General Update #303 - Tuesday, February 9, 2021

8:13 a.m. - Jess arrived to farmhouse, finding Joyce awake and happy to chat. Craig already on-site and using telephone. Craig informed Jess that he had only been on-site 10 minutes prior to her arrival - Joyce had been awake in her recliner with her oxygen line in place when he arrived.

8:15 a.m. - BP 153/76, pulse 73. BGL @ 146.

8:25 a.m. - Bathroom trip. Urinary incontinence, early bladder release. Remainder of urine passed. New diaper and pad. Toilet seat riser and bathroom floor sanitized. Returned to recliner by 8:38 a.m.

8:50 a.m. - Morning medication with nutritional shake.

9 a.m. - Breakfast (microwaved egg sandwich and banana). Breakfast finished by 9:55 a.m. Joyce had to force herself to finish eating all of her banana.

12:30 p.m. - Dusty attempted to pickup refilled Tramadol prescription he called in on Sunday. Refill was declined. Dusty called Moscow Medical when pharmacist informed him that they could not refill without doctor's consent due to classification of the drug and a no refill order tag attached to prescription.

12:54 p.m. - Evidence Joyce had taken herself to the bathroom to have a bowel movement (type 1-2) sometime after Jess departed farmhouse at 10 a.m. and prior to Dusty's arrival. Mess cleaned up, bathroom sanitized.

12:56 p.m. - BP 148/80, pulse 69. BGL @ 172. 

Bathroom trip declined, lunch declined. Had difficulty keeping Joyce awake.

1:30 p.m. - Lunch (mac & cheese, steamed green beans, cranberry juice, 1/2 can peaches). 2 Tylenol.

Joyce continued to insist that she is not hungry. Joyce complained about not having any teeth - became confused where her teeth had gone and why she had no teeth. Dusty explained her lifetime of poor dental hygiene and the resultant dental decay she now earned from it. Joyce expressed irritation that she had not taken better care of her teeth. Joyce had a mental shift and then remembered that she had dentures for the first time in months (but could not recall that she gets irritated at using them because they no longer fit correctly). Dusty gave Joyce her dentures.

Joyce sat idle for a long while just holding her dentures in her hand and staring at her plate of food, informing Dusty she was not hungry. Dusty continued to coax Joyce to eat before the Kindred nurse arrived to check on her. Joyce informed Dusty that the nurse could just deal with her having food on her tray, uneaten. Joyce eventually was goaded into eating.

1:58 p.m. - Carole (Kindred nurse) arrived to farmhouse, lunch paused. 

Carole informed Dusty that at their staff meeting today she was informed by her manager that Kindred visits to the farmhouse had reached their prescribed run set by Dr. Collins and would be discontinued as Joyce is discharged from Kindred's care per Dr. Collins' orders from summer 2020. Joyce appears to have stabilized overall and recovered from her fall in June. Family care providers are doing great work for Joyce and so little to no concern about her well being compared other patients Kindred oversees. 

Vitals taken. No fever. Oxygen saturation at 90%. Pulse 72. BP 140/76 (ok). Joyce initially reported no headaches when first asked if she was experiencing them, then changed her answer to indicate she was "having them from time to time." No falls, sore throat, dizziness, or nausea reported by Joyce when asked. 

Reviewed sore on buttock that Joyce picked open. Carole confirmed family caregivers are proceeding on correct track for care of wound. Health log reviewed. Tramadol possibly causing constipation that Joyce is experiencing. Family encouraged to monitor Joyce's bowel movements and treat with stool softener accordingly. Joyce's legs were checked and determined to be ok, no swelling today. Noted that Joyce's lack of appetite appears to be increasing.

Kindred is currently scheduled for one more visit next week but that may be canceled as today's visit was deemed positive and family caregivers for Joyce are so attentive to her. Kindred staff meeting tomorrow will determine if one more visit will occur or if it will be canceled. If visits to Joyce by Kindred are to be reinstated, Dr. Collins will write up the orders for it to renew via referral. Carole departed farmhouse by 2:03 p.m.

2:09 p.m. - Lunch resumed, all except green beans eaten. Joyce irritated that she was given them to eat "because I could choke to death on them!" Joyce wanted to keep her dentures in her mouth and would not relinquish them to be cleaned.

2:18 p.m. - Wendy (Moscow Medical) called Dusty's cellphone and confirmed Tramadol is working for Joyce and prescription refill order will be submitted to pharmacy for fulfillment.

2:30 p.m. - Bathroom trip declined, citing fatigue.

2:45 p.m. - Miralax dosage given to Joyce. Dusty departed farmhouse to return to work on campus. 

5:30 p.m. - Bathroom.

6 p.m. - Dinner (Beef stroganoff, noodles, peas). Evening medication.

8 p.m. - Bathroom.

8:30 p.m. - Ready for bed.

---

Joyce sleepy today. Slight confusion/disorientation throughout conversations.
Very irritable. 

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