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Posted 2015-11-17T07:41:00Z

Post for November 16, 2015 - Start of Week #17 in J5-5 CVICU

Perry awakened several times during the night due to loose & watery stools & had a chest x-ray completed as well. Otherwise the night was uneventful with his vital signs remaining stable for Rachel RN. Lora RN was his assigned day shift RN. The Intensivist's treatment plan discussed this morning was for: a chest & abdominal CT scan to be done today; additional diaphragm ultrasound to be completed in near future by Dr. Ajit Moghekar; dialysis & a bedside bronchoscopy to be done on Tuesday; continued weaning off of the Valproic acid (Depakene); re-order for stool specimen to be sent for occult blood as previous specimen sent was not properly collected. Dr. Udeh rounded & also discussed that he is looking into getting the Roho high profile seat cushion ordered for Perry. According to Dr. Koval, Infectious Disease, lots of discussion went on during this morning's meeting to discuss Perry's case with the need for more aggressive management. Two other physicians rounded with her & she mentioned to them he needs to get well enough so that he can undergo diagnostic tests & be further evaluated at University Hospital in Cleveland to determine if diaphragmatic pacers will need to be implanted. There are very few physicians in the U.S. that implant diaphragmatic pacers & the Dr. who developed the procedure is with Case Western & University Hospital. Bill RT had Perry on a CPAP vent setting which he tolerated for a short while. Dean PT was updated by me as to what all had occurred during his absence. He did a few leg stretching exercises with Perry followed by he & Tina assisting Perry to dangle at the edge of his bed. He began to complain of back & abdominal pain, so he was reclined back into bed after being upright for ~10 minutes. A different psychiatrist rounded & was updated on Perry's septic condition & sedation from the fentanyl & Dilaudid so he is just starting to show some improvement as far as his alertness. She will continue to wean Valproic acid & monitor him. Also will order for a thyroid level to be checked. He continued to have several episodes of loose & watery stools which may be relative to antibiotics. I requested a Skin Care RN consult due to several concerns to his behind & scrotal area.  His abdomen remains distended. The C-Diff stool culture was negative (YAY!!!). Another stool specimen was sent for occult blood test. The Levocarnitine which has been given to reduce his ammonia blood levels was discontinued as it may be part of the cause of the abdominal distention & diarrhea. Since the Valproic Acid (Depakene) is being weaned, hopefully the recent high ammonia levels will be returning to normal. Imodium was prescribed & given later in the day to hopefully lessen the frequent loose & watery stools. The Nutritionist rounded & was also updated on the abdominal distention & events of the last several days. Contrast was given via his jejunostomy tube in preparation for his abdominal CT. He was taken for his chest & abdominal CT scans at ~245p. I am still waiting to be informed of results. Hopefully the pigtail chest tube catheter will be able to be removed tomorrow with Dr. McCurry’s review of the chest CT results as that did not occur today. Upon his return, Bill RT brought in a new vent model that has a few additional features that his previous vent did not have. It takes up a little less space which is nice too. Had OT session with Kim completing Thera Band arm & shoulder exercises. He seemed to have less gross tremoring today, so we certainly hope that with the decrease of some of his anti-seizure medications the excessive myoclonus may be lessened. He required intermittent trach suctioning with serous (blood tinged) secretions returned, so still trying to limit the frequency of trach suction. He continues to have a lot of post nasal drip & the need to clear thicker cloudy white mucus secretions that sit above the trach cuff & is rather bothersome to him. His tongue is coated with thrush (yeast) so perhaps that can be creating part of the annoyance as well. Due to the anti-rejection medications, thrush is common & Nystatin is given daily to try to counteract it. At least right now he is not complaining of pain to his tongue or throat which can develop with thrush. He slept intermittently during the evening as my parents & I visited. He was able to sit up in chair mode for ½ hour to watch part of The Voice. His vital signs remained stable throughout the day/evening. He was awake throughout a majority of the day today which has not occurred since our anniversary on October 6th. An overall good day!!! His coloring has improved too. In remembrance of Perry's mother & my mother-in-law, Doreen. She's been missed here among us all for 11 years as of this evening but she's watching over us all & bringing us all together when the moments are right. https://www.mtholyoke.edu/~rghosh/index/quotes/friendship.html

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Comments (2)

  • Dennis G. Barker
    Dennis G. Barker

    It fortifies our souls to be here, to watch the love flow between Misty and Perry, and her near instant responsiveness as to his requirements. They have built a rapoure within this Caring Community which is Cleveland Clinic, both with the staff and their surrounding patients & families as they all strive for wellness! Nurses that demand to be The One that provide MR. PERRY with their Special Care for his needs, yesterday Denise brought in home made Spagehtti for Misty. Todd the prankster made a doorway announcement that "All Illinois Residents Would Promptly Have A Police Escort From The Premises!" Many smiles and words of encouragement from staff & Neighbors that love them! At CC CARE IS A MAJOR PART OF THEIR PRODUCT! Thank you God!

    3 years ago · Reply
  • Joni DeBusk
    Joni DeBusk

    Happy to hear - it was a good day. Always thankful for those. 2:41 am post, seems you are a night owl like your dad but he gets to sleep until 10ish the next day. LOL Steps forward so another good thing. Hopefully the new cushion and trach collar will be big improvements and aggressive management will allow Perry to "turn the corner". No need to remind you and Perry that you have a huge army of Prayer Warrior praying all the time. Hug your parents for me and keep one for yourself. E-Hugs and lots of prayers. Love, Joni & Ken

    3 years ago · Reply