General Update #177 - October 2, 2020

October 1 (Addendum) 

Dusty departed later from farmhouse than listed in yesterday's post, visited with Connie in driveway as she drove up as he was loading his Jeep. Dusty provided update to Connie and Joyce's visit with Dr. Collins and status on how she was doing overall today, warning she was a little irritable at times (mood swings). 

Northwest Respiratory called Dusty's cellphone while he was visiting with Connie in driveway and confirmed they were able to obtain a replacement basket for Joyce's walker (the original one was discovered to have been bent/warped and would not remain in place for holding portable oxygen bottle). Dusty confirmed order to be placed.

Dusty picked up the extended release metformin from the Moscow Walmart pharmacy for Joyce and confirmed dosage instructions with the pharmacist. No new warnings or issues with this version of metformin given.

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October 2

Dusty arrived at farmhouse ~7:40 a.m. and discovered Joyce in main entry hallway shuffling toward bathroom pulling walker behind her incorrectly. Dusty dropped off his gear and moved to assist Joyce who was struggling with moving into the bathroom. Joyce was assisted into position for lowering herself onto toilet riser. Dusty told Joyce to wait as he moved to get gloves on and Joyce cried out "Help me!" as her knee gave out. Dusty caught Joyce before she fell short of sitting on the toilet riser and helped her get seated. Joyce stated her knee had given out and she wasn't able to keep hold of the sink. Dusty helped adjust Joyce into proper placement on the toilet riser. Joyce passed urine and large Type 5 bowel movement. Dusty assisted her with cleaning herself up, cleaned her wounds and applied fresh barrier cream. Diaper and diaper pad replaced. Joyce was unable to stand unassisted from toilet riser or move under her own power back to her recliner. Dusty moved Joyce to sit on her walker and wheeled her out to the kitchen.

~8:10 a.m. Craig arrived into farmhouse to visit as Dusty finished assisting Joyce transferring onto recliner. Oxygen line put into place.

Vitals taken ~8:18 a.m. Blood pressure 170/83, pulse 84. Blood glucose level at 125. Joyce had removed her oxygen line while Dusty was preparing her breakfast. Dusty informed Joyce that he had been in touch with Linda (and Ken) about a project he and his colleague Ariana were working on for the Latah County Historical Society and Linda had asked about Joyce's condition and transition home. Joyce didn't seem to recognize who Dusty was talking about, thinking he meant Linda and Frank instead of Linda and Ken in conversation. 

Breakfast given to Joyce ~8:20 a.m. (Cream of Wheat, Strawberry Ensure, 1/2 banana). Joyce stated she was not hungry and had to be reminded to continue eating by Dusty as she kept falling asleep. Joyce refused to eat food placed in front of her. Played with Cream of Wheat in its bowl. Morning medication (extended release Metformin, Carvedilol, 2 Tylenol, Multivitamin, Iron, Potassium). Joyce had difficulty in using utensils and motor control of hands was poor. 

~9 a.m. Joyce asked for Cream of Wheat to be put into a mug so she "could drink it." Dusty departed farmhouse for his medical appointment at Moscow Medical ~9:05 a.m., Joyce left to work on her breakfast.

~11:50 a.m. - Dusty returned to farmhouse from doctor's appointment, X-rays at Gritman, and purchasing paper towels and toilet paper from Wal-Mart. Found Joyce sleeping in her recliner, Joyce had not finished her breakfast (did not eat banana, did not eat Cream of Wheat, did not drink Ensure - had dumped ensure bottle and contents of her cup onto her tray and set the tray onto her walker's seat at some point, also did not take her medication). Dusty cleaned up mess on tray, asking why Joyce didn't eat her food or take her pills. Joyce said she had wanted to take a nap and would eat later on when she felt like it. Dusty made Joyce eat her 1/2 banana to give her morning medication something to work with in her stomach.

12:04 p.m. - Joyce roused enough to be taken to bathroom. Traveled to bathroom under her own power though very slowly and with difficulty. Joyce transitioned from standing position to seated position without assistance. Joyce had issue with urinary incontinence requiring diaper pad insert replacement. Urine passed. Dusty cleaned Joyce's wounds and applied fresh barrier cream. Weight 166.8 lbs. Joyce returned to recliner under her own power ~12:16 p.m. Dusty changed her shirt.

Joyce declined lunch when offered at 12:18 p.m. Dusty informed her he would ask her again later. Joyce put on her own compression stockings for the day.

12:26 p.m. - Derik arrived to farmhouse to use the bathroom. Derik visited with Joyce briefly, updating her on his health conditions and President Trump's reported contraction of COVID-19 before departing farmhouse ~12:31 p.m. 

12:45 p.m. - Kindred Hospice contacted Dusty about Joyce. Joyce both does and does not fit criteria for their assistance at this time. Recommendation that Joyce's family contact them when end of life care is needed as Joyce will qualify for it but they would not be able to provide level/timeframe of care for Joyce in current condition. Otherwise their team would be able to come out 1-2/week to provide care services for Joyce. Recommendations provided to Dusty on options for home health providers (most already provided by Dr. Collins). 

1:04 p.m. - Joyce continued to insist she was not hungry at all today and did not want to eat anything. Dusty negotiated and server her lunch (1 hard boiled egg with Mrs. Dash seasoning, 1/2 banana, one 7.5 oz. can sugar free Pepsi). 

Joyce slept hard until ~3:03 p.m. when she woke, complaining of a sore throat. Dusty provided her with a saltwater mouth rinse to see if that improved the pain she was experiencing. Joyce was still disoriented and had difficulty in communicating. Joyce had difficulty in remembering to spit out the salt water rinse and not swallow it. Dusty suspecting she swallowed at least one mouthful.

3:44 p.m. - Joyce reported that the saltwater rinse has improved her mouth/throat. Joyce continued to take off her oxygen line throughout the hour, stating that she does not know why she takes it off when asked. Joyce continued to nap until Dusty was able to rouse her. Joyce began to perk up and become more coherent.

4:15 p.m. - Bathroom trip, Joyce able to travel under her own power but unsteady and experienced pain in walking. Urinary incontinence requiring diaper pad insert change. Remainder of urine passed. Wounds cleaned and fresh barrier cream applied. On walk back to kitchen Dusty asked if Joyce was mad at him as she wasn't speaking with him much today. Joyce insisted she was just "very tired." Joyce talked about Zero (their cockatiel) and stated that she thinks she hears him some days but then realizes its just the house settling or some random click or sound (real or imagined) that she believed was him skittering around on the counter or climbing on the fireplace wall. 

Dusty setup evening medications and dinner tray for use. Dusty departing farmhouse ~4:45 p.m. after getting Joyce settled and listening to her express concerns about her diet plan and medications (she expressed dislike over the inability to eat whatever she wants on a low sodium and low sugar diet). Dusty attempted to ease Joyce's mind by trying to explain keeping a good diet meant keeping her in good health and able to remain at the farm longer. Joyce semi-placated. Carol arriving to cover evening shift ~5:30 p.m. this evening.

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Participant observation: Joyce struggled with energy levels, ability to communicate verbally, and ability to focus today until late afternoon.