General Update #316 - Monday, February 22, 2021 (Updated)

5:52 a.m. - Dusty arrived to farmhouse, finding Joyce asleep in her recliner without oxygen line in place. Joyce woke easily but struggled to gain coherence about her environment and what was going on. Joyce did remember that she had appointments in Moscow today unprompted.

6:11 a.m. - BP 123/69, pulse 69. BGL @ 132.

6:30 a.m. - 1st barium sulfate contrast drink started.

6:40 a.m. - Morning medication administered.

7 a.m. - 1st barium sulfate contrast drink finished.

7:20 a.m. - Bathroom trip. Joyce was confused when coaxed to rise up from recliner - didn't know how to get to the bathroom "in this place." Joyce knew who Dusty was but did not know until reaching bathroom where she was overall. Urinary incontinence, early bladder release. Bathroom floor and toilet seat riser sanitized. Remainder of urine passed along with type 5 bowel movement. Joyce cleaned up and given new diaper and diaper pad. Barrier cream applied.

Craig arrived to farmhouse while Joyce using bathroom. Joyce loaded into wheel chair and then out to Subaru for transport to Moscow with Craig's assistance.

8:03 a.m. - Arrived to Gritman and checked Joyce in with the clerks.

8:15 a.m. - Blood collected from Joyce for lab work.

9:20 a.m. - CT scan at Gritman. Technician confirmed that it should be reviewed today by Gritman staff and sent on to St. Joseph's for Thursday appointment with cancer doctor.

9:55 a.m. - Joyce returned to farmhouse.

10:03 a.m. - Bathroom. Urinary incontinence, early bladder release. Remainder of urine passed. Joyce cleaned up and bathroom sanitized. New diaper and diaper pad insert. Barrier cream applied. PT walk to living room before returning to recliner.

10:12 a.m. - Breakfast (sausage, egg, cheese sandwich, has brown, and orange juice from McDonald's). Craig stopped in to visit.

10:37 a.m. - Breakfast abandoned after struggling to eat. Joyce citing that she is not hungry due to not feeling well overall. Joyce denied being tired, possibly having acid reflux from the barium sulfate and/or being stretched out flat onto the CT machine and not feeling well from the contortions related to that she said to Dusty and Craig. At half of her breakfast sandwich, 3/4 of her hash brown, and a few sips of her orange juice. Craig departed, Joyce began napping after requesting that orange juice be left out for her to work on drinking.

Joyce woke herself up at 11:48 a.m. Joyce expressed concern that she thinks the barium sulfate contrast drink that she was forced to drink for the CT scan is keeping her awake. Dusty informed her that she had been napping just now. Joyce denied napping and became agitated, thinking that Dusty was teasing her about having fallen asleep as she did not register falling asleep. Dusty calmed Joyce and confirmed he would help her get stretched out prone to nap in her recliner after Kindred nurse departs.

11:50 a.m. - Debra (Kindred) arrived to visit Joyce and perform check up. Debra informed that Joyce was not feeling too well, supposedly due to the barium sulfate ingestion earlier in the day. Debra confirmed that she would take that into account - Debra confirmed the quantity consumed most likely is the reason Joyce is not hungry this morning.

Debra confirmed Joyce was not on blood thinners or diabetes medication.

Joyce's overall pain self-reported as "normal" to Debra (right knee causing her pain today, confirmed not her left knee) - pain level of right knee reported 8 out of 10 on the pain scale. 

Joyce self-reported her appetite to be fair, Dusty confirming that she has been eating better in the last month with only a few instances cited on review of the health log that Joyce was stating she was not hungry and turning away food completely.

Debra confirmed Joyce has bladder and bowel incontinence - diarrhea and constipation varies from day to day. Dusty confirmed Miralax was approved to give to Joyce when family care providers notice her constipation increasing (Type 1-2 stool and difficulty passing stools overall) to off set constipation caused by Tramadol. Meals are being monitored to see if there are trigger foods for the diarrhea since medications like Metformin have been discontinued. 

Joyce self-reported she gets short of breath when she gets up and moves around. Debra confirmed 2 liter flow rate for oxygen. Dusty confirmed that Joyce tends to hold her breath when exerting herself (or hyperventilates) depending on activity, pain level Joyce is experiencing, or how she is focusing on tasks being undertaken.

Some swelling noted in Joyce's legs by Debra - recommending continued use of compression stockings and leg elevation to continue. Joyce confirmed that her family care providers try to get her to elevate her legs but she often lowers them down when they depart or are not around.

Vitals collected by Debra. No fever noted. Breathing and heart sound clear.
All vitals look good.

Debra asked Dusty if the doctors looked at Joyce's open pressure wound on right buttock today. Dusty clarified that today's trip into Gritman was for lab work and CT scan only. Debra inspected wound and confirmed that pressure sore is healing nicely, commended family care providers for keeping Joyce clean and tending to her wound with barrier cream. Debra had followed up with Dr. Collins last week after visiting Joyce at the farmhouse and confirmed Dr. Collins' direction that Kindred can discharge Joyce from nursing services because family care providers are taking such good care of Joyce.

Debra to review Joyce's chart later today when back at Kindred office and will plan to make one more visit at least to the farmhouse to do a discharge visit if all is in order.
Debra departed farmhouse ~12:07 p.m.

12:14 p.m. - Bathroom trip. Urinary incontinence, early bladder release. Remainder of urine passed. Bathroom sanitized. Diaper and diaper pad insert replaced. Barrier cream applied. PT walk to living room before returning to recliner by 12:25 p.m.

12:30 p.m. - Joyce requested to be allowed to nap. Dusty assisted her with settling into prone position in her recliner.

2 p.m. - Joyce roused by Dusty. Joyce declined bathroom trip stating that she would take herself to bathroom later on once she was more awake. 

2:17 p.m. - Bathroom trip. Urinary incontinence. Diaper and pad replaced. Remainder of urine passed along with high volume of flatus and small type 6 bowel movement. Dusty assisted with cleanup. Barrier cream applied. PT walk declined, citing fatigue. 

2:32 p.m. - Joyce returned to recliner and stretching back out to resume napping.

Dusty departed to head to work on campus ~2:40 p.m.

5:54 p.m. - Joyce returned from a bathroom trip.

7 p.m. - Spaghetti. Evening medication.

8 p.m. - Bathroom trip. Diaper and pad changed.

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

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Joyce reported no nightmares from overnight sleeping. Joyce did report having bad nightmares when woke at 2 p.m. by Dusty for bathroom trip.

Joyce reporting that her nose was stuffy in the afternoon and was producing quite a bit of nasal mucus - possibly allergies affecting her or she may be coming down with a cold? Recommending watching to see if additional symptoms develop.

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