Post for Thursday, November 5, 2015
It was another essentially uneventful night with the usual awakenings during Audra RN’s shift. Audra had gotten a call from Dialysis in the early AM & came to inquire with me that the plan is for Perry to be dialyzed later in the day which I confirmed was the case. A few minutes later, she returned & informed me that unfortunately due to staffing, Perry was going to have to be dialyzed during the early morning. Steve RN was his assigned day shift RN. The Dialysis RN, April, arrived with dialysis equipment @ 730a. I inquired as to why there was a conflict in the 2 phone calls from dialysis this AM & how it is that 730a equates to a late afternoon dialysis since Perry is to be the last patient to be dialyzed in ICU per the request of several physicians so that he can at least have PT & trach capping sessions before dialysis. She stated dialysis is either feast or famine & today there were 6 ICU patients & 6 nurses staffed so all 6 of the ICU patients were being dialyzed at the same time. She contacted the Dialysis Nurse Manager to come to speak with me. Basically, not much can be done from a staffing or budgetary standpoint regarding securing a late afternoon dialysis time & of course Tuesdays, Thursdays, & Saturdays happen to be typically the days with fewer dialyzed patients. Since the ICU PT/OT are scheduled in the house (hospital) on Mondays-Fridays, switching dialysis to a Monday, Wednesday, Friday schedule is not really an option either as he would then have fewer PT/OT two-a-day sessions. Therefore, a treatment plan that would best accommodate Perry’s specific needs, assist in his progress, & help to get him out of the CVICU sooner will cost him (us) even more time & money. I must say, in all honesty, it is so disheartening, disappointing, & overall rather depressing. The words, “I’m sorry” certainly, at times, don’t mean much or quite “cut it” after hearing the same words over & over. As they say, “actions speak louder than words.”
Dr. Akindipe, Pulmonologist rounded & was updated on plan for a Neurology consult requested by Psychiatry, Perry’s oral & trach mucus continue to be thicker & increasing, & that he continues to sleep throughout most all of the day & night.
He slept through most all of dialysis. He began to complain of L flank pain near the end. A total of 700 mL of fluid removed & an end weight of 128.7# which includes his head pillow, pillow between his knees, sheet, & his SCDs (sequential compression devices) on his legs.
Dr. Fatika, Nephrology, rounded. Will continue with dialysis 3 x week. I informed him of the report of Perry’s ammonia level having been checked on 11/3 with 204 result (normal result 17 - 47 umol/L). He said dialysis does lower ammonia level but unfortunately, since it hadn’t been drawn until 11/3 we don’t know for how long it has been elevated.
Trach capping was started by Matt RT @ 128p with an almost immediate complaint of feeling he was going to vomit, sudden increase of saliva, & smell of acidic gastric secretions/breath. The symptoms abated with suctioning, iced cold clothes, & comfort measures. He was initially on 4 L via nasal cannula & then lowered to ~1 ¼ L as his oxygen saturations were 99-100%. He came off trach capping @ 202p due to increasing labored breathing & complaint that his whole upper back was hurting. A total of 34 minutes attained today. He was given Tylenol for the back discomfort & fell asleep almost immediately.
At Perry’s next awakening around 635p, I was able to make calls to both Char & Sam. Char has continued to make progress after her hip replacement & sounded great. Sam was glad to receive our “Happy Birthday” wishes & that we loved him. He & Char both expressed that they were anxious to get to see each other at dinner tonight in celebration of Sam’s 87th birthday!!!! Michael shared pictures taken during Sam’s birthday celebration which I showed Perry when he awakened around 10p to receive his 10p medications. It was good for Perry to get to "see" his Dad on his 87th birthday & could fall asleep with more ease.