Post for Saturday, October 24, 2015
Perry slept fairly well with his typical interruptions for Erica RN during the night. Tracy was his day shift RN. Dialysis was started @ 745a & ended @ ~1145a with 1.5 liters of fluid removed.
Dr. Lane, Pulmonologist, rounded & I informed him that a repeat lung ultrasound had been completed yesterday ordered by the Intensivist which Dr. Lane felt was unnecessary, & after he reviewed it he said there was not any new findings. He is waiting to hear from Dr. McCurry as to what the plan will be to proceed with the collection of fluid & possible fibrotic layered hematoma (blood clot) between his L lung & chest wall. He mentioned that he does not micromanage patients in the CVICU as he has patients in the ICU & on the floors. How things are done is still so very confusing. It would bring assurance if we knew that everyone was on the same page. It is also baffling that perhaps something more could have been done weeks ago when it was still all a fluid collection & not a possible fibrotic layered hematoma infected with yeast. "It is what it is" at this point!!! Just hope & pray he does not have to endure additional complications as a result. The preliminary results on the blood cultures are at least not showing a growth of organisms so that is definitely a good sign relative to the restart of the anti-fungal IV medication Micafungin.
The Nephrology Dr. inquired about his urine output & concern that it has decreased significantly since being started on dialysis three times a week. They are only removing fluid the amount of fluid equivalent to his IV fluid & daily feeding daily volumes in attempts to not dehydrate him. He is considering returning to dialysis twice a week as long as his BUN & creatinine levels are within reason to see if his kidneys will make more urine.
Connie, the wife of the patient in room next to Perry’s, & I spoke in the Family Lounge regarding daily challenges that we both encounter. Her husband has had several complications after lung transplant. His sister & brother-in-law came to visit her husband & yesterday they were able to laugh which helped her husband. Unfortunately the laughter disturbed the family of the patient in next room separated only be a curtain. Each day there seems to be something new to have to overcome. We listen, hug & support each other too quite a bit. Her husband & I wave & smile at each other several times a day which seems to help perk him up & he appreciates.
Perry slept through most of dialysis & the afternoon. He agreed to getting a bath @ 115p from Mitch Clinical Technician. Perry was involved in conversation about raising a son & difficulties when at age 7 or 8 sons no longer want to get hugs & kisses from their daddy because “it’s not cool” & the importance of asking open-ended questions so children will share more than a “yes” or “no” answer.
If you recall, I was always forbidden to cut his nails & had been told I could only cut them after he got transferred to J8-2 (Heart Lung Transplant Unit), so he was not at all happy that I began the task of cutting his nails with my heavy duty instruments. The last two times I had cut them was when he was really “snowed under” on Propofol & not aware that I seized the opportunity while I could to complete the task. Unfortunately since he was focused on me cutting his nails, he had a lot more involuntary tremors, so it was even harder. Glad I had my glasses on because I might have needed to go to the ER with a deep penetrating eye wound. “Toe”tally disgusting but it HAD to be done against his wishes.
Bill RT capped his trach at 321p with oxygen @ 4 L per nasal cannula. With soft music, eyes closed to focus, iced washcloths to his forehead, gentle caresses to his scalp & hands, lots of silence with occasional interjected words of encouragement & praise, Perry was able to tolerate capping until 531p. Shortly afterward he fell asleep until ~8p. We then watched part of Jurassic Park & he was settled for bedtime around 945p.
As I was viewing FaceBook happenings in order to have a connection of sorts to the outside world, & I came across a video that I had seen a while back on a local television program. I would like to share it on behalf of Perry's donor & others whose lives have been too quickly ended & his/their family & friends who will forever love & miss him/them to such a tragedy called heroin. Use & overdose of heroin & heroin laced with Fentanyl is a huge problem for many youth in Cleveland & Chicago as well as throughout our country. https://www.youtube.com/watch?v=Qdj65B1lxVc