Post for Friday, November 6, 2015
Perry had another uneventful night with his typical awakenings. Rachael RN was his assigned day shift RN. Matt RT started him out on pressure support vent settings. Dr. Akindipe, Pulmonologist, rounded in early morning without significant changes made in Perry’s treatment plan.
Dean began PT session ~945a with leg exercises without & with 3# ankle weights. He was then dangled on side of his bed with complaints of dizziness which abated after several minutes. He was then assisted to stand briefly, returned to sitting position & then briefly stand again with pivot into chair @ 1015a.
Thick cloudy white oral secretions have remained. The generic equivalent for Afrin was administered x 2 sprays into each nostril & Mucinex will be ordered to hopefully lessen the thicker mucus secretions. A repeat chest x-ray was done @ 1035a as Perry has been complaining of back pain & occasional labored breathing. Chest x-ray revealed bilateral lung opacities and effusions not significantly changed since last x-ray.
Kim OT & OT Assistant Maddie came @ 1040a with Kim OT beginning Thera Band arm & shoulder exercises with Perry. Shortly after completing his OT session, Perry was returned to bed @ 1110a by Dean with brief stance & pivot. He fell asleep soon after being returned to bed.
Perry awakened @ 1218 with the complaint of feeling lower chest tightness “like there’s a tight bandage around me” & Dr. Anthony happened to come into his room & was informed of Perry’s complaints. At 1225, the Music Therapist, Laura, came to see if Perry would like to hear some music. He nodded “yes” as he was falling back to sleep right after she asked her set of questions for rating pain, shortness of breath, anxiety, depressed feelings/sadness. She sang “Sittin’ On the Dock of the Bay” by Otis Redding & “And So It Goes” by Billy Joel. He seemed to sleep calmly while she was here.
He had an EKG @ 115p which did not reveal any rhythm or tracing abnormalities. Ally (girlfriend to Matt who is a friend of Ryan’s) came for a brief visit @ 120p. She is a Physician’s Assistant here at the Cleveland Clinic with ENT (Ear, Nose, & Throat) & was on rounds in the CVICU.
At 2p, Neurology physician came to consult on Perry per the request of Psychiatry on 11/4 due to his increased ammonia level of 204 on 11/3. Valproic Acid (Depakene) is known to increase ammonia levels so they will plan to begin to wean him off of the Depakene.
Dr. Koval, Infectious Disease, rounded a bit later & I informed her of his continued increase in sleeping, increased secretions & complaints, as well as having had an increased ammonia level. She was glad I had told her as she mentioned a lung infection, ureaplasma that has been linked recently to lung transplants so she is going to order a blood test to rule it out. She said Doxycycline is the antibiotic used for this particular infection & she will order for a Urea Plasma PCR to be done.
At 410p, Dean PT came for a repeat session & began leg exercises. Perry was given LevOCARNitine (CARNITOR) 2960 mg/14.8 mL IV @ 415p as ordered to facilitate decreasing his ammonia levels. It will be given every 8 hours. Dean then assisted Perry to complete leg exercises using the MiniPress Shuttle followed by dangling him on side of the bed. He then took a long nap.
I took a nap around 630p & was awakened by a very familiar face @ 7p & shouted out his name, Michael, in total surprise!!! Perry was awake already so he was elated to see him. Perry mouthed the words, “Thank you for coming!” & had a very happy smile that I haven't seen for quite some time. He was even smiling in his sleep as Michael & I visited & went to get a bite to eat. Later, we all watched “My Cousin Vinny” (a family favorite) beginning at the scene about what kind of pants Vinny should wear to go deer hunting. It was a nice evening & Perry was able to sleep well. I stayed at the hospital per request of Perry & sent Michael to the Transplant House around midnight.