Hannah RN reported that Perry awakened @ 3a & remained awake for a couple of hours. Otherwise an uneventful night. During the morning, he was placed in a sitting position with bed conversion to a chair. The Passy Muir was applied briefly, but due to low oxygen saturations to 80%, it had to be discontinued. The RT plans to give Perry another attempt tomorrow. He later completed ~30 minutes of trach collar breathing. During his PT session, he was assisted to a standing position by Dean & 2 other staff members also providing assistive support. He was then assisted into the bedside chair @ ~9a. He seemed to tolerate being up in the chair until ~1200p & requested to be returned to bed as he began to experience lower back & sacral pain due to his arthritis & lack of muscle/fat padding. It was then that we learned that the lift team breaks for lunch from 12p-1p. Despite me applying warm packs, repositioning him, & providing massage, his pain increased to a "10" on 0-10 scale. He received pain medicine shortly before being returned to bed @ 130p with the arrival of the lift team. He fell asleep within minutes of being returned to bed from exhaustion. Kim from Occupational Therapy provided passive range of motion to his upper extremities as he remained soundly asleep @ 3p. I discussed with her the need for Perry to be provided with adaptive tools for communication until the Passy Muir becomes a viable option for speaking & measures to allow him to begin to participate in basic activities of daily living (ADLs) so that he does not become more deeply depressed. I also discussed the need for Perry to be able to meet goals that he desperately wants to be attaining, should be attaining, & is capable of doing with staff & my assistance such as sitting at the edge of his bed to dangle for at least 15 minutes 3 times a day so that he can develop his abdominal core muscles which is essential to help get him off the vent. I discussed the extreme importance of a schedule for Perry as he had requested such yesterday & due to the fact that had to follow a very regimented routine because of his health needs prior to transplant. He is in desperate need to have some aspect of control now in his life for a sense of accomplishment & progression. She will plan to coordinate with Dean PT so that she can also begin to start to assist Perry with some basic daily activities such as washing his face & combing his hair with adaptive measures during the earlier AM hours. She also plans to help dangle Perry so that he can accomplish the goal of dangling at least 2 x a day with the help of therapists. I will be moving to a lower level apartment at the Transplant House on Friday so I will be occupied with cleaning this apartment & a few additional tasks to complete that move depending upon the time that other apartment is vacated. In the meantime I'm in need of some sleep.