General Update #283 - Wednesday, January 20, 2021

8:05 a.m. - Jess arrived to farmhouse. Joyce asleep in recliner with oxygen line in place.

8:06 a.m. - BP 150/83, pulse 75. BGL @ 142.

8:30 a.m. - Morning medication with nutritional shake.

8:35 a.m. - Breakfast (Egg in toast with banana). 

8:53 a.m. - Breakfast stopped for bathroom trip, Joyce expressing urgency. Joyce had difficulty standing - left knee not wanting to function. Jess used wheel chair to move Joyce to bathroom. Urinary incontinence (Joyce did not have a diaper pad insert in her diaper). New skirt. Joyce returned to recliner by 9:13 a.m.

9:33 a.m. - Breakfast finished.

9:55 a.m. - Bathroom trip. Joyce wheeled into bathroom on wheel chair. Jess noticed a discoloration on the lower front panel of the diaper leg - Joyce appears to have scratch marks over her right leg on her tummy in the crease where the skin folds over. Urine and type 6 bowel movement passed. Joyce reported that her buttocks was hurting and asked Jess to check for pressure sores. Hemorrhoidal cream and barrier cream applied. 

10:18 a.m. - Wendy (Dr. Collins' nurse at Moscow Medical) called Dusty's cell phone and left a message as Dusty was in a meeting at work. Wendy wanted to confirm that Carole (Kindred) had contacted Moscow Medical to confirm that the family care providers have started giving Joyce her remaining Tramadol doses to help mitigate pain. Wendy just wanted to check in and see if the Tramadol has aided Joyce's pain mitigation at all or if other options needed to be explored.

Joyce returned to recliner by 10:35 a.m.

10:40 a.m. - Joyce stretched out to nap in recliner.

12:20 p.m. - Dusty arrived to farmhouse, finding Joyce hunched forward and asleep in recliner with oxygen line in place. 

12:25 p.m. - BP 126/76, pulse 65. BGL @ 157. 

Joyce became irritated at the suggestion she trim her finger nails - refused to clean/trim finger nails. Dusty will try again tomorrow. Joyce could not articulate why she was so against the idea. 

Joyce claimed that she was very hungry as she had not been fed breakfast or eaten anything all day. Lamented that she had been left alone in the farmhouse with no one checking in on her at all. Dusty reminded Joyce that Jess had been out, spending the morning with her and feeding her breakfast. Joyce recalled none of it and then stated that she was not hungry and did not want to eat lunch. Lunch negotiations began.

12:35 p.m. - Lunch (bologna sandwich with mayo and mustard, 1 cup diced peaches, V8 juice). Tramadol and 2 Tylenol for pain relief. When food was delivered, Joyce got very excited and animated - thanked Dusty for giving her food because she thought that she had been told she was not going to get lunch today and in the next sentence stated that she had not wanted lunch. Dusty clarified that Joyce would be eating lunch and she began eating with enthusiasm. Joyce very suspicious of her medication cup, repeatedly asking Dusty "What did they put in this?" and "What is this stuff for?" and "Do I really need to take these?"

Joyce's enthusiasm switched to lethargy and distractedness as she ate half of her sandwich. Joyce began becoming distracted and staring off into space or falling asleep while eating, requiring Dusty to keep her focused or continually wake her up. Joyce finished lunch by 1:45 p.m.

Joyce declined bathroom trip when asked, Dusty pressed the issue. Joyce became irritated. Joyce informed Dusty that she "can take herself to the bathroom and does not need people to help her so [you] can just leave." Dusty reviewed the reasons she has family caregivers on site with Joyce and cited her inability to clean herself or clean up after herself with consistency. 

1:50 p.m. - Bathroom trip - Joyce able to walk to/from under her own power very slowly. Urinary incontinence. Diaper pad insert replaced. Remainder of urine passed. Joyce returned to recliner by 2 p.m. Joyce experienced some confusion in the bathroom, moving through her post toileting steps out of order (washing hands immediately after standing up from toilet without wiping, allowing buttockst to be cleaned by Dusty or have hemorrhoidal/barrier cream to be applied, didn't pull diaper up or skirt down). Hemorrhoidal cream applied. Joyce returned to recliner under her own power by 2 p.m. and stretched out to nap.

Dusty departed farmhouse ~2:10 p.m.

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