Monday, September 28, 2015 Peter, his night shift RN, said he slept fairly well throughout the night & that he had a few "communication bumps" trying to figure out what Perry wanted to convey but that Perry was very patient with him. His hemoglobin this morning was 6.8. I was told the doctor did not want to transfuse him. Upon my arrival, his day shift RN Audra informed me that Perry did receive a unit of blood this morning. At the time of Peter's call, it had not yet been determined if he was going to have dialysis. He was put onto Tuesday's schedule for dialysis so the blood was given. He was in chair mode & Denise was completing his morning care. His formula feedings were increased to 60 mL/hr. The Nutritionist visited & after reviewing his most recent Metabolic Cart results & based upon 60 mL/hr, he is getting 300 kcal/day too much. His feeding pump gets turned off during PT activities, increasing abdominal distention, episodes of nausea, when he needs to be cleansed, moved up &/or repositioned in bed, & with the administration of medications. Needless to say, due to all of the above, his formula feeding rate is still 60 mL/hr to allow for some of the difference he’s actually not receiving in 24 hours. With it being Monday, a new set of physicians take over on all of his speciality services, oh boy!!! After I discussed what can be done regarding the continuation of his low hemoglobin levels, it was decided that the Nephrology team will be consulted as to whether or not Erythropoietin will be ordered & given weekly to stimulate Perry's bone marrow to produce red blood cells thereby increasing hemoglobin thus facilitating the delivery of oxygen to his tissues. If you recall, erythropoietin is a hormone that is secreted by the kidneys & with Perry’s kidneys still in a state of confusion, hopefully the need for transfusions can be lessened. The Nephrology team was consulted, & they agreed with starting Erythropoietin today. The scheduled daily dose of Reglan was held per my request as Perry has continued to have loose stools. Colace (stool softener) has not always been held despite all of the loose, watery stools & the continuation of other bowel regimen medications. Finally, Colace has been discontinued as I certainly don’t want him to have to have another FMS (Fecal Management System) placed. Perry was able to tolerate 20 minutes of trach collar breathing @ 1210. During his OT session with Rob & Kim, he was dangled & assisted to a standing position on 4 separate occasions with the use of gait belt strapped to both Perry & Rob & support assistance by both therapist. Perry stood for ~1 minute on his last stand with their continued assisted support. Exhausted from PT, he took a long nap. Dr. Udeh (my “go to physician”) has been very faithful & has continued to check in on Perry via cell phone &/or visits. He tolerated being up in chair mode on 2 additional occasions this evening. He had been asking to watch the Cubs game since 2p today & was watching the clock very closely until the game time!!!! At the end of the game, I whispered "Cubs win, Cubs win!!!!!!" as he had fallen asleep shortly after 9p.