tag:blogger.com,1999:blog-64252925158666070662024-03-14T00:04:05.188-07:00Notes to SelfDoes what it says on the tin! Notes to self. A diary, if you will, recounting and recalling my life thus far, with and without MND.KBhttp://www.blogger.com/profile/14336456654246398684noreply@blogger.comBlogger470125tag:blogger.com,1999:blog-6425292515866607066.post-8254524090227134682013-11-17T01:24:00.001-08:002013-11-17T01:24:19.589-08:00Dehydrated<div class="MsoNormal">
13<sup>th</sup> October (Sunday)<o:p></o:p></div>
<br />
<div class="MsoNormal">
Two nurses hoisted Rachael to change her pad and clean her
with I's help. Rachael reported that
she felt dehydrated at 4.30pm. The nurse
made a note of this and said that she will also inform the doctor. The nurse came back to say that a doctor will
be coming to see Rachael re being dehydrated.
He may need to put a IV line in to hydrate her. Rachael wants to make sure that the TPN team
are made aware of what happens. The H8
nurse came at 6.30 to change Rachael’s feed.
She will make sure that something is done about Rachael’s
dehydration. Rachael’s syringe driver
was changed at 6.50.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com4tag:blogger.com,1999:blog-6425292515866607066.post-73927197616453683492013-11-17T01:23:00.002-08:002013-11-17T01:23:32.744-08:00Blood thinners..<div class="MsoNormal">
12<sup>th</sup> October (Saturday)<o:p></o:p></div>
<div class="MsoNormal">
Rachael finally received her Citalopram liquid and took
0.25ml. The nurse was asked to check if
it was ok to take the Citalopram at the same time as Lorazepam and whether
there would be any interaction between the two drugs. She was told that it was fine to use both and
that there should be no side affects.
Rachael has been having problems with her catheter again. Nurse L gave Rachael a bladder wash but
it doesn’t appear to have improved Rachael’s discomfort.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
Nurse L also informed Rachael that, as her blood base
line readings are as they should be if she were at home she no longer is being
prescribed “Blood thinners”. Rachael however thought Dr A had said that
she should continue with the medication.
This will obviously need clarifying with Dr A.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-77471369635131499192013-11-17T01:21:00.002-08:002013-11-17T01:22:08.873-08:0011th October - hospital stay continues - preparations for going home...<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<div class="MsoNormal">
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.<o:p></o:p></div>
<br />
<div class="MsoNormal">
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.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-39677452248237020822013-11-17T01:16:00.000-08:002013-11-17T01:16:03.888-08:00PICC Line procedure was a success..<div class="MsoNormal">
10<sup>th</sup> October<o:p></o:p></div>
<div class="MsoNormal">
Nurse came to take bloods at 11.30 wanted blood from right
arm so results would be correct.
Rachael wasn’t happy about this so nurse went to speak to doctor and
decided they would just take them from the PICC line. S arrived to come down with E and
Rachael to have the Picc line.
Everything went smoothly apart from the fact that they couldn’t x-ray
Rachael in her chair. She had to go in
the bed but was kept elevated as much as possible. Rachael’s arm is quite sore but the actual
Picc line is fine. We have been advised
not to touch the Picc line and to leave it to the professionals. Brother and B visited, so put a smile on
Rachael’s face. When giving Rachael her
bedtime drugs the rig kept getting jammed – only solution at the time was to
force back then try again. This was
successful! Citalopram has been prescribed to start on 11<sup>th</sup> October
says 4 drops on bottle but nurse advised 10 ml.
Double checked and on their system it says pills so as liquid has been
given, nurse advised wait for later on to get correct dosage.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<br />
<div class="MsoNormal">
<br /></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-63893546099112091942013-11-17T01:14:00.001-08:002013-11-17T01:14:26.492-08:00Visit from Dr E - hospital rounds (9th October)<br /><div class="MsoNormal">
Doctor – morning rounds.
