Sunday, 17 November 2013

11th October - hospital stay continues - preparations for going home...

DM rang saying she works in partnership with DF.  DM said she will ring and inform the hospital of what can be put on Rachael’s nose to ease the pressure when she is using the Bipap.  She also said she would get a doctor to have a look in Rachael’s mouth as she believes Rachael may have mouth thrush.

E arrived at 8.15am.  Nurse L came in to discuss Citalopram dosage.  L said she would get the pharmacist to visit this afternoon to answer any queries that Rachael had to ask.  The Doctor saw Rachael on the ward rounds at 1.15pm.  He looked in Rachael’s mouth but could not see any abnormality.  He did point out Rachael’s lips were a bit chapped but stressed this could be remedied with lip balm.  Rachael explained how much her shoulder was hurting her.  Rachael asked if it was possible to have an injection to dull the pain in her shoulder.  The doctor said he would look into it.  Rachael then asked when she could go home.  The doctor said Rachael needed to wait 4 -5 days whilst everything was readied for her to go home.  Rachael got very upset and said she wanted to spend as much time at home with her daughter as possible.  The doctor said he would double check with Dr A.

J, nurse came to take blood from Rachael’s Picc Line.  Rachael stressed that H8 have been adamant about being the only department to deal with the line to prevent infection and clotting.  J said she would have to get somebody to take blood via normal methods.

Dr S, Palliative Care Team visited Rachael to see how she was doing.  Rachael initially discussed how painful her shoulder was.  Her PA asked about injections to numb the pain directly at the site.  Dr S said this was a very difficult procedure and had to be handled by the pain team.  She stressed it would not be impossible for Rachael, just very difficult to numb the right nerve.  Dr S received a phone call from Dr A.  When Dr S returned, Rachael told her that she had been prescribed Citalopram to try and combat her emotional ability.  Rachael also explained that the oxycodone seemed to be reducing the pain in her shoulder, when positioning of a physio hadn’t.  Dr S then explained what Dr A had told her.  He had said that Rachael needs to stay in hospital a few more days so they can see if Rachael tolerates feed and the rate of feed through the PICC line.  He said they need to arrange delivery of a fridge to Rachael’s home, have the correct feed made up and organise when BUPA nurses will be calling.  Rachael was less upset once she knew what needed to be done to get her home.   She asked DR S to inform all the nurses that the PICC line must only be dealt with from people from ward H8.  She said that if Rachael ever gets frustrated or needs someone to talk to ring her on her hospital extension at anytime.  At 3pm the pharmacist visited to discuss the Citalopram.  Rachael explained that she was concerned about the imprecise measurements given by the dropper.  The pharmacist said she would look into whether tablets could be crushed and dissolved.  At 3.30 pm a student doctor came and asked to take Rachael’s bloods.  He looked at the mark on the back of Rachael’s hand and asked if people struggle to take blood from her.  She said the mark was from a canulla and requested blood be taken from the back of the wrist.  He said he would get a nurse to come back.
D, nurse came in to stop machine from beeping.  PA stressed it must only be touched by H8.  D said he will continue feed by another 50 ml, meaning Rachael had had an extra 150ml today.  He said H8 will be up shortly to change bag over.  Pharmacist came back to see if Rachael would feel better about mixing drops with water.  Rachael said she would be happier if she could get a specific volume so the measures are constant.  The pharmacist said she would measure out the 4 drops and get a specific volume.  A few moments later the pharmacist expressed difficulty getting a consistent drop of Citaloprom.  She said she would discuss with colleagues and get back to Racahel with a definite action plan.
The pharmacist rang at 4.45 to say that Rachael’s prescription of 10mg actually equates to 0.25ml.  She said she would try and speak to Dr E over the weekend about upping Rachael’s dose to 2.0mg/0.5ml as they definitely have a syringe to measure that amount.  She also advised Rachael to try the 0.25l in the morning mixed with water and flushed.  Rachael said she would try this.
K from Ward H8 came at 5.10pm to change Rachael’s TPN.  She said the feed would be on over the next 24 hour period and stressed a nurse from her department would change the feed over at roughly the same time everyday.

At 6.00pm Citalopram tablets arrived from the pharmacy.  Rachael spoke to the nurse and said she will wait for drops as she now has a volume o.25ml.  The nurse said she would speak to pharmacy and get back to her in the morning.  This can be administered using a 2.5ml enteral syringe.

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