Post for Tuesday, November 3, 2015
Perry awakened during the night for position changes that he initiated as well as those that were staff assisted, oral suctioning, & due to 2 loose stools otherwise he slept fairly sound for Audra RN. She continued to hold his Klonopin & Valproic Acid in order to maintain his BP in the 80s-90s/50s-60s. There was not much drainage other than the initial 80 mL of serous drainage from the pigtail chest tube catheter. Steve RN was his day shift RN. Perry aroused on his own around 9a. His oral mucous secretions have continued to be thicker & cloudy white.
Dean began his PT session @ ~915a with leg exercises. He had Perry also bend his knees & begin to shift his legs from side to side. He then also started to have Perry lift his buttocks upward off the bed which he was able to do for a couple of seconds. I asked Dean if there was a different chair available that was more proportionate to Perry's size with higher chair arms so that he could begin to try to push down on the chair arms to shift his weight while sitting as well as help him to maintain his posture without sliding down or leaning to his left. He is still not able to tolerate prolonged timeframes of upright sitting due to lack of tissue padding to his backside & rheumatoid arthritis. The pressure points persist regardless of being reclined, added seat cushions, & sheepskin padding. Dean was able to locate a chair with a smaller seat & higher arms on a different unit, so he “confiscated” it for Perry’s use. It does not have a high back to provide head support when he tires, but it is a start & will be much better then the recliner. Once Perry is able to stand & pivot 180 degrees, we could position the chair close to the wall & then put pillows behind his head to allow him to rest his head & neck when he tires. Perry has been able to initiate raising himself up from about a 45 degree angle with minimal assist & has been able to start to bring his legs over the side of the bed. He needs assistance to complete the transition to a full upright position, to be brought forward to the edge of the bed, to steady the tremors of his torso, & to have counter-pressure applied to his knees to steady & slow some of the tremors of his legs & feet. After he dangled for a while & after the dizziness & nausea subsided, he stood fairly upright with Dean’s & Larry’s assist & was pivoted into chair @ 955a.
Dr. Olufemi Akindipe, Pulmonologist, rounded & continued to reinforce to Perry that his recovery is definitely going to continue to take a long time & he will need to be patient with the slow progression which unfortunately going to have to be part of the process until his body is able to gain strength. He reinforced with Perry the progression that he notices just looking at him compared to the last time he was on service. I asked for Dr. Akindipe to please write orders again stressing the need for Perry to be dangled by staff at least 3-4 times daily as he still has not been getting dangled except for when Dean assists him to do so & on only a few other very rare occasions. Dean also reinforced with Dr. Akindipe the need for Perry to be dangled in order for Perry's strength & core to be increased. I also asked Dr. Akindipe if he would order for Perry to be able to have thickened lemon ice &/or lemon drops to help break up thick mucous secretions as his oral secretions have been noticeably thicker & cloudy white for the last several days.
Michael happened to FaceTime me at 1055a & was able to see his father be assisted by Dean & Larry to push off on the arms of the chair into a standing position, & then pivoted with assistance back into his bed for the very first time since 8/4!!!! What a great sight for us both to get to see & cheer him on!!!! Upon his return back into bed although it was an hour of sitting, his lower back, sacrum, & buttocks were so very reddened. Hopefully, he will be able to gain the ability to shift his weight soon in order to increase the time he can be in an upright sitting position which will help facilitate breathing, bowel function & his core abdominal strength & tone.
Dr. Richard Fatica, Nephrology, rounded as well & has put in the request for Perry to be the last patient dialyzed in ICU & will request order for a 24 hour urine collection. Ironically, Heather RN arrived to dialyze Perry @ ~1p. Unfortunately, today there are only a few patients who required intermittent dialysis. He is to have a 3 ½ hour treatment for filtration of toxins only.
Dr. Koval, Infectious Disease, rounded & she is in favor of having Perry undergo a bronchoscopy sooner than the projected end of November slated procedure relative to chest x-ray results, the increase in his secretions, & ongoing excessive sleeping.
I had planned to go to the Transplant House to shower & do a few loads of laundry while he was on dialysis, but Perry asked if I would please stay until after dialysis “because I need you here with me.” I reinforced that I will HAVE to do laundry this weekend while Michael & Kim are here.
Rachel RN took over for Steve RN @ 4p. Dialysis was uneventful & completed at 5p. His trach was capped by Bill RT on 4 L oxygen via nasal cannula @ 517p. He had a moderate amount of thick cloudy white mucus suctioned both orally & from his trach upon trach cuff deflation. He needed to end trach capping @ 6p due to exhaustion, discomfort to his sides, complaint of headache @ rate of “5” & oxygen saturations decreasing to 93-94%. Tylenol was given in addition to comfort measures & he fell asleep rather quickly. When I awakened him to tell him I was going to the Transplant House @ 635p, he said “Please don't be gone very long” & asked if I could be back in a ½ hour. Since I so desperately wanted to take a shower that lasted at least a ½ hour, I reinforced that he would be okay & I would return by 8p. He asked that I kiss him when I got back.
Erica RN was his night shift RN. The 24 hour urine collection was not started until 730p. Perry was asleep upon my arrival & he got his kiss that he had requested. He asked that I request Erica to give him Melatonin tonight too with his night time medications. He aroused for brief intervals for assistance to help him turn, suction lots of oral mucus intermittently, & to flip his pillow to the cool side. There still has not been much drainage from the pigtail chest tube catheter.