After telling and showing the doctor how swollen Rachael’s feet are he
said there wasn’t a lot he could do,
adding that water tablets wouldn’t help as the swelling is due to
positioning. I explained that R had been
put on water tablets and asked if they could be stopped – he was happy for that
to happen. The Doctor reassured us that
Rachael is on the licat for a new PICC line tomorrow (10<sup>th</sup>
October). We asked if he had had any joy
finding out what time the procedure will be taking place – he said he had
phoned but couldn’t give a time. I asked
if he would try and find out if it would be am or pm at least. We explained that R was still having problems
with R’s catheter as it doesn’t appear to be draining properly. He said he would try and get someone from
urology to come and have a look. Just as
they left R was in pain with her stomach.
I had tried to release some air with no joy so Rachael asked me to ask
the DR to come and have a look, he had a fell and reassured us that it was just
air after a few more attempts to release the air it worked.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Dr E and S H S (MND Nurse) came to see
Rachael following S's chat with Rachael yesterday. S ran over what her and Rachael had talked
about yesterday (8<sup>th</sup> October) with Dr E and S trying to find
solutions.<o:p></o:p></div>
<div class="MsoNormal">
Dr E wasn’t sure what to suggest regarding Rachael’s
shoulder pain so said he would speak to physio.
He ran over what would happen tomorrow when Rachael has a new PICC line
put in to make sure Rachael was happy.
We asked if he was able to find out what time it may happen but he had
had no joy.<o:p></o:p></div>
<div class="MsoNormal">
Both Dr E and S were keen to try and help Rachael
control her emotions. They strongly
recommended trying an anti depressant drops.
Rachael has tried in the past and wasn’t keen but is willing to try
again.<o:p></o:p></div>
<div class="MsoNormal">
The physio from the MND clinic came to see R regarding her
shoulder after taking a look she asked R if she would consider an injection in
her shoulder to stop any pain. R said
yes so she said someone would do it soon, she also asked if Rachael would mind
if she rang wheelchair people to see if there is a better back cushion that
would have less pressure. R was happy
for her to do this. I asked if she would
have a look at Rachael’s swollen feet.
She confirmed that the swelling was water, she said the best thing we
can do is massage the feet pushing the water up R’s leg. This seemed to work using a little cream to
stop any friction.<o:p></o:p></div>
<br />
<div class="MsoNormal">
I have tried to phone D F re Rachael’s mask on
bipap causing Rachael to have some cuts in Rachael’s mouth (inner lip) there
was no answer so I will take her number and phone again tomorrow.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-12978608551657833142013-11-17T01:11:00.002-08:002013-11-17T01:11:33.430-08:00Cold feet..(8th October)<br /><div class="MsoNormal">
E arrived at 8am greeted by S who explained
procedures. R was hoisted at around 10am
due to by passing fluid onto pad rather than through catheter. E spoke to nurses P and A who have
requested someone from urology department to come and look at the catheter to
see why Rachael is bypassing. Macmillan
nurse came to see Rachael to check about discomfort. Told her she was still having trouble with
her left shoulder. She advised she will
speak to someone regarding physio. 3
doctors came in to explain about Rachael having an x ray and pick line done on
Thrusday. Rachael requested a specific
time as she wants S to be present.
Doctors said would ring and find out.
Rachael was hoisted again, this time with much less messing about by E and P (nurse) at around 2pm as pad was wet again. S the MND nurse spoke with R regarding 3
main topics – shoulder pain, emotions and the procedure with the pic line. R got very emotional explaining she can’t stop
crying. Brother visited at 7.30pm R has been
complaining about her cold feet especially her right one. Brother spoke to the nurse to see if any other
way of keeping feet warm. They said to
keep feet raised and they will inform doctor in the morning. Also bipap starting to cut into R’s
nose. R requested to ask Z to speak
to D F about it. We then
resorted to battery socks but due to swollen ankles socks were causing
discomfort. Sister saved the day by
handing over the ones she was wearing when visited with B. Before bed checked leg bag and was empty and
Rachael was bursting for a week. I
rubbed tube and could feel it blocked.
