Pullman Regional Hospital - Monday April 5, 2021

 These entries will be a bit odd as I (Jess) will be transcribing text messages from Dusty of the events as they happened and he had time to reach out to myself and the family. I will have him come back and edit/add more when he can. 

8:33 a.m. Dusty: Dusty back on site at PRH. Checking with Sam (Nurse), BiPAP system worked and Joyce "back to normal"

8:49 a.m. Dusty: ICU is short staffed today. Sam is being assisted by LCSC nursing student intern. Alyssa today. Joyce is very responsive and back to what family would recognize as baseline normal. Joyce knows who Dusty is but cannot recall which of her sons is the oldest.

8:50 a.m. Dusty: Sam informed Dusty that the BiPAP was kept on Joyce until about the time she returned to cover morning ICU shift.

8:54 a.m. Dusty: BP 155/67    Pulse 82    Oxygen level 90%    CO2 saturation 19    Joyce responding to interrogatives and able to talk fairly coherently. Doesn't know where she is, but does understand she is at PRH when told compared to previous days where she could not comprehend. 

9:07 a.m. Dusty: Breakfast (egg whites with Mrs. Dash seasoning, slice of whole wheat toast with grape jelly, applesauce). Joyce nibbling at it with Dusty working on keeping her focused. Door/wall facing nurses' station being left open today so Sam and Alyssa can keep eye on Joyce, but their activities are too interesting for Joyce and she forgets she is eating :)

9:47 a.m. Dusty: Sam and Alyssa arrived to administer antibiotics to Joyce.

9:48 a.m. Dusty: Antibiotics are being administered to Joyce because docs "covering bases" to ensure Joyce does not have pneumonia

9:49 a.m. Dusty: X-rays were difficult to read due to Joyce's kyphosis

10:29 a.m. Dusty: Sam and Alyssa arrived to administer next round of antibiotics. Sam spoke with doc, doc should be in touch with Craig for direction on how to proceed with Joyce. 

10:30 a.m. Dusty: BiPAP resolved the CO2 narcosis last night, suspicion is that a sleep study and BiPAP (or similar treatment device) use may be in Joyce's future. Joyce's confusion noted in daily health log family keeps might indicate CO2 narcosis has been an ongoing issue. 

10:31 a.m. Dusty: Joyce still responsive, smiling, making jokes, and conversant. Joyce is breathing shallow and raid per her normal. 

10:38 a.m. Dusty: Alyssa collected vitals BP 128/56    Pulse 72    O2 level @ 94% Temp @ 98.6

10:42 a.m. Dusty: Dusty purchased an oximeter and spirometer, as an FYI, last week from online vendor. Should arrive for use by time Joyce gets discharged from PRH (whenever that will be)

11:22 a.m. Dusty: Alyssa arrived to take Joyce's lunch order and record blood glucose level to see if insulin needed. 

11:28 a.m. Dusty: PT and OT team arrived to work with Joyce and shower Joyce. Reviewed home activities and support equipment with Dusty.

11:35 a.m. Dusty: Home toileting routine and clean up processes reviewed with OT and PT team. Joyce walking well for her age and physical condition according to PT.

12:09 p.m. Dusty: PT/OT and shower had to be paused as Joyce stated she needed to toilet. Constipation, usual coaching on how to pass stool underway. Joyce taking too long to pass stool (usual coaching needed). PT and OT teams departed and will try to return later. 

12:36 p.m. Dusty: Joyce showered and PT/OT. Pressure sores reviewed with Dusty and confirmation that pillow at home get adjusted regularly. since Joyce primarily sedentary in recliner most of her days.

12:37 p.m. Dusty: Sam stopped by, due to ICU staff shortage , nurse Cindy is taking over on primary care of Joyce but Sam will continue to monitor and update Dusty on Joyce. Cindy updated by Sam on Joyce's condition and what's been happening with her and plans developed so far. 

12:39 p.m. Dusty: PT and OT commented Joyce has great balance and movement.

12:49 p.m. Dusty: Alyssa arrived to log Joyce's vitals and blood sugar. Alyssa knew Joyce was having toileting issues and PT/OT delayed schedule so she re-ordered lunch so Joyce can have hot food.

