Pullman Regional Hospital - Thursday April 8, 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. 

8:23 a.m. Dusty: Dusty back onsite at PRH. Breakfast was just delivered to Joyce (diced potatoes and sausage patty, assorted fruit pieces) but she claims she is not hungry. Joyce informed CNA she wants to sleep.

8:24 a.m. Dusty: Joyce knows who Dusty is but does not remember him being with her in the hospital at all. Joyce thinks she is in a bank.

8:25 a.m. Dusty: Joyce does not know why she is in hospital ("What did I do?")

8:30 a.m. Dusty: Nurse Peggy stopped Dusty last night on his way out as he passed the ICU room she was assisting in, she informed him Joyce did not sleep much at all on night before last (night of 6th to 7th), she was often wide awake, staring at nurse's station and waved everything they made eye contact. Peggy asked if Joyce usually does not sleep at night when she is at farmhouse. Dusty confirmed he did not know that as family leaves Joyce on her own overnight at farmhouse so no data logged.

8:33 a.m. Dusty: Abby (CNA) informed Dusty she did not know if Joyce used BiPAP much last night. Kim arrived after Abby left room. Confirmed Joyce refused to have BiPAP last night, Joyce reported to not have kept oxygen line in place either. Joyce did not really sleep last night according to Peggy's logbook received at this morning's staff meeting. Overnight labs and vitals collected from Joyce look good.

8:34 a.m. Dusty: Kim was about to collect vitals and do morning inspection but as Dusty just convinced Joyce to eat Kim is going to leave Joyce be and return later.

9:01 a.m. Dusty: Marty (respiratory tech) arrived to check Joyce's oxygen levels and breathing.

9:20 a.m. Dusty: PRH social worker stopped by, Joyce on track for discharge but their only concern is if Joyce has 24 hour care. Social worker confirmed that she knew Dr. Geheb spoke with Craig yesterday, but her chart had not been updated to reflect family being able to provide 24 hour care at farmhouse for Joyce.

9:21 a.m. Dusty: No timeline for Joyce's discharge at this point but barring Joyce taking a nose dive health wise should be discharged today. Social worker departed.

9:22 a.m. Dusty: Joyce asked Dusty, "I will ask a stranger question...where is home?". At the moment, Joyce remembers she lives somewhere but does not know where. Resumed picking at her breakfast.

9:40 a.m. Dusty: Nurse Kim arrived to administer meds (aspirin, carvedilol, Miralax, torvastatin, metformin, insulin and spironolactone). 

9:41 a.m. Dusty: Kim asked what Miralax dosage was for Joyce at home. Dusty updated that family administered it to Joyce when constipation signs appear. Kim thinks it should be done once per day at least. Possibly twice? Dusty clarified that with metformin being administered again regular bowel incontinence may resume in Joyce.

9:43 a.m. Dusty: Dusty reviewed September through present care and work with Dr. Collins and Kindred home care nurses about trying to dial in and resolve bowel incontinence. Explained how Joyce was switched from Metformin to extended release metformin to try and alleviate bowel incontinence issues, with metformin stopped eventually all together by Dr. Collins. Tramadol use for pain relief then led to constipation, which led to Miralax dosing.

9:44 a.m. Dusty: Kim agreed Miralax twice a day with metformin may be too much for Joyce. Dusty suggested Miralax may not be needed if metformin is to be used again for Joyce as that seems to cause diarrhea consistently in Joyce .

9:45 a.m. Dusty: Room service arrived to deliver high protein milkshake from dietician.

9:46 a.m. Dusty: Breakfast abandoned. Kim working on getting Joyce to drink her protein shake.

9:50 a.m. Dusty: Joyce given a smoothie,  not a milkshake, which she finds "sour" (citrus) when she was expecting "sweet" so feels like Kim and Dusty were lying to her.

10:24 a.m. Dusty: Kim stopped by to inform Joyce and Dusty discharge orders for Joyce to return to farmhouse have been written.

10:25 a.m. Dusty: Kim dealing with recent arrival to ICU and then will return to assist with cleaning up Joyce and helping to get her dressed. 

10:34 a.m. Dusty: "It will be really strange going home, I have been gone a long time" -Joyce

11:04 a.m. Dusty: Pharmacist Paige, arrived to review new meds. Carvedilol increased dose to 12.5mg twice per day, losartan dosage increased from 25mg to 100mg once per day (morning best) be aware of low blood pressure (dizziness and falling dangers increased with increased dosage, 1/2 tablet once per day of spironolactone (diuretic). Stopping potassium supplements. When following up with Dr Collins in future, potassium levels will be checked with labs.

11:05 a.m. Dusty: Start baby aspirin regimen to prevent blood clots, Joyce may begin to start to bruise more easily as an fyi. 

11:12 a.m. Dusty: Miralax dosage to continue twice a day until 2 stools per day output reached or until she has diarrhea then switch to once per day. 1-500mg tablet per day of metformin for blood sugar control. Metformin important for blood sugar control. Dr. Geheb prescribing this. Pharmacy tech recommends following up with doc Collins on this.

11:14 a.m. Dusty: Dusty reviewed past bowel  incontinence issues with metformin with pharmacy tech. Give Joyce metformin, not miralax, if diarrhea begins to occur with metformin then stop metformin. Metformin may balance out with tramadol constipation side  effects. 

11:15 a.m. Dusty: Continue centrum multivitamin, cranberry supplement, Tylenol, tramadol 5pmg twice per day. 

11:16 a.m. Dusty: Ignore typo (5pmg). Stop mucinex medication as well. 

11:17 a.m. Dusty: Next appt with Dr. Collins on April 13. Dr. Geheb submitted orders to Walmart pharmacy.

11:18 a.m. Dusty: Paige departed. Kim and Abby arrived to get Joyce dressed and remove IV.

11:33 a.m. Dusty: Joyce loaded into car, heading for farmhouse.

12:00 p.m. Dusty: Joyce back at farmhouse. Dusty getting her unloaded from car and then cleaned up. May be unresponsive to texts and pho e calls for next 1-2 hours while getting her settled in. 

1:10 p.m. Dusty: Joyce stretched out in recliner, indicated she wanted to nap but is now "reading" newspapers after spying them on the counter. Lunch meds administered. Tray of food left beside Joyce on folding table (turkey sandwich, whole banana, pudding cup, cheese wheel) in case she gets hungry while Dusty leaves farmhouse to pickup new meds from Walmart and equipment he ordered that was delivered to his apartment. 

1:41 p.m. Dusty: Craig stopped by briefly while Dusty was showering Joyce, Craig getting Kip and Phil going again with repairs then we be back to farmhouse to visit mom. Joyce claiming no appetite, mood improved and more relaxed being at home. 

3:45 p.m. Dusty: Dusty back at farm house, Joyce awake in recliner, oxygen taken off, has just started working on eating her lunch. 

4:29 p.m. Dusty: Medications adjusted, pill cups refilled with new meds. Post-it notes updated.


The rest of this day is logged under General Update #356 - April 8, 2021


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