General Update #266 - Monday, January 4, 2021 (Updated)

8:19 a.m. - Jess arrived to farmhouse to provide morning care for Joyce. Joyce found awake with oxygen line in place. Joyce had taken herself to the bathroom recently.

8:20 a.m. - BP 156/101, pulse 81. BGL @ 152.

8:45 a.m. - Morning medication taken with nutritional shake.

8:50 a.m. - Breakfast (1 slice egg in toast with syrup). Breakfast finished by 9:05 a.m.

Joyce reported to be "1000 yard staring" but enjoyed her breakfast.

10:12 a.m. - Joyce slept most of the time Jess was at farmhouse following breakfast, declined bathroom trips.

~Noon - Andrew (Kindred nurse) arrived to check Joyce, no family care provider present for visit.

1:18 p.m. - Dusty arrived to farmhouse, finding Joyce asleep in her recliner without oxygen line in place. Joyce had taken herself into bathroom and passed a Type 1 bowel movement - large mess left in bathroom (toilet seat riser, toilet handle, sink, floor) and in hallway where Joyce had tracked portions of fecal matter). Evidence that Joyce had extreme difficulty in cleaning herself. Hemorrhoids an issue as there was quite a bit of blood. Bathroom and hallway sanitized. Joyce's shoes sanitized. Joyce's hands cleaned.

Joyce unable to communicate during entirety of Dusty's shift. Joyce had difficulty comprehending sentences or directions, unable to form words or sentences of her own, did not know who Dusty was at all. Joyce could not comprehend/follow directions to stand up from her recliner to be assisted with post-toileting cleanup (several attempts made by Dusty). 

1:37 p.m. - Lunch (bologna sandwich, whole banana, small Pepsi Zero, tall glass of water with Miralax mixed in). 2 Tylenol. 

Craig arrived to visit and check on Joyce ~2:30 p.m. Craig worked on getting Joyce to finish her lunch while Dusty was in living room on video call with his director. Joyce did not know who Craig was when asked by Dusty to identify him. Craig departed by 2:43 p.m. 

Lunch finished by 2:50 p.m. after frequent stops to sit and stare into space in a non-responsive manner or fall asleep while eating.

3 p.m. - Joyce declined bathroom trip, began napping. 

Dishwasher loaded and run. Trash taken out of farmhouse.

3:25 p.m. - Joyce declined bathroom trip, citing desire to continue sleeping. Joyce moved into prone position in recliner and settled for sleep.

3:30 p.m. - Dusty departed farmhouse to return to campus office.

3:35 p.m. - Moscow Medical attempted to call Dusty's cellphone but he did not answer as he was driving back to Moscow. Message left to call them back about Joyce's blood pressure readings and a new prescription being written for Joyce to (re)start using losartan.

3:56 p.m. - Dusty returned Moscow Medical's phone call upon reaching his office, spoke with Dr. Collins' nurse Wendy. Kindred nurse visitation data was received and medical log book indicates that Joyce's blood pressure has been running high since being removed from Metformin. Joyce's blood pressure was high during last visit to Dr. Collins' office as well. Dr. Collins putting Joyce onto Losartan (Joyce took this previously, pharmacist will review potential side effects to be aware of with Dusty when he picks it up). Dusty to go to Walmart pharmacy to pickup this evening when he picks up additional supplies for farmhouse inventory. The plan is to begin administering the losartan to Joyce once per day - it will not have instantaneous effects and will gradually bring down her blood pressure. Wendy commented that it worked well for Joyce in the past when previously used. Dusty also visited with Wendy about Joyce's mobility issues and mental deterioration since Sunday night since he had her on the phone and was going to call her when he returned to Moscow. Wendy is putting in request with Dr. Collins for Kindred to collect urine sample from Joyce and have her tested for urinary tract infection. Wendy will visit with Dr. Collins and call Dusty back later tonight or tomorrow morning to confirm plan for urine sample collection - if Kindred cannot get it collected then Dusty will make plans to bring Joyce into Moscow Medical. Wendy suspects Joyce's mental deterioration from Sunday night to present may be due to a new urinary tract infection occurring. 

4:32 p.m. - Dr. Collins' nurse, Wendy, called Dusty's cellphone to confirm that Kindred will collect the urine sample from Joyce (either tonight or tomorrow). Dusty should expect the Kindred team to be in touch about scheduling. Kindred will process the urine culture after collection and send on the results to Dr. Collins for review and a plan to treat any UTI will be enacted at that time. 

5:45 p.m. - Losartan picked up from pharmacy for Joyce. Will send out with Jess to add to morning medication dosage for Joyce tomorrow.

6:30 p.m. - Dinner (chicken noodle soup, crackers, baby bell cheese roll). Evening medication.

9:45 p.m. - 10:30 p.m. - Joyce could not get up from the toilet without assistance, Craig wheeled her from bathroom to her recliner.

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Medication name updated - "losartan" was prescribed by Dr. Collins, not "lovastatin." Medication is used to treat high blood pressure, protect kidney function in diabetic patients, and to lower the chance of stroke in people with high blood pressure and some certain heart problems.

Dusty discovered that Andrew (Kindred nurse) had arrived to farmhouse around noon after failing to connect with Dusty to schedule visitation after attempting to call Dusty earlier in the morning. Andrew contacted Moscow Medical about Joyce's high blood pressure. Dusty was unaware that Andrew had been by to see Joyce. Andrew collected urine sample for Joyce during his visit and dropped it off to culture. Wendy and Dr. Collins apparently unaware that a urine sample had been collected at this time for processing when they called Dusty ~4:32 p.m.

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