12:55 p.m. Dusty: BP 140/66     blood glucose @ 165     PT walk started. 

1:01 p.m. Dusty: PT provided new foam pillow with coccyx gap for home use

1:08 p.m. Dusty: Nurse Cindy arrived to administer insulin and Lovenox (blood thinner/anti coagulant) to Joyce.

1:33 p.m. Dusty: Lunch delivered to Joyce (Green beans, salmon, mashed potatoes, chocolate pudding). Joyce told Dusty to leave and feed himself. Dusty grabbing lunch across street then will return to PRH.

2:58 p.m. Dusty: Dusty back on site. Joyce had eaten everything but green beans. Joyce rigged up to wireless sensor system while Dusty was out.

3:02 p.m. Dusty: Joyce back to confused state, not being certain where she is at or why.

4:26 p.m. Dusty: Tech arrived to do ultrasound of Joyce's heart. Joyce stopped the process as they were moving her to bed, citing she needed to use the bathroom.

5:03 p.m. Dusty: Dinner delivered by room service (spaghetti with meat sauce, peaches, fruit sorbet). Cindy arrived to check Joyce's blood sugar while tech took last of ultrasound images of heart.

5:07 p.m. Dusty: Joyce retaining water. Cindy informed Joyce and Dusty that due to Joyce's incontinence and inability to log urine output via the commode collector reservoir, the doctor wants Joyce to have a catheter put in so they can track urine output.

5:11 p.m. Dusty: Plan to leave in catheter for 24 hours for sample collection.

5:23 p.m. Dusty: Joyce returned to recliner after catheter insertion and setup to eat dinner. Joyce informed Cindy that she did not think she had been fed today.

5:25 p.m. Dusty: 2 units insulin administered to Joyce by Cindy.

5:37 p.m. Dusty: Dr. Karen Geheb stopped by to check Joyce. Will talk with Craig tomorrow about wishes for Joyce. Joyce needs BiPAP, BiPAP requires sleep study (outpatient service) to be done and BiPAP prescription setup, cannot do sleep study at PRH.

5:38 p.m. Dusty: Collection of urine is to monitor output of fluids and calcium levels. Joyce calcium levels high, which could be a signal of a problem.

5:41 p.m. Dusty: Joyce informed Geheb she was not hungry. Geheb asked Dusty if lack of appetite for Joyce normal at home. Dusty confirmed it happens but that Joyce eats slowly and just finished her lunch at ~1:40pm. Geheb departed. Joyce attempting to get Dusty to eat her food for her. Joyce moving between understanding she has to stay another night and so can't understand why she has to stay.

5:45 p.m. Dusty: Joyce knows who Dusty is but does not know where she lives. Joyce trying to tell Dusty that Geheb said she could go home.

5:50 p.m. Dusty: Geheb informed Dusty that if Joyce gets BiPAP for home use she will need overnight supervision as she does not believe Joyce is mentally competent enough to put it on correctly, set it to run, keep it on, or troubleshoot if she has problems in the middle of the nights. Concerns will be reviewed when Geheb talks to Craig tomorrow.

5:51 p.m. Dusty: Respiratory tech arrived to check Joyce's oxygen levels. Confirmed Joyce is on 2 liter flow rate at home.

5:55 p.m. Dusty: Joyce not focusing. Fidgety and playing with whatever she can get her hands on. Just cracked her foam cup containing sorbet in half like an egg shell on her tray because she wanted to know what was in it even though Dusty told and then showed her. 

6:01 p.m. Dusty: Joyce informed Dusty she will eat her sherbet, put her peaches in her coat and they can go home. Dusty reminded Joyce she is staying in PRH and Joyce became irritated, saying "well then just say goodnight and go." Dusty working on calming Joyce and talking through her emotions while working on dinner.

6:04 p.m. Dusty: Joyce, for the moment, understands she is in a hospital. Apologized to Dusty for getting mad. She thought he was forcing her to stay in some hotel because he wanted her out of the farmhouse for some reason.

