General Update #187 - October 15, 2020

October 14 Addendum

Dusty picked up supplies for farmhouse (2 boxes of XL disposable gloves, 2 packages of diaper pad inserts, 1 package of diapers, bread, saltine crackers, laundry detergent, dishwasher detergent, paper towels). 

Dusty received notice via email that his test results showed negative for COVID-19. 

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October 15, 2020

Dusty arrived to farmhouse ~8:10 a.m. after traveling to UI campus to unlock his department's training room for use. Craig on-site and assisted Dusty with carrying in supplies purchased yesterday. Joyce was found to have just traveled to the bathroom and seated herself on toilet riser. Joyce had urinary incontinence issue requiring removal of diaper and diaper pad insert, appearing to have released her bladder as well as she sat onto the toilet riser. Joyce was in midst of removing her diaper when Dusty arrived to assist. Joyce passed remainder of urine and small Type 5 bowel movement. Joyce returned to her chair ~8:35 a.m., difficulty in walking back under her own power (said "ouch" with nearly ever step).

9:05 a.m. Vitals taken after Dusty setup his work station and finished packing away the supplies he'd acquired and Joyce had time to level out after walking. BP 132/74, pulse 85. Blood glucose level @ 133.

9:07 a.m. -Nutritional shake and morning medication (Carvedilol, Metformin, 2 Tylenol, potassium, iron, multivitamin). 

9:14 a.m. - Breakfast (1 slice whole wheat toast with butter, 1 hard boiled egg with Mrs. Dash seasoning, 1/2 banana). Breakfast finished ~9:38 a.m. Joyce requested to nap, Dusty assisted her with getting stretched out.

10:45 a.m. - Craig returned to change clothes, preparing for departure to see Christy in Idaho Falls.

~11:04 a.m. - Carol arrived to check in on Joyce and provide update on last night's care before departing with Craig to catch their flight. Joyce had difficulty in moving under her own power last night. Dusty confirmed he will bring up the mobility issues with Marshall (Kindred PT assessor) when he arrives to farmhouse today. 

11:21 a.m. - Joyce complained about her back itching. Dusty removed lidocaine patch that had been applied from yesterday. Joyce stated that it felt like he had removed the skin in peeling it off. Dusty used the waterless soap to help alleviate the itching Joyce stated she was still experiencing. 

11:45 a.m. - Marshall (Kindred PT) arrived to farmhouse to do the re-assessment on Joyce, apologizing for running behind schedule. Joyce reported stiffness being experienced, but no pain, when asked. Confirmed 2 liter oxygen flow rate. Joyce told Marshall she had a complaint about last night (being unable to walk), Dusty reviewed occurrence rates of left leg going non-functional with Marshall. Vitals on Joyce checked - BP 130/80, pulse 81. Oxygen levels at 96%. Joyce reported no difficulty in being able to breathe when asked. Dusty confirmed that no known falls have occurred for Joyce since she returned home. Slight swelling noted in her left knee with some tenderness, Marshall thinking that it is most likely due to arthritis advancement and recommends family caregivers continue on with treating it as such, if pain continues on then bring up again with Dr. Collins at next appointment with her for review. Marshall worked through lower extremity PT exercises for functionality with Joyce (extensions, repetitive motion, etc.), moderate pain reported during and at conclusion of exercises. Left leg pain reported to have the most pain in her knee (as opposed to ankle or hip). Marshall reviewed Jay's posted reports and Joyce reported she likes working with him when asked. Marshall continued with PT workout for Joyce's neck, spine, and arms. A timed stand up/sit down exercise conducted (stand up, short-distance walk, sit down) while Marshall observed and handled her oxygen line, followed by Marshall inspecting her left leg. Joyce put through standing and balance exercises using walker with brakes engaged for support (Marshall had to repeat himself as Joyce had difficulty mentally comprehending his directions) - marching in place, toe raises, free standing without holding onto walker, free standing with eyes closed, lateral hip shifting. Joyce expressed she was experiencing fatigue, Marshall managed to get Joyce to take one brief walk to the green recliner in the living room, turn on the spot, and then return to her powered recliner. Marshall asked if Joyce felt that she was making progress with PT work. Joyce stated she did not know, looking to Dusty to answer the question. Dusty confirmed her activity level/stamina Marshall experienced today is about the average she can do with Jay. Dusty confirmed that Joyce cannot/will not do PT or OT exercises per the pattern that was set by Kindred due to her stamina and so is not making good progress outside of Kindred visits. 

