Post for Sunday, October 25, 2015
Once again, it was mostly an uneventful night with Perry’s usual awakenings intermittently. Nate RN had told Perry that when his brother who was engrossed with dinosaurs was allowed to watch Jurassic Park he became horrifically terrified of dinosaurs for years to come, so he hoped that Perry would not be awakened due to bad dreams involving dinosaurs.
Tracy was his day shift RN & wanted Perry to be able to get an early start on his day, so she put in computer request for the lift team shortly after assessing him thinking it would take awhile for them to arrive. Surprisingly, they arrived within minutes of her placing the order, so he was transferred into recliner by the lift team @ ~810a. Due to complaints of pain to his buttocks & lower back, Perry was returned back to bed by lift team at 1000a after a short wait time for the lift team. He definitely had a very reddened lower back & tailbone so onto his sides he went for most all of the AM & afternoon hours to prevent tissue breakdown.
According to Dr. Lane, the plan is to wait until tomorrow for the team of Drs to decide what is the best approach to remove the exterior L lung/chest wall hematoma but tPA medication administration via the pigtail catheter is most likely the front runner approach. tPA is the clot buster medication given during the immediate phases of a stroke or heart attack to help break up a clot.
Bill RT began his trach capping on 4 liters of oxygen via nasal cannula @ 1023a & once again with comfort measures Perry was able to tolerate capping until 1207p. At 1207, he was switched from nasal cannula oxygen supplementation to BiPap ventilator mode via facial mask while remaining capped. He was able to tolerate this method of breathing until 209p. We are hoping that this technique will be the bridge allowing for longer times off of the vent & moving Perry in the direction of being able to transfer out of CVICU & onto J8-2 Heart/Lung Transplant Unit. It was a great start with lots of praises given for such a great accomplishment. He was able to rest fairly well while on the BiPap mode. He is a mouth breather, so I hope we can escape the abdominal distention issues he’s been able to lessen since he began with the consistent trach capping.
For the first time Nicki, one of the two Advanced Practice Nurses (APN) on J5-5 CVICU, came in to complete an assessment on Perry. The APNs have not been involved in his care other than to have an occasional order written when needed. I’m not exactly sure why that is, perhaps due to the complexity of his case & the number of staff assigned to him, but it would be nice to have them advocate along with me for Perry & keep the Drs on the same page as they are the “daily constants” on the unit & do not change from week to week as the physicians do.
He was taken off the vent BiPap mode via facial mask & returned to 4 liters of oxygen via nasal cannula with his trach remaining capped from 209p until 225p. Outstanding effort, endurance, & toleration with intermittent needs of praise, encouragement, & ice cold forehead washcloths. A much needed rest was in store for Perry so permission was granted for me to go to Costco & Wal-Mart. I ventured out to a few different suburbs of Cleveland, so I was able to locate different shopping & eateries that may interest future visitors. I received a phone call from Nate his night shift RN @ 743p to inquire about my return ETA per Perry’s request.