General Update #290 - Wednesday, January 27, 2021 (Updated)

7:45 a.m. - Craig arrived to farmhouse to cover Jess' morning shift as she was getting her teeth repaired at the dentist. Joyce informed Craig that she had already been to the bathroom.

8:48 a.m. - BP 146/77, pulse 78.

9 a.m. - Morning medication administered. Bathroom trip.

9:30 a.m. - Breakfast (banana, 1 piece of toast with jam, baby bell cheese wheel). Joyce informed Craig she was not particularly hungry.

11:02 a.m. - Joyce was returning from using the bathroom as Craig re-entered the farmhouse. Joyce informed Craig that she had a bowel movement.

11:25 a.m. - Dusty arrived to farmhouse. Found Joyce in her recliner, awake, without oxygen line in place struggling with the television remote - she had loaded some sort of Spanish dubbed video onto the television and was frustrated she could not get it to stop or change back to Netflix. House smelled of bowel movement. Evidence of type 6 bowel movement in bathroom - floor, toilet seat riser, sink were sanitized. Evidence found Joyce had soiled herself.

Joyce refused to be showered.

11:40 a.m. - BP 135/75, pulse 75. BGL @ 129.

Joyce refused shower, refused lunch, refused bathroom trip. 
Joyce asked Dusty for paperwork from a doctor that says she needs to be showered regularly. 
Joyce wanted to know who was telling Dusty that she was soiling herself, who was telling Dusty that she needed to be showered, and who she needed to talk to about being able to "get a note" to be excused from having to go through showering. Dusty reviewed the need for proper hygiene. Joyce has not been cleaning her hands well - Dusty assisted Joyce with cleaning fecal matter out from under her fingernails. Joyce refused to allow Dusty to trim her fingernails. Dusty will attempt again tomorrow, bringing his larger clippers from home.

1:11 p.m. - Bathroom trip. Urinary incontinence, early bladder release. Remainder of urine passed along with high volume of flatus. Joyce verbally protested being showered, attempted to negotiate out of it occurring today. Joyce asked again for "the directive" that tells Dusty she has to be showered regularly. Joyce also spent time attempting to form thoughts to words (unsuccessfully) trying to articulate questions about the showering. Dusty unsure if Joyce was having dementia moment or just stalling as long as she could to remain seated on the toilet. Joyce was eventually showered after Dusty forced her to stand up off the toilet and helped scrape off fecal matter which had not been previously cleaned off of her buttocks, thighs and hip areas when she self-cleaned. 

Weight 154.4 lbs.

PT walk to living room following shower. Joyce asked to know "if your rooms are cold in this facility" to Dusty. Joyce asked if she was "going the right way" while heading down the main hall as she "wasn't sure of her way around this place yet." 

2:18 p.m. - Lunch (cheesy chicken & broccoli casserole with riced cauliflower, dinner roll, apple cranberry juice). Tramadol and 2 Tylenol. 

Joyce suspicious of the apple cranberry juice. She wanted to know what had been mixed into it (she saw the bubbles and thought that powdered medication had been mixed into it). Joyce suspicious of the Tramadol and Tylenol pills, attempting to set them aside twice. Dusty made Joyce take them in front of him after she became concerned and said that she had already taken her medication for the day. Dusty confirmed that she had only taken what Craig had given her with breakfast and reminded her she has medications with all of her meals. Joyce became placated and started working on eating, falling asleep or staring off into space for long period of time.

Joyce picked her way through the casserole, removing larger portions of broccoli. Joyce informed Dusty that "the staff must have wanted her to choke to death" when Dusty asked why she was removing the small broccoli that was Joyce-sized from her food with her fingers and fork. This transitioned to Joyce directing concerns over people wanting her to choke to death on food she cannot eat toward Dusty. Joyce did not care for the suggested alternative of moving to a liquid or all soft food diet. Joyce removed about 1/2 of her casserole before mixing it back together and sorting through it again. Dusty attempted to get her to focus on eating but she declined, continuing to play with her food and eat slowly.

Dusty left Joyce still working at eating her lunch at 3:15 p.m. (no further progress has been made but she refused to relinquish her tray when Dusty attempted to remove it - uncertain of how much she will have actually eaten when she "finishes"). 

5:38 p.m. - Joyce went to bathroom. Was quite confused.

6:15 p.m. - Dinner (fish fillets, sweet potato fries, green beans). Evening medication.

8 p.m. - Bathroom trip without incident.

8:15 p.m. - Bed time.
 
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Joyce having difficulty communicating coherently today while Dusty was present, often starting an attempt to talk about something only to fizzle out after two or three words then stare off into space or she would back up and say "never mind, this is a dream" or some other dismissive statement. 

Joyce was very concerned with needing a directive or note from a medical professional about having to shower today for approximately 30 minutes.

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