General Update #331 - Tuesday, March 9, 2021

8:10 a.m. - Dusty arrived to farmhouse to cover Jess' shift (Jess down with migraine). Joyce awake in her recliner with oxygen line in place. Joyce reporting that she still has a headache but that it is diminished from yesterday. Joyce reported she was able to sleep during the night but had nightmares. 

8:13 a.m. - BP 129/73, pulse 80. BGL @ 131.

8:27 a.m. - Bathroom trip. Urinary incontinence. Diaper and pad insert replaced. Remainder of urine passed. Barrier cream applied to right buttock and left hip/pelvic crease of skin fold (minor spread of sore on hip). Pressure wound on right buttock closing up nicely and scabbing over - some signs Joyce picking/wiping at it which may cause it to reopen if she is not monitored and stopped when using toilet. 

PT walk, Joyce gasping for breath as she made her way out to kitchen (Joyce reportedly not in pain, she was holding her breath while walking again). 

8:39 a.m. - Morning medication administered with nutritional shake.

8:41 a.m. - Breakfast (omelet, cubed watermelon, Baby Bell cheese wheel).

8:44 a.m. - Tramadol reorder submitted by Dusty to pharmacy.

8:52 a.m. - Joyce abandons her breakfast tray, tossing it onto her walker. Joyce complains that everything she was given (except for the cheese wheel) was "too hard to eat" because her "mouth was sore." Dusty inspected her mouth and did not see any obvious wounds or redness. Joyce indicated pain was on the "upper part of her mouth" and "all over in there" when gesturing with her finger. Possibly may need to have Joyce's teeth stubs inspected by dentist? Dusty will pickup an oral analgesic.

8:54 a.m. - Joyce given her leftover mac and cheese from yesterday's lunch and she ate it without fuss. Joyce ate very slowly, frequently zoning out/staring off into space. Finished by 9:35 a.m. and began napping in her recliner with legs elevated. Dusty departed farmhouse to go to work on campus.

1:59 p.m. - Dusty returned to farmhouse. Joyce awake and upright in her recliner with oxygen line in place and coloring in her coloring book. Joyce appearing more alert and stated that her headache was still present but was only minor now.

2:04 p.m. - BP 131/71, pulse 67. BGL @ 126. Bathroom trip declined.

2:08 p.m. - Lunch (chicken tenders, cheddar macaroni salad, apple/peach/mango juice). 2 Tylenol with cranberry supplement. Joyce immediately discarded chicken tenders, citing they would be too hard for her to eat with her still hurting. Dusty attempted to negotiate with Joyce to try but she refused to attempt eating the chicken, even with breading removed. Joyce at the macaroni salad, very slowly, and kept zoning out or falling asleep. 

2:43 p.m. - Debra (Kindred) called Dusty's cellphone to notify him she would be stopping by ~3:15 p.m. to 3:30 p.m. today to check on Joyce and process her discharge order from their care if anyone would be around. Dusty confirmed that he would remain at the farmhouse longer to be present for her visit.

2:58 p.m. - Joyce woke randomly and informed Dusty that her headache was better and she was ready to have the curtains opened up. Dusty reopened the curtains in the main living area.

3 p.m. - Joyce finished her lunch and resumed coloring.

3:21 p.m. - Debra (Kindred) arrived to process Joyce for discharge from their care. 

Health log family care givers was reviewed. Praise given to Joyce's family for their support of her in keeping her in such good overall health and care provided to keep her at farmhouse. Debra lamented that other people she and her team see do not have such a caring network for them and are struggling to remain in their homes.

No falls reported when asked. No new trips to the emergency room logged since June 2020 fall down the basement stairs. 

Joyce self-reported that she was in no pain when asked, Dusty clarified and provided information collected by family care providers (ad-hoc back pain, reduced knee pain, potential breathing pain, and current headache). 

Confirmed Joyce had the flu vaccine, is on the waitlist for COVID-19 vaccine, and that she has had the shingles vaccine (and also previously had shingles a few years back). 

Dusty confirmed use of Tramadol and Tylenol - Debra glad that the Tramadol is working for Joyce as there have not been as many immobility issues due to leg pain logged in the logbook as previously were occurring before use. 

Pressure wound on right buttock inspected and confirmed to be healing. Wound on left hip/pelvic area confirmed healing and family doing correct treatment to promote healing.

Some swelling in Joyce's legs were noted, listed as ongoing issue. Joyce immediately confessed to Debra that the family has been doing a good job of getting her to elevate her legs and that the swelling has been mitigated most days because of it but that she has recently been "putting [her] legs down after my nurses get me set up and leave for the night or for napping time." Joyce commented that her legs were more swollen today because of her not following family caregiver directions to keep her legs elevated.

2 liter oxygen flow rate from oxygen concentrator confirmed.

Debra asked Joyce if she ever gets short of breath while walking or moving around and Joyce said "no." Dusty clarified that Joyce does become short of breath with activity. Joyce confirmed to having a cough but stated she was not producing sputum. Dusty confirmed that the coughing has eased from what it was previously since adding mucinex to Joyce's medications to help remove fluid from Joyce's lungs due to shallow breathing.

Joyce's lungs checked with stethoscope - some "slight crackle" heard by Debra. Most likely due to Joyce's continued shallow breathing. Family care providers encouraged to work on deep breathing exercises with Joyce and/or obtaining an incentive spirometer. Dusty confirmed that Joyce previously had one but threw it out due to irritation at having to use it. Joyce's primary care provider, Dr. Collins, can write an order for one if the family desires to obtain one for use. Dusty will inquire about that when he next meets with Dr. Collins for follow up on Joyce's recurring nightmares.

Confirmed continued urinary incontinence issues for Joyce. Logbook reviewed.

Confirmed Tramadol causing constipation issues but family care providers are doing a diligent job of logging bowel movement frequency and consistency and being mindful of when to administer Miralax to counter the Tramadol's side effect.

Joyce's appetite appears to be good overall. Reviewed Joyce's mouth sores and pain, potentially related to her teeth? Joyce possibly grinding her tooth nubs into her upper gums when she sleeps or while eating. Diet could have caused sores in her mouth (micro cuts or scrapes from more textured/tough foods). Family care providers should continue to monitor Joyce's mouth pains. Soft foods are always good to provide to the aged.   

Vitals checked - temperature normal. BP 130/61. Pulse and oxygen levels normal.

Joyce approved for discharge from Kindred Home Health care.

If Joyce or family care providers wish this service to renew it can be requested via Dr. Collins who can write the order. 

Debra departed farmhouse ~3:40 p.m.

3:42 p.m. - Bathroom trip. Urinary incontinence. Early bladder release. Remainder of urine passed. Diaper and diaper pad insert replaced. Bathroom floor and toilet seat sanitized. 

PT walk - Joyce reported pain in her upper back "like a knot." Joyce able to continue with walk, returning to recliner by 3:54 p.m.

3:55 p.m. - Joyce setup with enrichment activity (coloring). Dusty departing farmhouse to return to work on campus.