General Update #282 - Tuesday, January 19, 2021 (Updated)

8:07 a.m. - Craig arrived to farmhouse. Joyce reported that she had just sat down on her recliner after taking herself to the bathroom on her own. 

8:08 a.m. - Jess arrived to farmhouse, finding Craig on-site. Craig reported that Joyce reported she had a good night.

8:15 a.m. - While Jess was talking with Joyce about what to have for breakfast Joyce said that "it depended on what everyone else wanted." When Jess asked who else Joyce was referring to, Joyce said "all the others." Jess reminded Joyce that it was just the two of them (Jess and Joyce) as Craig already had his oatmeal. Joyce said "oh" and dropped it - Joyce may possibly be hallucinating again?

8:30 a.m. - Joyce was rocking forward and backward in her recliner every minute or so while Jess was preparing breakfast (usually a sign that Joyce has to go to the bathroom). Jess took Joyce to the bathroom - Joyce had removed her diaper pad insert at some point but did not replace it. Joyce was dry. Urine and type 5 bowel movement passed. Joyce struggled to pass her bowel movement - Jess suspecting that the "struggle" was because it did not just "fall out" as her diarrhea does. Hemorrhoidal cream applied. Joyce had to be wheeled back out to kitchen (~9:30 a.m.).

9:33 a.m. - BP 192/119, pulse 82. BGL @ 152.

9:35 a.m. - Jess transitioned Joyce from sitting on her walker to the recliner. Joyce reporting that her left knee was hurting.

9:45 a.m. - Morning medication with nutritional shake.

9:50 a.m. - Breakfast (4 small pancakes and a banana). Breakfast finished by 10:20 a.m.

Joyce had changed her clothes at some point last night.

1:15 p.m. - Dusty arrived to farmhouse, found Joyce asleep without oxygen line in place. Joyce had apparently changed her clothes again, having rolled up her long sleeve shirt and short sleeve shirt and stacked them onto her walker. Joyce was now wearing a purple long sleeve shirt. Joyce claimed she changed her clothing because her tops did not match her skirt. 

1:25 p.m. - BP 158/88, pulse 69. BGL @ 222.

1:42 p.m. - Bathroom trip - Joyce able to walk to/from bathroom under her own power using walker. Urinary incontinence. Early bladder release. Diaper and diaper pad insert replaced. Remainder of urine passed. Joyce had severe confusion. Evidence that Joyce had bowel movement at some point after Jess left but before Dusty arrived to farmhouse. Toilet seat riser, bathroom floor, and bathroom sink were sanitized. Joyce unable to be showered as Carole from Kindred stated she would arrive to the farmhouse between 1:30 p.m. and 2 p.m. Dusty informed Joyce he would shower her after Carole's visit with her - Joyce became distressed.

Weight 155.2 lbs. 

Returned to recliner by 1:55 p.m., snack refused.

2:07 p.m. - Carole (Kindred) arrived for weekly checkup on Joyce. 

Vitals collected. Oxygen levels at 97% (with oxygen line in place), pulse 78. No fever (temperature at 98 degrees Fahrenheit). 

BP 130/80 - compared to Dusty's 1:25 p.m. reading. Last week's BP readings reviewed from health log. Carole inquired about what kind of device was being used to capture the data, Dusty provided the wrist cuff blood pressure unit for review. Carole stated that the at-home wrist units tend to run higher than upper arm blood pressure cuffs used by medical professionals. Dusty and Carole did a quick calibration test to check the variance between the two units they had on-hand. Carole's kit reported Joyce at 138/80, the wrist cuff unit reported Joyce at 142/73 - Carole deemed the wrist cuff as being very close to accurate. 

Carole checked Joyce with stethoscope - breathing and lung functions sounded fine (lungs clear), heart sounded fine, stomach/bowels sounded fine. 

Joyce's legs were checked and noted to be noticeably less swollen.

Bowel and bladder output log reviewed - confirmed Joyce is struggling with urinary and bowel incontinence again.

Confirmed that no UTI was found from urine sample collected by Dusty and taken to Gritman for processing.

Joyce reported no dizziness, no headaches, and no neck pain when asked.

Medication list reviewed and updated (Nabumetone confirmed as ceased, was still listed as being taken). Confirmed daily supplements. Carole asked why Joyce was not using Tramadol - Dusty reviewed log and directives from Aspen Park and Dr. Collins finding that there were directives from Aspen Park that it should be ceased if possible soon after Joyce's return home on September 11 (which was done). Dr. Collins did not prescribe or reinstate Tramadol for use but it was reviewed as a medication that Joyce took while under Gritman and Aspen Park's care and was in the Moscow Medical logs. 15 doses remaining from what Aspen Park sent home with Joyce on September 11. Family recommended to provide remaining doses per instructions to Joyce to see if that alleviates her left knee pain. Carole will contact Dr. Collins at Moscow Medical to notify the Tramadol is being used again to attempt to mitigate Joyce's daily pain now that she is off Nabumetone and no replacement was provided by Moscow Medical. Carole will follow up with family care providers next week when she comes to check in on Joyce to see if the Tramadol has helped Joyce with her pain and mobility issues. Carole confirmed that Tramadol is safe for taking with Tylenol. Carol asked if Joyce takes Advil daily and Dusty confirmed that is not in her daily medications.

Carole departed by ~2:30 p.m.

Joyce declined shower with hostility. Joyce declined lunch, negotiations began.

2:34 p.m. - Lunch (bologna sandwich with mayo and mustard, 1/2 can sliced peaches). 2 Tylenol. Joyce ate very slowly citing fatigue and concerns that Dusty would put her in the shower. Lunch finished by 3:31 p.m.

3:38 p.m. - Bathroom trip to/from recliner under her own power using walker. Urinary incontinence. Diaper and diaper pad insert replaced. Remainder of urine passed. Shower declined. Returned to recliner by 3:50 p.m.

Dusty departed farmhouse ~4:10 p.m.

4:30 p.m. - Connie arrived to provide evening care for Joyce, visiting about haircut and Joyce's weekend until Joyce fell asleep.

5:15 p.m. - Enrichment activity (coloring) until Joyce fell asleep.

5:45 p.m. - Bathroom trip without incident. Joyce fell asleep on toilet. Joyce returned to recliner under her own power.

6:10 p.m. - Joyce wanted to color again upon returning to recliner but resumed napping.

6:40 p.m. - Dinner (KFC mashed potato bowl without corn). Joyce kept falling asleep while attempting to eat. Dinner ended at 7:05 p.m. when Connie took away Joyce's tray as Joyce was asleep. 

7:10 p.m. - Evening medication.

8:15 p.m. - Joyce stretched out into recliner with feet elevated. 

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Dusty has added Tramadol back into Joyce's medication routine per conversation with Carole (Kindred nurse). 1 Tramadol pill with each meal already added to cups for dinner time this evening and into tomorrow's pill administration schedule.

Joyce extremely odorous, Dusty will attempt to shower her tomorrow on his lunch break if Jess cannot make that happen during her morning shift. Joyce extremely petulant about the idea of showering.