Wednesday, December 19, 2007

Peggy's Doc Visit Yesterday

Here is a report from Peggy's doc visit yesterday - her concerns and then Dr. Davis's responses:

1. 'Cuff is leaking 2 CC every other day.'
Cathryn took out 15 CC's and put 15 CC's back in. Please do not
manipulate with the cuff is possible.

2. 'Pain in stoma.'
The stoma actually looks good - no bleeding or raw skin. Pain may be
due to the trauma.

3. 'Having extreme hallucinations lately.'
Peggy says that hallucination usually happens in the late afternoon and
had 10 episodes of it so far but none today. Dr. Davis feels that this
may be related to the medications, possibly Oxycodone and Lorazepam.
We need to monitor. Please note the time of the day it happens and
what does Peggy see or hear.

4. 'Reflux is getting worse.'
Not discussed today although not new for Peggy. Please continue to
keep Peggy's head of bed up with feedings. Turn feeding off or hold
during position changes.

5. 'My tummy doesn't hold as much as it used to.
Peggy feels that 200cc of water at one time is too much so water
flushes were split apart
Water schedule changed to:

100 cc 1pm
100 cc 3pm
60 cc prune juice and 60cc of blueberry juice at 1800
100cc 8pm
100cc 10pm with meds

6. 'I'm experiencing choking every night and if I can't communicate that
I'm choking, I'm going to aspirate. This choking problem is the main
reason I'd like to start ALS drug

Not addressed due to Dr. Davis needing to go. But Cathryn put in the
communication log for the HCA nurses to ask Peggy if she is choking in a
yes or question rather then trying to have Peggy spell it out.

8. 'Toe okay'
Toe looks really good but please monitor and continue foot soaks, warm
compress, keep clean and dry.

9.'Skin breakdown on coccyx'
Duoderm to coccyx intact. Please continue to monitor for any
skin breakdown to coccyx, buttock, underbreast, etc.

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