General Update - Thursday, April 15, 2021

7:25 a.m. - Craig arrived to farmhouse and found Joyce awake without oxygen line in place. Joyce reported that she has not been to the bathroom yet.

7:54 a.m. - Joyce returned from bathroom. Started eating breakfast (toast with jam, baby bell cheese wheel, applesauce, nutritional shake, morning medication).

10:17 a.m. - Dusty arrives to farmhouse, finding Joyce awake without oxygen line in place. Joyce had towels in her walker's basket...could not recall where they came from or what she was doing with them.

10:19 a.m. - BP 127/74, pulse 76. O2 @ 87%. BGL @ 300. 

10:25 a.m. - Bathroom trip without incident. Urine passed. Evidence of bowel movement and poor attempt at self-cleaning discovered. Fecal matter in shoes and on bathroom floor from earlier trip. Shoes sanitized. Showered under protest. 

Weight 157.4 lbs. 

PT walk, returned to recliner by 11:20 a.m., legs elevated.

1:27 p.m. - Joyce removed her oxygen line. When instructed to put it back into place by Dusty, Joyce asked how it was supposed to be worn - Joyce did not know how to put it back on without assistance.

1:47 p.m. - Deanne (Kindred) arrived to perform occupational therapy assessment. Confirmed every day living (EDL) activities for Joyce. Reviewed Joyce's toileting routines and family care provider assistance for Joyce with toileting activities. Confirmed 2-liter oxygen flowrate. Vitals taken. BP 131/78, pulse 66. Encouraged Joyce to continue working with pulley system in entry way hallway that was setup previously to maintain flexibility and range of motion. Confirmed that Joyce primarily sleeps in recliner and does not need to practice transitioning to/from bed on her own. Reviewed health and injury history for Joyce. Confirmed family care provider schedule and gaps in care coverage. Asked if family is considering commode use for Joyce during overnight hours. Joyce reported slight pain in back of her right leg (1-2 out of 10 on pain scale) when asked by Deanne about current aches and pains Joyce was experiencing. Reviewed Joyce's ability to dress herself and other independence activities that Joyce performs. Confirmed medication is dispensed by family care providers. Confirmed Joyce diabetic. Bathroom assistive and safety features inspected by Deanne. Wheelchair use reviewed. Legs noted to be swollen - reviewed fluid retention issues that manifest with congestive heart failure. Range of motion and flexibility in Joyce checked by Deanne. Resistance and strength tests conducted. No issue with strength - recommended to continue using free weights (2 times per week minimum if possible), pulley exercises 3 times per week. Sit/stand ability reviewed. Meal prep and food service for Joyce reviewed. Joyce had difficulty operating powered recliner remote on her own when tested by Deanne (Dusty not allowed to help or provide verbal guidance to Joyce as part of the test). Reviewed Kindred PT and OT plan for Joyce. Joyce struggled with comprehension of verbal directions and interrogatives at times. Deanne departed at 2:12 p.m.

2:14 p.m. - BP 149/68, pulse 66. BGL @ 125. O2 @ 94%. Temperature 95.9 degrees Fahrenheit. 

2:20 p.m. - Lunch meds with Miralax in water. Bathroom trip declined. Lunch negotiated.

2:28 p.m. - Lunch (peanut butter sandwich, applesauce, pudding cup). Dusty left tray with Joyce as he departed to return to work.

4:50 p.m. - Bathroom. Type 6 bowel movement, "diarrhea everywhere." Joyce was fine until she was almost seated onto the toilet. Joyce showered. Bathroom cleaned, garbage taken out. 

Coloring.

6 p.m. - Dinner (1/3 mashed potato KFC bowl, biscuit).

7:14 p.m. - Evening medication. 

Coloring.

8:07 p.m. - Bathroom. Dry.

8:52 p.m. - Ready for bed.

---

Dusty has Subaru. Jeep broke down. Call Dusty if Subaru needed to transport Joyce.

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