Spoke to nurse who came to syringe the catheter but was no joy as it was
blocked up so the nurse put an urgent call out to the doctor. By then Rachael had already relieved
herself. Rachael was hoisted. Still no
sign of doctor by 11.15pm. Doctor came
at 11.30pm and put a new catheter on.<o:p></o:p></div>
<br />
<div class="MsoNormal">
<br /></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-57659563194511134292013-11-17T01:08:00.003-08:002013-11-17T01:08:34.615-08:006th October<br />
<br />
<div class="MsoNormal">
M arrived at 8am.
Racahel was in pain with her shoulder, arm, bottom and neck. She had pain relief throughout the day. Rachael was hoisted and repositioned at
12pm. Rachael asked again for the IV
nurse to look at her PICC site as it is still aching. The nurses were unable to contact her and
will try again tomorrow. S and E visited Rachael in the morning and R visited later on in the afternoon.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-23095898621680401112013-11-17T00:40:00.002-08:002013-11-17T00:40:19.327-08:00Hospital stint continues - 5th October<br /><div class="MsoNormal">
PA I arrived at 8am and took over from Z. At 9am Rachael was hoisted and given a
freshen up. Unfortunately when she was
put back in her chair her pad was causing a burning sensation on her
bottom. Nurse P and I then
re-hoisted Rachael to correct this problem.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
Rachael’s arm where her PICC line is sited has become
sore. The IV nurse took a look and
decided there was no sign of infection.
She suggested the problem was being caused by irritation from the line
within the vein itself. She recommended
warm compresses be applied around the IV site to ease the pain. She said she would ask the nurses to organise
this (10.30am) As of 14.40 no compresses have arrived. At 15.30 the staff nurse, after chasing her
up arrived with warm compressers in the form of pieces of gauze soaked in hot
water. These were totally unsuitable for
purpose. Rachael’s arm has continued to
be sore and is gradually worsening. The
IV nurse needs to be contacted tomorrow to try to resolve this problem.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-65720197504581153372013-11-17T00:38:00.004-08:002013-11-17T00:38:40.779-08:003rd October<br />
<br />
<div class="MsoNormal">
E arrived at 8.30am. S gave a list of instructions
which must be passed on. Dr A is
to visit Rachael to discuss installing a PICC line. S needs to be advised
when the appointment is made for. The
nurses have requested we use the fold up bed at night. Blankets can be found on the bed. A nurse must be called for extra pain
medication, cleaning and hoisting, water, if the suction machine needs
emptying, alarms on the machines go off.
Also the nurses are weighing Rachael’s urine so please advise a nurse
when you have emptied her leg bag.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-61051447347130652132013-11-17T00:37:00.004-08:002013-11-17T00:37:33.615-08:0029th September Cough assist stopped working<br />
<br />
<div class="MsoNormal">
M arrived at 8am.
Rachael had had breathing difficulties during the night. Her cough assist machine isn’t working. D and R arrived. W hospital could not be contacted
til tomorrow. The nurse sent for a
physiotherapist to come and assess Rachael’s breathing and to use the cough
assist machine. Dr B came to visit
Rachael. He listened to her chest, which
was ok. He also checked her bloods. Rachael requested a hoist so that she could
be cleaned. She had to wait for over an
hour for this. The physiotherapist came
and assessed Rachael. She used the cough
assist and suction machine. She arranged
to come back this afternoon before 4.30pm and then send a night physio at
10.30pm . Rachael was getting very
panicky and upset due to lack of breath.
The suction machine was used repeatedly<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-38847995347848604382013-11-17T00:35:00.005-08:002013-11-17T00:35:47.991-08:0028th September - still in hospital..<div class="MsoNormal">
I arrived at 8am.
