Post for Friday, October 30, 2015
It was an uneventful night except for the typical awakenings. Nate RN took over for the day shift. Perry left the unit to go for the repeat chest CT scan @ 1025a with the transporter, Nate RN, & Varsha RT. While he was gone, Janelle Romond APRN, BC from Psychiatry came. I began to provide her with details relative to Perry’s past medical history. Perry returned within a short time from CT, & additional information was shared to bring Janelle up to date.
Perry then left to go Radiology Department for the Modified Barium Swallow Study @ 1130a. This is a diagnostic test performed by a Speech-Language Pathologist & X-ray Technician. X-rays are taken of the mouth & throat while swallowing various consistencies of foods & liquids mixed with barium to determine if food is going into the esophagus or instead down the trachea (airway or windpipe). If food or liquid is going into the trachea, it is known an aspiration & can lead to pneumonias & other serious lung complications. The test helps to identify which parts of your mouth & throat that may not be working well, the kinds of food that are safest for the person to swallow, & certain positions or strategies that can help a person to swallow better. The preliminary unofficial report of what was learned according to Nate RN was that Perry was able to tolerate swallowing thick nectars but had trouble with other liquids & was not able to swallow a cracker.
Dean began PT session with leg exercises on the Mini Shuttle Press @ 2p. Dr. Aaron Douglas, Intensivist, rounded @ 215p & reported that the chest CT scan showed an improvement with the loculated effusion having decreased in size from 14 cm wide x 4 cm thickness to 10 cm wide x 2 cm thickness. He checked with Dr. Brian Stephany, Nephrology, regarding the request for Perry to have late afternoon/evening dialysis, & informed him that they were not being finicky but that it would allow Perry to have more successful physical therapy & vent weaning results. Unfortunately, the Dialysis RNs who do intermittent dialysis do not work around the clock, so depending on staffing issues there will be times that he will have to have early morning treatments. Perry was assisted by Dean & Larry to a brief stance & pivoted into the recliner @ 228 while I maintained his trach/vent connection.
Varsha RT began trach capping @ 246p on 2.5 L oxygen via nasal cannula. When his tracheal cuff is deflated to begin capping, he has been having thicker cloudy white mucous noted. Our dear friends from Indianapolis, Greg & PJ, arrived @ ~310p, so I went to greet them in the parking garage to escort them to J5-5 CVICU. It was a nice reunion of friends as it has been a long while since we were able to see each other. Perry was able to talk to them intermittently for a little while as he was capped which was indeed a sign of progress for them to witness first hand.
Janelle Romond APRN, BC & the psychiatrist stopped by briefly as they did not want to interrupt the visit with our friends due to the many positive benefits for Perry especially. It was decided to start him on Lexapro 5 mg daily for now, & they will round on Monday for continuation of his evaluation & to recommended a treatment plan that may be able to assist in decreasing some of his myoclonus by tweaking a few of his medications.
He was able to tolerate trach capping until 418p for a total of 92 minutes. He was then transferred back into bed by lift & able to rest. Greg tended to Perry’s needs as I took PJ on a tour of the Clinic areas that Perry will be transferred to upon release from the CVICU & the rooftop after getting a sample of salted caramel popcorn yogurt & a fu-fu coffee from Starbucks.
Later in the evening, Greg, PJ & I went out to dinner @ Valerio’s in Little Italy, but we missed out on making it to the Italian bakeries before closing time. I then returned to the Transplant House, showered, replenished food items, & returned to the hospital. Perry had requested that I give him a kiss upon my return. According to Katelyn RN, he had been sleeping fairly well prior to my arrival.
“That’s What Friends Are For” by Burt Bacarach & Carole Bayer Sager https://www.youtube.com/watch?v=V22ahe9xzC4