Post for November 1, 2015 - A Long Night Made Even Longer Due to the End of Daylight Savings Time & Breathing Issues
Post for Sunday, November 1, 2015
Perry continued to require an increase in oral suctioning with thicker cloudy white oral saliva & mucous returns into the early morning hours. While he was sleeping, Lora RN also noticed that he began to make noises as though secretions where in the back of his throat with a stridor type of a noise & some vocalization noises too & she continued to provide intermittent oral suction as well. He awakened around 110a & complained of feeling as though secretions were stuck in the back of his throat & labored breathing. His oxygen saturations remained 98-100% & his color was pink. He tried frequently to cough & clear his throat. An occasional ice chip was given in attempts to help liquify any thick mucous with additional intermittent oral suction. Maryanne RT suctioned down the trach with moderate amounts of cloudy white mucous returns as well & both Lora RN & I provided frequent oral suctioning as needed. He continued to feel as though there were secretions stuck in his throat. Oxygen supplementation of 4 L via nasal cannula was started & Maryanne RT deflated the trach cuff with very little amounts of mucous if any were brought up & his cough was not effective in clearing any further secretions. Maryanne RT completed saline lavages with cloudy white mucous returns. His trach cuff was reinflated with 10 mL sterile water & he was returned to the vent. The oxygen supplementation of 4 L via nasal cannula was continued. Since he continued to complain of feeling as though secretions were stuck & labored breathing, she passed a suction catheter into his nose in attempts to suction his nasopharyngeal area with very little secretions suctioned out. He began to make repetitive involuntary vocalization & stridor noises. Throughout the entire timeframe, his oxygen saturations remained 98-100% & his color remained pink. He was feeling warm although his temperature was not elevated. I applied cold clothes to his forehead & his formula feeding was stopped. The “On Call” Intensivist was notified & she came to see Perry. She did not want to sedate him in order to pass a laryngoscope to determine if he had anything stuck in his throat or trachea/vocal cords due to the hour & due to there being fewer personnel in the house. He was tiring & in addition to Chloraseptic spray being given, he received Ativan 1 mg IV in attempts to make him comfortable. About every 30-45 seconds a pattern of 4-7 involuntary stridor & vocalization noises continued in addition to wetness with Lora RN, Maryann RT, & I considering such to possibly be laryngospasms. He was given Fentanyl IV ~445a & soon thereafter the involuntary stridor & vocalization noises were rather continuous. Thanks be to God the entire time his oxygen saturations remained between 97-100% & he remained pink although exhausted with labored breathing. By ~720a, Bill RT was at Perry’s bedside & he made a few ventilator adjustments, increased the amount of sterile water added to his trach cuff & soon Perry was able to rest & fall asleep with less labored breathing. Of course since the clocks were changed during this event in reality the amount of time was an hour longer.
Tracy was his day shift RN & he was allowed to rest. I was able to rest intermittently as well from 730a-11a. The Pulmonology resident rounded but no specific interventions were ordered nor were any additional interventions completed or ordered by the Intensivist. Perry slept almost the entire day with in between awakenings for suctioning, position changes & to use the bedpan. No trach capping was completed, & he remained on a rate on the vent to not “rock the boat.” It was a very long day, & I must admit I was tearful at times as it was hard to watch Perry endure such a long span of labored breathing with increased exhaustion, & I witnessed yet another person being able to be transferred from J5-5 CVICU. Plus, it is now the start of another month, & it is so hard to believe that it is now November. Dr. Douglas rounded later toward the evening & the plan is to still do a trach change later this week but they may or may not decrease the size of his trach to a 7 as a size 7.5 is more conducive for bronchoscopy. He may or may not have a repeat bronchoscopy before the end of November. A repeat dose of tPA is currently being planned for Monday. Perry was awake for a short bit so we watched some of America’s Funniest Home Videos - at least I got to laugh a little this evening which did help. We were able to Face Time with cousins Nick William & Monica as well as Sam & Char, Nick & Tonya, Jim & Diane, & Nikki & Dean. Sam is to have an appointment tomorrow, November 2 to determine if he will be able to begin to weight bear on his L leg & be able to proceed with scheduling his heart surgery. Char is doing well her hip replacement recovery.
His night shift RN was Kelsey & Maryanne was his night shift RT. Perry requested another dose of Melatonin in order to sleep throughout the night. He did not experience any further incidences of labored or abnormal breathing episodes throughout the day or into the evening.