Post for Thursday, October 28, 2015
Perry seemed to sleep fairly well with fewer interruptions during the night. Nate RN was his assigned day shift RN. He too gave Perry words of encouragement throughout his shift of the progress he has made & reinforced that Perry had absolutely little if any reserve to go on before his transplant was done & every bit of what he did have was needed to breath.
During his PT session, he worked very hard on the Moveo doing progressive intense controlled squats & completed a total of 50 reps. Dean is pleased with the progress & the determination that Perry has shown. He was transferred back onto his bed & then assisted to upright sit & dangled. I was able to get behind him, help steady him from some of the shaking, & give a big embrace for a little bit. He then was assisted by Dean, Larry, & myself for a brief stance to pivot into the recliner @ 1015a.
The Metabolic Cart is still to be done as it cannot be done until no changes have occurred with his formula feedings for 12+ hr of time. Also very few of the RTs are specialized in performing the test.
Dr. Maryam Valapour rounded & continues to be pleased with the drainage output from the pigtail catheter. Perry & I shared some of what Perry has been concerned about, & she will order for a consult with Psych in order to facilitate his progression. No changes have been needed with regards to his anti-rejection medication levels. She will be in Chicago for a conference but returning on Friday. Dr. Douglas stated Dr. McCurry had been in surgery almost all of yesterday, so he did not receive a return call. He plans to be in contact with Dr. McCurry today to discuss the effectiveness of the tPA & whether the plan will be to proceed with an additional dose of tPA or not. Nothing has grown on the blood cultures done on 10/21.
Since dialysis depletes his energy reserve, I have continued to inquire each week for dialysis to be scheduled later in the afternoon/evening so that PT, OT, & trach capping can be completed earlier in his day which will help Perry to progress with more successful weaning off the vent & to gain more muscle strength & tone. And in so doing then perhaps Perry will be able to see that he is making some progress. Additional questions posed to Dr. Douglas & Dr. Valapour were whether a repeat chest CT scan will be done to evaluate the effectiveness of the tPA; when the next bronchoscopy will be; when the next trach change is to occur; when the modified barium swallow is going to occur as it was ordered several weeks ago but still not been done; whether the plan is to continue with the EMG after the chest blood clot is decreased or resolved.
Answers received were that he most likely will have chest CT scan done in near future; the next bronchoscopy will be at end of November; his next trach change is due 11/5-7; the modified barium swallow will be reordered; & it is uncertain when EMG for diaphragms/phrenic nerves will be done as the physicians didn't want proceed while yeast infection/pleural effusion fluid collection/hematoma are present.
Perry was assisted to stand up very briefly from the recliner x 2 to utilize the bedpan with the help of Nate RN & Chad RN. He then was assisted to stand briefly for a 3rd time & pivoted back to bed by Nate RN & Jason RN.
Trach capping was started @ 140p by Bill RT on 2.5 L supplemental oxygen per nasal cannula. Shortly after starting capping, he became very hot with reddish purple discoloration. Ice cold washcloths were applied to his forehead. He then had another BM & with the position changes & increased tiredness his oxygen saturations decreased to 93-94% despite increasing supplemental oxygen to 4 L via nasal cannula. He was only able to tolerate capping until 157p (17 minutes total) before discontinuing capping. He fell asleep rather quickly after going back on the vent. He awakened briefly @ ~315p & I informed him of the need for me to shower, replenish food, & get to the post office. I unfortunately made it to the post office @ 501p so will have to return tomorrow. Upon my return, he continued to sleep. Nate RN, Nick RT & I tried to get him to try capping again. He's never done capping on evening shift & has to learn to "trust" the RTs. He didn't want to do it at all due to tiredness & weakness, but he eventually said he’d try again. He was able to go from 652p-804p on 4 L oxygen supplementation via nasal cannula, so he was able to complete an additional 1 hr & 12 minutes of capping for today. Praises were given for trying despite having been tired & weak.
No answer has been received yet if they plan to repeat giving tPA. He has had a total of ~600 mL out since the first dose was given on 10/26 & is having only a very occasional trickle of drainage now.
He watched part of the GOP debate. Dr. Udeh came by for a few minutes this evening & reinforced with Perry changes he noticed since last seeing him ~2 weeks ago stating “Perry you look like you have gained some weight. You’re not just skin & bones. You really are making progress.”
He asked his night RN, Indu, to give him Melatonin to help him sleep during the night. By 930p he was soundly back to sleep.