Marshall recommends leg exercises should be continued with Joyce daily while she is in the recliner. Joyce is walking good, but is just slow. Joyce noted to be unstable in walking and that Joyce is failing to set the walker's brakes when making transitions away from it. Marshall informed Joyce that she needs to work with her caregivers daily on her PT exercises. Joyce told Marshall that he needs to ask her caregiver (Dusty) to work with her more, but that he is pretty good at helping her. Marshall said that the goal is to prevent decline in mobility and current baseline functions in Joyce with the PT and OT work. Marshall confirmed that starting next week Jay's visits have been scheduled to be reduced down to 1/week per the discharge plan and directives from Dr. Collins' office from August. Dusty confirmed that would most likely be fine as Joyce has been unable/unwilling to perform the PT exercises fully when not with Jay. Marshall departed ~12:20 p.m.

12:21 p.m. - Daniel (Lincare) arrived to service Joyce's oxygen concentrator. Dusty's cell phone added to Joyce's account for scheduling next appointment in 2 weeks. Oxygen concentrator operating within specified parameters for its current operating life run time.

~12:27 p.m. - Bathroom trip. Urinary incontinence requiring diaper replacement. Joyce released her bladder as she moved to sit onto toilet riser. Floor and toilet riser cleaned and Joyce's diaper replaced. Joyce returned to recliner ~12:48 p.m.

12:50 p.m. - Scam phone call intercepted to farmhouse landline by Dusty. Caller asked for Joyce but refused to identify themselves.

1 p.m. - BGL @ 128. Lunch (Stir fry rice, 1 cup pistachio crème salad). 2 Tylenol. Dusty noticed that Joyce had proceeded to stir the fried rice around in its bowl with her fork and spoon and asked Joyce why she was not eating. Joyce informed Dusty she was not going to eat the stir fry rice because "[she] hates rice!" Dusty reminded her that she used to eat rice all the time when he was growing up and asked her to eat it because it was warm and would be good for her stomach. Joyce stated that she did not want to eat it, pulling her walker close to her and placing her tray onto it before pushing it away. Dusty asked if she was not feeling well and Joyce said that she felt fine, she just did not want to eat rice. Joyce became irritated with Dusty as he attempted to offer alternative food and negotiations temporarily failed. Joyce consented to eat the pistachio crème salad ~1:17 p.m. 

~1:40 p.m. Joyce asked Dusty why "the nurse" kept giving her food she did not like eating at this place. Dusty reminded Joyce she was at the farmhouse and it was him who had tried to give her lunch today. They talked through her confusion and eventually Joyce recalled it was Dusty who had attempted to give her lunch and she confirmed she knew she was at the farmhouse. Joyce's feelings had to be talked through as Joyce became disheartened that she felt she was a burden, causing trouble by refusing to eating. Dusty confirmed Joyce is not a burden and he was not upset with her just scared about what a decline in appetite could signal. 

2 p.m. - Joyce woken, declined bathroom trip, returned to napping.

3 p.m. - Joyce woken, declined bathroom trip, returned to napping.

3:50 p.m. - Joyce woke from sleeping on her own and wished Dusty a "good morning." Dusty informed Joyce that it was the afternoon and she processed that, taking it well once she stared at the clock across from her for a few moments. Joyce concerned about what was going on in her kitchen (Dusty was unloading the dishwasher and staging sanitized jars for canning grape juice). Dusty asked if Joyce felt like traveling to the bathroom and she consented "once she woke up enough."

4 p.m. - Bathroom trip. Urinary incontinence requiring change of diaper. Urine passed. Joyce returned to recliner ~4:17 p.m. after stopping to apply hair spray to her head, comb her hair, then wish Dusty a "good morning" as she noticed him waiting for her out in the hallway by the bathroom doorframe. 

Dusty departing ~4:45 p.m. after setting next load of canning jars to sanitize in the dishwasher and storing cleaned stockpile of jars into family room. Joyce stretched out to nap in her recliner until Connie arrives to provide evening care for Joyce. Dusty returning to farmhouse tomorrow morning ~8 a.m.

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Joyce continued to removed her oxygen line (accidentally and on purpose) throughout the day.

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