Post for Monday, November 2, 2015
Perry had an uneventful night with few awakenings. A chest x-ray completed during the night.
Steve was his day shift RN. A Metabolic Cart was completed shortly after 7a. Perry slept until ~930a. During his PT session with Dean, he was dangled on edge of bed with complaint of dizziness which eventually subsided. Dr. Akindepe, Pulmonology, rounded & Dean was able to provide Dr. Akindepe with an update of Perry’s Physical Therapy progress & abilities. He was later assisted to stand briefly & then pivoted into recliner @1135 by Dean, Julio, & Larry.
Janelle Romond APRN, BC with Psychiatry came to see Perry & explained why it was decided to start him on Lexapro instead of Celexa as originally discussed due to fewer side effects. We were able to provide her with more detailed information that will be beneficial for a plan for him to be devised. I showed her the video of Perry taken last week which gave her even more insight.
Dr. Koval, Infectious Disease, rounded & has been pleased with his progress. She made no changes in his treatment regimen, & he will continue to receive a daily IV dose of Micafungin.
Eucharistic ministers then came by today, so we were able to receive communion & prayer.
The Nutritionist also rounded with a review of today’s Metabolic Cart with the plan for him to receive 2310 calories/day, continue with Novasource Renal Complete Nutrition formula @ 60 mL/hr (overshooting the amount to take into account the many times that his feedings are interrupted for therapy, medications, & procedures).
He requested to be returned to bed by ~1245 due to discomfort to his behind. The lift team arrived ~115p & instead of having to wait even longer for Jason’s availability, the lift team & I returned him back into bed @ 130p. Perry fell asleep shortly after being settled back into bed.
At 216p, Dr. Dale Marsh, Intensivist, administered tPA 2.5 mg in 50 mL sterile normal saline into the L pigtail chest tube catheter without difficulty & then clamped. Total amount of drainage from pigtail chest tube catheter since placed on 10/17 has been 1000 mL, so an approximate total of 700 mL since he’s received the tPA. A new drainage container was applied today so accurate measurement of the output from today’s tPA could be accounted for since the original one had been tipped over a few times & the previous drainage had gone into 3 different columns. Perry continued to sleep & was awakened for position changes to allow the medication to hopefully circulate better around the pleural effusion. The pigtail catheter was then unclamped @ 520p.
His weekly IV Erythropoietin was given to help stimulate red blood cell production due to his low hemoglobin levels.
He awakened around 6p & although exhausted despite having slept almost the entire day, he agreed to a trach capping which Bill RT started @ 635p on 4 L supplemental oxygen via nasal cannula. He became warm again shortly after starting, so iced cold washcloths were applied & I provided fanning rather continuously. He was ready to stop by 730p but I pushed him with more encouragement to continue until at least 745p. By the time the RT was able to gather supplies needed it was 752p before he went back onto the vent. He was able to complete 77 minutes total. Tylenol was then given for complaint of headache a few minutes after the cap was removed by Audra RN, his night shift RN. He returned back to sleep not long afterward.
Between 930p-10p, his BP readings were recording in the 60s/40s but he was able to be aroused without difficulty & he was oriented to time, place & person. Shortly after 10p, his BP 76/47 so his Klonopin & other anti-seizure medications which tend to lower his BP were held.
At 1020p, his BP 81/51 with an eventual 90/54 reading before 11p. He has continued to remain asleep without further issues. The total amount of drainage from the pigtail has been ~80 mL less 50 mL of the normal saline included with the 2.5 mg of tPA so only 30 mL in actuality has drained.
Good news was received today that Sam's L hip fracture has been healing very well, & he was given the okay to fully weight bear on his L leg & to proceed with his aortic heart valve replacement procedure. He will be 87 years of age on Thursday, November 5th.