Post for Wednesday, November 4, 2015
The night was uneventful. A repeat chest x-ray was done. His day shift RN was Steve. And Danielle was his assigned RT. Ryan was asking me about Perry’s lab results for today, so I’ve included a few: Hemoglobin 7.7, Hematocrit 24, BUN 33, Creatinine 1.31, GFR 57 compared to yesterday’s BUN of 83 pre-dialysis & 20 post-dialysis & Urea Reduction Ratio 76, Creatinine 2.31.
Dr. Akindipe & resident rounded & will plan to order a bronchoscopy next week instead of waiting until the end of November & change his trach at that time instead of changing his trach 11/5-11/7. Since Perry has gained a little more strength & it has been awhile since Perry has undergone trach collar breathing, he would like to see how Perry tolerates trach collar breathing in addition to trach capping.
Dean will plan to work with Perry twice a day on Mondays, Wednesdays & Fridays. Dean also has been given permission to come in & work with him this Saturday as Dean is typically assigned to work in the Outpatient PT on weekends. Today’s PT session included leg exercises, dangling Perry on side of his bed with 3# ankle weights applied to decrease leg tremors, assisted & supported standing from sitting position by Dean & Tina with Perry holding onto walker during the transfer into a stance & return to sit back down on the bed. He then stood briefly with Dean’s assist & was pivoted into chair @ 1055a.
From 1120a-1155a, Kim OT worked with Perry using Thera Bands (stretch bands) to complete 3 different upper extremity exercises - elbow flexion (biceps), elbow extension (triceps), & shoulder horizontal abduction. She provided him with handouts for these & more advanced Thera Band exercises for the future with goals to do 10-20 reps 2-3 times a day. She then used my computer table to also have him press 5 small plastic pieces into therapeutic putty & then roll the putty into a ball to hide the plastic pieces. He then had to search to find the plastic pieces with pinching & pulling apart the putty. Kim OT will plan to work with Perry also on Mondays, Wednesdays, & Fridays. Her schedule is at times more flexible, so she said to page her if Perry is ready for a session on those days which may help Perry to have a sense of control in part of his day.
At 1200n, he was assisted to stand & pivoted back into bed by Dean, Larry, & Tina. He soon fell asleep.
At 229p, shortly after awakening him, Danielle RT provided trach suction x1 & then started him on trach collar breathing on 10 L humidified oxygen supplementation followed by additional trach suctioning. He became hot & sweaty not too far into his trial. I lowered his gown off of his torso (I usually do this during all of his trach cappings as he gets so hot, & it allows me to visualize his abdomen for increased labored breathing signs/symptoms), applied iced cold clothes to his forehead, & fanned him. Danielle provided additional trach suctioning with a moderate amount of cream mucus returns. He was running out of energy by 3p; however, with it being change of shift @ 3p Danielle RT & Varsha RT were not available as they were in process of shift report. He also began to complain of mid upper back & side pain which he rated @ a “9” on 1-10 scale with 10 being the worst. At 328p, he was returned back to the vent by Varsha & additional trach suction completed with moderate amounts of cream mucus returns. Melissa RN took over Perry’s care @ 330p.
At 345p, Dr. Naveed Khokhar & Janelle Romond APN from Psychiatry rounded. They are still in favor of Perry being weaned off of some of the anti-epileptic medications in particular Valproic Acid (Depakene) as his ammonia level was 204 yesterday (normal result 17 - 47 umol/L). They have requested Neurology to consult.
Denise CT (Clinical Tech) gave him his bath. She was going to shave his overdue whiskers, but Perry has decided to grow out a mustache & beard for the month of “Movember” meant to increase the awareness & education of serious health issues affecting men: prostate cancer, testicular cancer, poor mental health, & physical inactivity (hence MOVEmber). Refer to: https://us.movember.com
Perry continued to sleep a majority of the late afternoon & evening only awakening for turns & suctioning. He has continued to have thicker cloudy white mucus orally & slightly light cream colored mucus from his trach today with need for more frequent suctioning throughout all of today. At 730p, the 24 hour urine collection completed. He requested Audra RN to give him Melatonin @ 9p in order to sleep through the night.
There has been 130 mL drainage from L pigtail chest tube catheter since tPA was last administered on 11/2; however, the 130 mL drainage output includes the 50 mL sterile normal saline that was used to dilute the tPA so there’s only been a total of 80 mL actual drainage.