contact information to the front desk staff. Wendy reviewed bowel movement log with Dusty and Wendy confirmed that the Metformin was most likely the reason for Joyce's loose stool bowel movements (given medication and bowel movement documentation Joyce's family has been keeping) and she would recommend to Dr. Collins that that Joyce be switched from "regular" metformin prescription to "extended release" metformin as the former is known to cause diarrhea. Dr. Collins has already departed for the day and would be in tomorrow and Wendy said that she would visit with her and attempt to get the prescription order updated first thing in the day so Dusty could switch metformin medications being administered to Joyce starting tomorrow or Friday. Dusty informed Wendy that Joyce would be into Moscow Medical for her follow-up appointment tomorrow with Dr. Collins. Wendy stated that she would enter in the information and request to that appointment and Dr. Collins will discuss Joyce's bowel movement issues and plan for adapting the medication. Wendy will brief Dr. Collins on information Dusty provided from the log book that has been kept so she is ready for when they arrive to discuss tomorrow.

3:47 p.m. - Dusty called Carol and provided update on information Wendy wanted and plan for discussion with Dr. Collins tomorrow. Confirmed list of durable medical equipment to get Dr. Collins authorization for (new wheel chair), information on skilled nursing care fees from Aspen Park, fees from care providers for at-home care given by Aspen Park social worker, and calls Dusty has been making to UI Employee Assistance Program for elder care.

4 p.m. - Bathroom trip. Urinary incontinence requiring replacement of diaper pad and diaper. Dusty cleaned Joyce's wounds and applied fresh barrier cream. Joyce returned to her recliner ~4:20 p.m. after difficult walk out to kitchen as she self-reported being "very wobbly" and had a high amount of pain with each step. Joyce requested to recline and nap until dinner time.

Dusty departing farmhouse ~4:45 p.m. to head into town to work at his office on campus. Dusty picking up groceries for Joyce using errand envelope funds after he ends his day on campus, returning to farmhouse ~8 a.m. tomorrow morning.

Carol arriving to provide evening care for Joyce ~5:30 p.m.