General Update #181 - October 7, 2020

October 6, 2020 Addendum

Northwest Respiratory called Dusty's cellphone ~4:35 p.m. to notify him that the replacement basket for Joyce's walker had arrived and was ready to be picked up.

Dusty delayed departing farmhouse until ~4:45 p.m., taking out trash, visiting with Connie, and updating Joyce's health log book. 

Jay (Kindred PT) called Dusty's cell phone ~5:10 p.m. and notified him that he would arrive tomorrow ~10:30 a.m. to work with Joyce.

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October 7, 2020

Dusty arrived to farmhouse ~8 a.m. finding Joyce rolled forward in her recliner without her oxygen line in place. Joyce claimed she had just returned to her recliner from taking herself to the bathroom, though she was not sure how long ago that had happened. Joyce directed Dusty to look at her kitchen and all the work that Connie did last night. Connie had set to cleaning the floor and putting away all of Joyce's gardening station supplies.

Craig arrived ~8:10 a.m. to visit.

Vitals taken at 8:26 a.m., blood pressure 160/89, pulse 83. Blood glucose level at 149.

Breakfast served at 8:27 a.m. (1 slice whole wheat toast with butter, 1 hardboiled egg with Mrs. Dash seasoning, 1/2 banana, strawberry Ensure). Morning medication (Carvedilol, Metformin, Multivitamin, Potassium, Iron, 2 Tylenol). Breakfast finished ~9:30 a.m.

Joyce napped in her recliner until Jay (Kindred PT) arrived ~10:27 a.m. to work with her. Jay asked about Joyce's left leg pain and she reported that she thinks she is feeling better. Joyce informed Jay she was getting lots of sleep and that has probably helped. Confirmed no falls when asked. Joyce reported no pain in her body today so far. Vitals taken - temperature 98.8 degrees, blood pressure 139/82, pulse 82. 

Jay took Joyce for a PT walk to living room and back. Dusty pointed out Joyce's right foot/ankle to Jay, letting him know that it has been "rolling" and Joyce has been walking on its side since at least Monday evening that he noticed. Dusty also alerted Jay to Joyce having difficulty with motor skills with ankle when she attempts to lift and maneuver it for placement into her diapers or skirt. Jay inspected and confirmed that Joyce is rolling her right ankle when she walks. Jay suggested that an ankle brace may be needed for Joyce when she walks (and possibly shoes or slippers with more support). Joyce reported pain in her ankle area when Jay touches it. Joyce said that she could live it with and Jay informed Joyce that they did not want her to live with it but to get better. Joyce yelped with pain at one point while Jay was inspecting her ankle and stated "that felt like you were going to break it off!" This gave them both a good chuckle. Impaired range of motion in Joyce's right ankle noted. Jay provided ankle exercises to Dusty for Joyce to perform at anytime ("work the gas pedal" and "circle drawing/around the world" motions) when seated to help improve and maintain Joyce's range of motion in her right ankle.

Joyce taken for a short walk into kitchen to the main sink by Jay to observe her walking once more before transitioning to performing more lower leg exercises from a standing position (Joyce holding onto sink basin). Right leg gave her more trouble than the left leg. Joyce's stamina gave out fairly quickly and Joyce stopped the exercises. Jay returned her to her recliner. 

Jay departed ~11 a.m. after Joyce stated that she felt too exhausted to continue on with PT for the day. Jay let Joyce know she is off the hook for working with him for the remainder of this week and that he will coordinate with Dusty when he comes out next week.

Dusty asked Joyce if she needed to get up and use the bathroom at Noon and Joyce declined. Dusty asked again and she declined at 12:15 p.m. so Dusty began making her lunch. Joyce got up from her recliner and moved to take herself to the bathroom at ~12:20 p.m. while Dusty's hands were dirty with meal prep and headed down the hallway. Dusty caught up as Joyce was preparing herself to sit on the toilet riser. Urinary incontinence requiring diaper pad insert change. Joyce's earlier trip to the bathroom before Dusty's arrival showed she had wet her diaper and skirt so Dusty replaced diaper, diaper pad insert, and skirt. Urine passed. Joyce's wounds were cleaned and Joyce returned to her recliner ~1 p.m.

Vitals taken at 1:02 p.m., blood pressure at139/66, pulse 91. 

1:05 p.m. Lunch served to Joyce (6 meatballs, yellow squash medallions, and softened diced onion, and iced tea). Joyce exclaimed she needed to use the bathroom as Dusty placed the tray in her lap and proceeded to soil herself in her recliner (Type 6 bowel movement). Lunch paused as Dusty moved to assist Joyce with traveling to the bathroom. As Dusty was removing Joyce's diaper Joyce stated she could not stand any longer. Dusty told Joyce he was almost done removing her soiled diaper and he just needed a few more seconds to cut it away from her body when she defecated on his arm, floor, and toilet riser (Type 6 bowel movement). Joyce unhappy with herself and Dusty worked on cheering her up while cleaning up the mess. Joyce stated she was unable to articulate "feeling" if she needs to have a bowel movement or not and is uncertain if her stomach feels upset or not as she states "it just happens and sometimes I don't know it is happening." Dusty assured her that was part of the dementia and not her fault. Joyce cleaned up after passing remainder of Type 6 bowel movement. Joyce initially refused quite adamantly but eventually consented to be showered. Joyce became panicked post-shower when being helped move to walker and Dusty placed her LifeAlert monitor around her neck, stating she was missing her "second necklace." Dusty asked Joyce to explain what other necklace she felt she was missing. Joyce continued to panic as she looked around for it in the sink, her clothes, in the toilet bowl, and in the baskets containing her diaper and diaper pads before finally announcing that it does not matter and started shuffling out into the hallway. Joyce returned to her recliner by 2:30 p.m. after being changed into fresh clothes.

2:34 p.m. - Lunch reheated and served to Joyce. 2 Tylenol for pain relief. Dusty washed dishes and set Joyce's laundry to run. When Dusty returned to the room, Joyce fought having her oxygen line put back into place after combing her hair. Joyce then transitioned to trying to locate her "second necklace" again, stating that she didn't know what it looked like and that she could not describe it, but that it looked like the LifeAlert necklace she was wearing "but was different." Joyce became irritated at Dusty when he attempted to help her look for it and informed her that he thought she only had the one LifeAlert necklace. Dusty attempted to redirect Joyce to eating her lunch which proved successful. Dusty took out the bathroom trash. 

Derik arrived ~2:50 p.m. to use the farmhouse bathroom, departing after use.

2:59 p.m. - Joyce stated meatballs were too difficult for her to eat. Dusty prepared a microwave meal for her instead (Salisbury steak with mashed potatoes). Joyce finished picking at her lunch ~3:40 p.m.

Bathroom trip ~3:50 p.m., urine passed, wounds cleaned. Joyce returned to recliner, requesting to nap until Carol arrives ~5:30 p.m. to provide evening care. 

Dusty departing farmhouse ~4:15 p.m. to work at his office on campus. 

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