6:23 p.m. Dusty: Cindy arrived to check on Joyce. Joyce attempted to get Cindy to override Dusty making her eat.

6:25 p.m. Dusty: Joyce now requesting clothes and back to attempting bargaining for release from "this place."

6:29 p.m. Dusty: Dinner abandoned. All of spaghetti and sorbet eaten .

6:30 p.m. Dusty: Joyce now attempting to remove her sensors.

6:38 p.m. Dusty: Cindy arrived and removed first urine sample, set up night shift collection containers in ice buckets. Sam stopped by to check on Joyce. Sam departing in 30 minutes and will be back as day charge nurse tomorrow.

7:02 p.m. Dusty: Joyce took brief nap before shooting awake and attempting to first remove her sensors, then get up to go urinate (forgetting the catheter was in place), then attempting to disconnect her wireless sensor suite and drop it in the ice bucket containing her catheter collection container.

7:09 p.m. Dusty: Amy, the night shift nurse for Joyce tonight, stopped by to check in and introduce herself. She has been on shift previous nights with Sam and is familiar with Joyce and Joyce's plans and needs.

7:10 p.m. Dusty: Amy checked all of the connections Joyce had tugged and verified catheter and IV tubing is still in place with Joyce's fidgeting and attempts to remove what bothers her.

7:15 p.m. Dusty: Sam stopped by to tell Joyce goodnight. She has tomorrow off and wanted to wish Joyce well in case they don't cross paths again.

7:22 p.m. Dusty: Joyce intermittently passing out after being stopped from playing with her urine collection bag in the ice bucket.

7:30 p.m. Dusty: Nursing assistant (Jessie) arrived to collect vitals.

7:35 p.m. Dusty: Oxygen level at 90%, temperature normal, BP 122/61. Deemed good overall in current condition.

7:46 p.m. Dusty:  Amy and sleep tech arrived and discussed BiPAP plan with Joyce and Dusty. BiPAP level settings will be lower tonight than last night as Joyce not in as bad of shape as last night's CO2 narcosis.

7:47 p.m. Dusty: Tech will continually monitor Joyce's BiPAP through night as long as Joyce will tolerate using it. As Joyce is somewhat more coherent now than she was at this time last night, Amy worried Joyce may resist BiPAP use more.

7:49 p.m. Dusty: Plan from Dr. Geheb: Amy will keep BiPAP on Joyce as long as Joyce tolerates it, removing it if it keeps Joyce from sleeping. If Joyce begins to have CO2 narcosis, BiPAP therapy will be started back up. Joyce will be monitored closely by Amy either way .

7:51 p.m. Dusty: Amy and sleep tech (Vickki? Nickki?)  will return shortly to setup BiPAP. Going to try to run BiPAP on Joyce in recliner instead of in bed to see if Joyce likes that.

7:52 p.m. Dusty: Jimmy and Kate arrived with portable X-ray machine to take images of Joyce's chest.

8:33 p.m. Dusty: Amy arrived to assist Dusty with getting Joyce's oxygen line back in place that Joyce was removing after hearing Dusty verbally struggling with Joyce. Joyce's recliner adjusted and legs elevated.

8:36 p.m. Dusty: Jessie arrived to check Joyce's vitals and blood sugar levels.

8:37 p.m.  Dusty: Blood Glucose @ 251 Amy and Jessie repositioned Joyce in her recliner.

8:40 p.m. Dusty: Joyce attempted to remove iv and identification bracelet after Jessie and Amy left.

9:00 p.m. Dusty: Amy administered carvedilol. No diuretic for this evening. 4 units of insulin were going to be administered but Dusty stopped Amy, pointing out the high blood sugar levels were likely to late dinner and not rogue blood glucose spike. 

9:01 p.m. Dusty: Amy concurred and will have Jessie retake blood glucose in 1 hour to recheck blood glucose. Insulin will be administered at that time if needed.

10:01 p.m. Dusty: Jessie arrived to check Joyce's blood sugar level. 

10:02 p.m. Dusty: Blood glucose @ 211

10:06 p.m. Dusty: Joyce being prepped for BiPAP use. Dusty heading out for home and will return to PRH tomorrow morning.