The nurse arrived with a full set of Rachael’s drugs that Rachael had
already had. These were sent back. Rachael had a Phosphate tablet as her salt
levels were low. The site of the driver
entry on Rachael’s arm is sore and twitchy.
Rachael asked the nurse to take a look and also get a bag from the
pharmacy for the driver machine. Nurse
N moved the driver needle further back on Rachael’s arm. Rachael refused the suggestion that the needle
be placed on her left arm or stomach.</div>
<div class="MsoNormal">
<o:p></o:p></div>
<br />
<div class="MsoNormal">
At 10.30am Rachael suffered a bladder spasm which required
hoisting. Unfortunately it was staff
break time so Rachael decided to wait rather than hoist with only one
nurse. Rachael has been struggling with
her breathing. Nurse N was asked to
chase the Palliative care team at W hospital but nobody available until the
morning. Nurse N also forgot to order
a driver bag. She said she will do this
in the morning. Rachael’s new driver
site has become sore so it was moved to her right thigh. This needs to be monitored.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-18305251247633424092013-11-17T00:24:00.001-08:002013-11-17T00:24:13.182-08:0027th September - hospital stint continues - visit from Dr E<div class="MsoNormal">
27<sup>th</sup> September<o:p></o:p></div>
<div class="MsoNormal">
On morning rounds the doctor said Rachael’s nutrition needs
building up so she should continue with the feed through the PICC for at least
a week, whilst a long term solution is found to Rachael’s stomach problem. The doctor was unsure as to whether Rachael
would ever be able to find feed via the rig again. Unit a solution is found Rachael will remain
on a drip with additional vitamins.
Rachael is tolerating the PICC feed.
The palliative care nurse came to see how Rachael’s pain is today. She was happy that Oxycodeine was working
better than Oramorph but thought Rachael would benefit from a higher dosage via
syringe driver and stressed she is still happy for Rachael to have an extra
dose whenever needed. Rachael explained
that she is in pain after meds are given through the rig. The nurse promised to look into this to see
if there is any other way drugs can be given.
Rachael asked if she could ring Wythenshawe re cough assist
machine. Rachael said the pressure nees
readjusting. After discussing Rachael’s
bowel movements, the nurse thought Rachael may have a blockage, so she has
arranged for a rectal examination next time Rachael was hoisted. Rachael has been biting inside of her mouth. The nurse recommended bonjela.<o:p></o:p></div>
<div class="MsoNormal">
After reading Rachael’s notes Dr E had a look at Rachael’s
drugs list to see if he could reduce the amount going through the rig. Dr E decided to stop the Riluzole, ferrous
fumerate and Domperidone for the time being.
He also asked Rachael about end of life matters. Rachael got upset and asked to speak to him
on Monday or Tuesday. Rachael needed
hoisting so Dr E volunteered to do the rectal examination whilst she was in the
air. He said he couldn’t feel anything
so he was happy that Rachael didn’t need to take suppositories/ laxatives over
the weekend.<o:p></o:p></div>
<br />
<div class="MsoNormal">
<br /></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-89466736770533120342013-11-17T00:22:00.001-08:002013-11-17T00:22:39.066-08:00Pain relief - 26th September<br />
<br />
<div class="MsoNormal">
At the morning visit, the doctor decided Rachael needed some
vitamins before they start trying to feed down the new PICC line. The doctor said she would need to take these
for the next four days via a drip. The
macmillan nurses visited to discuss pain management. Rachael explained that Oramorph via rig
wasn’t helping with the pain, it caused more pain forcing Rachael to sleep
through it. The doctor decided to try
Rachael on Oxycodeine; to be given as a background pain killer through a
syringe driver over a 24 hour period.
