Erica RN's morning update indicated Perry slept fairly well throughout most of the night. No significant changes occurred. He had PT in the morning & was assisted into the bedside chair after PT & was lifted back into bed prior to my arrival. He was very tired throughout the entire day. He was starting to experience an increase in bilateral hand tremors compared to recent days. Dr. Adi contacted Dr. McCurry, who is out of town, regarding the findings of the recent chest CT. He will be able to review the CT remotely for additional recommendations; however Dr. Adi is pleased that Perry is otherwise not showing signs & symptoms of significant concern & feels an invasive evaluation of the fluid collection could lead to more risks vs benefits. He also mentioned that due to nerves being affected from removal of a donor heart & those of the recipient's original heart, it is not unusual for a transplanted heart to have higher heart rates. The Speech Therapist recommended for RT to determine whether Perry may be able to utilize a Passy-Muir® to facilitate communication, but she did not provide an actual evaluation as I had expected to determine other methods that could benefit Perry based upon his current capabilities. The Passy Muir is not typically utilized in the CVICU. RT plans to evaluate if it may be a possibility for Perry hopefully tomorrow. Sited from www.passy-muir.com: "Invented by a patient named David Muir, the Passy-Muir® Tracheostomy & Ventilator Swallowing and Speaking Valve is a simple medical device used by tracheostomy and ventilator patients. When placed on the hub of the tracheostomy tube or in-line with the ventilator circuit, the Passy-Muir Valve redirects air flow through the vocal folds, mouth and nose enabling voice and improved communication." Additional Passy-Muir information is available on You Tube @ https://www.youtube.com/playlist?list=PL0137BE00D6BF8DF8 We will miss one of Perry's great nurses, Summer RN, who has accepted an Advanced Nurse Practitioner position with Cardiothoracic Surgery. She came to say goodbye to Perry, to wish him all the best, & to tell him how proud she was of him & for all the progress that he has made. Tears, tight embraces, & sincere thanks were given by me & on behalf of Perry for her all of her superior, conscientious, & compassionate care given to Perry!!! Perry mouthed that he was ready to go to sleep for the evening at 730p, but due to shift assessment, medication administrations, bodily functions & need for cleaning, positioning, repositioning, oral care etc, he was finally settled in for the night by 945p.