General Update #200 - October 29, 2020

October 28, 2020 Addendum

~6:49 p.m. Tracy (Kindred Nurse) called and left a message on Dusty's cell phone to confirm she will be out to check on Joyce tomorrow ~12:30 p.m.

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Dusty arrived ~8 a.m., finding Joyce asleep in her recliner, rolled forward with forehead touching her knees and oxygen line off. Joyce claimed that she had taken herself to the bathroom "earlier, sometime around 7 a.m., maybe." Joyce declined bathroom trip, citing she had gone already and passed a bowel movement but insisted that she had not soiled herself. Dusty investigated and discovered that toilet riser required cleaning. Dusty sanitized toilet riser and sink. Joyce declined trip into shower, expressing emphatic concerns at the suggestion. Dusty calmed Joyce, stating that he will look at her when they go to the bathroom later on in the morning and help her get cleaned up at that time. 

 

8:10 a.m. - Vitals taken. BP 155/84, pulse 77. BGL @ 132. 

Joyce asked for today's newspaper and excitedly exclaimed that because she got it in her hands she now knew what day it was. She asked where Craig was, as she thought he usually reads the paper first and Dusty suggested that Craig is most likely out working in the fields to get his fall chiseling/ploughing done. 

8:24 a.m. - Breakfast (1 slice whole wheat toast with butter, 1/2 banana, 1/2 avocado). 

8:30 a.m. - Dusty called NW Respiratory to confirm updated information about Joyce's wheel chair order should be coming through from Dr. Collins office now that things have been clarified from the October 1, 2020 appointment. 

Craig arrived ~8:50 a.m. to visit and read newspaper. Craig departed ~9:25 a.m.

Joyce given nutritional shake and morning medication (carvedilol, metformin, 2 Tylenol, multivitamin, iron, potassium). 

Joyce expressed unhappiness to Dusty about the conversations/bickering that he and Craig did in her kitchen (over COVID-19). Dusty apologized for upsetting her and let her know that all was well between he and Craig. 

9:30 a.m. - Snack (Rosauers 1/2 maple bar).

10 a.m. - Bathroom trip declined. 

10:22 a.m. - Bathroom trip. Minor urinary incontinence (and fecal staining from earlier morning's solo toileting trip) requiring change of diaper pad insert. Joyce refused shower, Dusty cleaned Joyce up using disposable washcloths. Urine and Type 5 bowel movement passed. Weight 159.7 lbs. PT walk post-toileting to living room, returning to recliner ~10:40 a.m.

10:41 a.m. - Lidocaine patch applied to Joyce's back after she reported that it was aching. Joyce declined Tiger Balm patch for her left knee, stating that it is "not bothering her enough to warrant it at the moment." Joyce napped in her recliner.

12:27 p.m. - Vitals taken. BP 142/78, pulse 89.  BGL @ 126. Joyce informed Dusty that she wanted a slice of toast for lunch with peanut butter and apricot jam. Dusty attempted to negotiate increasing food to be what he had planned to serve but Joyce declined. Joyce accepted the addition of a 1/2 banana to her request for lunch.

12:33 p.m. - Lunch served, then abandoned as Joyce stated that she needed to go to the bathroom.

12:34 p.m. - Bathroom trip without incident. Joyce passed urine and small amount of fecal debris (small particulate) with flatus. PT walk to living room before returning to recliner ~12:52p.m. Joyce unsteady as she walked and had to stop frequently. Joyce expressed concerns about something she "felt on her back." After Joyce was unable to provide description about what she was meaning, Dusty inspected and determined that Joyce was referencing the lidocaine patch.

12:54 p.m. - Attempted to serve Joyce lunch again (1/2 banana, 1 slice whole wheat toast with peanut butter and apricot jam). Joyce declined lunch, stating she was not hungry and directed Dusty to wrap it up for her to eat later. When asked why, as Dusty had brought her what she requested, Joyce stated she was sleepy and did not feel like eating.

12:56 p.m. - Tracy (Kindred Nurse) arrived to check on Joyce. Health log reviewed (weight, blood pressure and blood sugar). Noted bowel incontinence issues (and their absence this week), issues with left leg mobility, increased odors (and efforts to mitigate them using feminine hygiene products), and loss of appetite. Derik arrived to use farmhouse bathroom while Dusty was reviewing Joyce's health information with Tracy. Tracy took Joyce's vitals. Joyce reported no pain in her left knee and no chest pain when asked. Tracy reviewed and confirmed medication and that Joyce is on a 2-litre flow rate for oxygen concentrator. BP 122/77, 93% oxygen level. Tracy checked Joyce's lungs and heart for irregularities. Tracy reviewed plan for care for November with Dusty, Joyce confirmed that she knows she is lucky she is able to have family take care of her now. Tracy confirmed that the family is doing really well with their care of Joyce. Joyce's legs showed signs of swelling. Dusty confirmed that the family care providers have been using compression stockings, getting Joyce to elevate her legs in the recliner, and been taking more walks around the house. Tracy departed ~1:20 p.m. after confirming that she will be in touch with Dusty to schedule next visit for her or Carole to come out and check on Joyce. 

Dusty sterilized all points of contact Tracy had with farmhouse (kitchen sink, entry door handles & handrails, storm door handles and frame, pocket door handle and frame, chair, etc.) after she informed him in passing that her husband was now very sick following exposure to COVID-19 positive case individuals at his place of employment but that her husband was refusing to go get tested. Dusty took precautions and sterilized bathroom as well as Derik had touched surfaces Tracy had contacted (entryway door handles and pocket door) before Dusty could sanitize the doors/surfaces Tracy touched to prevent potential cross-contamination. Dusty could not locate Derik on-site at the farm to inform him he should re-sanitize his hands and so called Craig to get a hold of Derik to let him know Derik should re-sanitize his hands. Craig informed Dusty that Derik was not with him doing fall work today as Derik was ill and could not work. Craig asked if Derik had come into the farmhouse to use the bathroom and if he was wearing a mask. Dusty confirmed that Derik did not appear to be wearing a mask when he came into the farmhouse to use the bathroom. Craig confirmed he will notify Derik. Dusty confirmed that exposure risk should be minimal as Tracy was masked, maintained social distance, and used disposable covers on her equipment. Only time there was potential for transfer was from her vehicle to house was upon initial entry contact with handrails, handles, etc.). 

1:53 p.m. - Bathroom trip without incident. Urine passed. PT walk into living room following toileting, returning to recliner ~2:03 p.m. Joyce resumed napping. 

3:40 p.m. - Joyce declined bathroom trip, stated that she would be able to take herself to the bathroom if she needed to go before Connie arrived to farmhouse.

Dusty departing ~4 p.m. to work on campus at his office and meet with his director. 

Connie will be providing evening care for Joyce.