General Update #312 - Thursday, February 18, 2021 (Updated)

7:48 a.m. - Dusty arrived to farmhouse (covering for Jess who is down with migraine). Craig already on-site. Joyce awake in recliner without oxygen line in place.

BP 138/81, pulse 77. BGL @ 150.

Bathroom trip declined, Joyce wants to eat breakfast first.

7:52 a.m. - Morning medication and nutritional shake.

8:02 a.m. - Breakfast (donut, whole banana, Baby Bell cheese wheel, apple peach mango juice with Miralax added). Breakfast finished by ~9:10 a.m.

Bathroom trip declined. Dusty preparing to return to campus for work.

9:19 a.m. - Joyce soiled herself in her recliner. Assisted to bathroom by Dusty and cleaned up. Remainder of type 5 bowel movement and urine passed. Joyce in agitated state, did not follow verbal directions from Dusty and made bigger mess.

Joyce showered under protest. Laundry started.

159.2 lbs. 

PT walk to living room before returning to recliner by 10:35 a.m.

11 a.m. - Joyce stretched out to nap, Dusty heading to campus for work. Will return early afternoon to fix lunch for Joyce.

1:48 p.m. - Dusty returned to farmhouse, finding Joyce asleep in her recliner with oxygen line in place.

1:58 p.m. - BP 148/69, pulse 65. BGL @ 120.

2:03 p.m. - Bathroom trip. Urinary incontinence. Early bladder release. Remainder of urine passed. New diaper and pad. PT walk.

2:20 p.m. - Lunch (turkey sandwich with mayonnaise, mustard, cheddar cheese, V8 juice, mashed potatoes, Baby Bell cheese wheel, sugar free orange Jell-O cup). 

3:15 p.m. - Debra (Kindred) called farm landline phone. Informed Dusty she was arriving to do a continuation of service check on Joyce. Dusty expressed confusion as he had previously been told by Carole (Kindred) and Dr. Collins that the service had been halted. 

3:45 p.m. - Debra arrived to farmhouse and informed Dusty that Joyce has 4 more visits from Kindred Home Health nursing staff to occur - but if today's visit is okay then she will continue on with discharge process that supposedly was done with Carole earlier in February.

Debra asked Joyce about pain and current condition - Joyce self reported no headaches, dizziness or neck pain. Debra asked Joyce if she has dentures and Joyce stated she does not - Dusty clarified that Joyce has upper denture plate but does not wear it regularly as she complains it does not fit/hurts to use it. Open wound on buttock noted and inspected and measured by Debra. Debra cites this as a concern and so Kindred visits will continue.

Debra reviewed health log data family care providers are keeping for Joyce and is most impressed with their attentiveness, care, and information collected. High praise given for family care providers and Debra wished that all the people she visits had families who were as dedicated to caring for their elders as Joyce's family. Joyce deemed to be doing so well currently because of what her family care providers are doing for her everyday living support.

Debra checked Joyce's breathing using stethoscope. Joyce's ankles were checked and noted to be swollen. Joyce informed Debra that the family has been getting her to raise up her legs when she sleeps but confessed that she often lowers her legs down soon after family members depart or are out of the room and returns herself to a normal upright seated position. Compression stockings were recommended for Joyce to use if she is going to refuse elevation of her legs - Dusty explained that due to Joyce's frequent early bladder releases it is difficult to keep a supply of clean compression stockings on Joyce throughout each day. Reviewed urine and bladder incontinence issues - noted to log. Confirmed Miralax being administered to Joyce to help alleviate Tramadol induced constipation.

Joyce's oxygen flow rate confirmed to be at 2 liters. Temperature 99.1 degrees Fahrenheit, which was high, but Debra noted that Joyce was under two blankets and sitting in front of a continuously running electric space heater. BP 152/73, pulse 67. 95% oxygen saturation level. 

Debra writing recommendation Joyce remain on schedule for all upcoming nursing visits until at least her open wound on buttock heals. A re-assessment will be done on Joyce at a future date closer to end of next 4 visit cycle and visits will be ended or renewed again at that time.

Carole will most likely be in touch with Dusty to schedule follow up visit to farmhouse next week. Debra departed farmhouse ~4 p.m.

4:09 p.m. - Bathroom trip declined. Joyce informed Dusty she would take herself when she felt like going. Joyce stretched out to nap in her recliner, Dusty returning to campus to continue his work day.

4:30 p.m. - Enrichment activity - Joyce given pots by Connie to decorate with stencils.

5 p.m. - Bathroom trip. Urinary incontinence, diaper pad changed.

5:20 p.m. - Dinner (KFC mashed potato bowl and biscuit)

7:35 p.m. - Evening medication.

8:50 p.m. - Bathroom trip. 

9:05 p.m. - Ready for bed.

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Debra (Kindred) seemed to not have certain data in her tablet about Joyce that Carole and other Kindred staff had been entering and previously verified with Dusty when checking on Joyce. Debra could not explain discrepancies (such as no notes about family treating Joyce with Calmoseptine barrier cream even though it was Kindred staff who recommended it, had incorrect medications listed (metformin) as still being taken, did not have oxygen flow rate information, and did not appear to have notations about recurring pressure sores and that family care providers were treating them). Debra seemed evasive when Dusty pressed for clarification on why Carole stated earlier in the month that the Kindred staff deemed Joyce no longer needing visits, conducted a discharge visit, didn't communicate that information to Dr. Collins, didn't seem to have Dr. Collins' office renewal orders for continuation of visits, etc.). Dusty will follow up with Carole when she arrives next week to check on Joyce.