Extra pain relief can be give an Rachael’s request through the butterfly
needle in Rachael’s leg. Macmillan nurse
said they are in hospital all week if Rachael needs anymore questions
answering. Rachael had some bloods taken
through the PICC. Syringe driver set to 0.38ml/hr extra pain relief Oxycodeine
1.25 mg<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-80907860781260594362013-11-17T00:21:00.000-08:002013-11-17T00:21:26.296-08:0025th September - hospital stint continues..PICC line procedure<div class="MsoNormal">
<br /></div>
<br />
<div class="MsoNormal">
Rachael was taken down to x ray via
porter. After a 30 minute wait, Rachael
entered the x ray room. After giving
lengthy directions on how Rachael must not be lay down under the X ray due to
respiratory problems a nurse emerged to help hoist. Once pillows had been stacked on table,
Rachael was hoisted. The pillows were
inadequate and after a few minutes of trying to support Rachael’s head, Rachael
asked to go back in the chair. The
radiographer explained that once the Barium was in Rachael’s body it could take
upwards of 2 hours to complete the procedure, with x rays being taken every 20
minutes. Rachael protested that A&E
had said she could be scanned in the chair.
The radiographer explained this would never have been possible. Rachael felt she would be unable to last for
2 hours, being hoisted onto table of back into the chair. Rachael was very distressed upon getting back
to the room, a nurse came to scan Rachael’s arm to see if a Picc Line could be
put in. Rachael had some difficulty in
putting her arm out to a right angle.
The surgeon said a main PICC line would not be possible. This distressed Rachael greatly. After some thinking the surgeon once again
scanned Rachael’s bicep and said he could possibly put in a peripheral line. He enlisted the help of a student doctor to
hold Rachael’s arm in place throughout the procedure. He said he would be back later after an x ray
to see if it had been successful. The X
ray team came with a mobile machine. Rachael
was hoisted into bed of an x ray taken.
The surgeon came back almost immediately saying the Picc line was in her
jugular vein, not her chest as he had wanted, meaning he would need to pull
some out. He did stress the line would
still be usable despite it now only being a mid line. Procedure was carried out with PA holding
Rachael’s arm in place. Rachael was shattered
after the days hoisting and was up and in pain every 15 – 45 minutes throughout
the night.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-34646344969324173512013-11-17T00:18:00.001-08:002013-11-17T00:18:09.197-08:00PICC line discussion - 24th September <br />
<br />
<div class="MsoNormal">
Rachael was moved to a room - Rachael had a
rough day. Nurse T was very lovely
and treated Rachael like a human being rather than talking down to her. Rachael was asked if she wanted a procedure
to enable her to be fed through a PICC line.
It also meant that they could administer drugs and take blood more
easily. Brother read out the information and
signed on her behalf after Rachael had confirmed the Lydocaine would completely
numb the arm and not cause pain.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-75379205484422854152013-11-17T00:16:00.002-08:002013-11-17T00:16:38.769-08:00Birthday - day release from hospital<div class="MsoNormal">
Brothers arrived on Sunday morning and took Rachael home on
her birthday. Rachael said she would
like visitors to her however could we stagger them. Rachael was met by Z and M who were able to
give Rachael a shower which was something she really wanted after not being able to have one in the hospital. My sister and her family arrived with AJ with gifts. Later brother and Rachael’s
mum and dad arrived where happy birthday was sang with a carrot cake made by AJ. At 5pm Rachael felt she needed her drip so brother D drove Rachael back to the hospital with B followed by M. Rachael got to the ward at 6.30pm and had to
wait nearly an hour for her drip to be put on.
At 8pm S arrived but the suction machine had lost a knob on the
side. During the night the nurses complained
at S as Rachael was in a female ward. S told
them that Rachael needed a room and that he needs to be there. During the day Rachael saw a specialist in
Gastro-Entereology who said that they wanted to carry out a barium test. During the day the ward manager complained at
S again that he was sat on the bed and that he was in a female ward. S arrived at 7pm and spoke to the nurses also
and told them there were 3 options: move Rachael to a room, stop complaining at
S and put up with it or Rachael would have to leave the hospital. Also S had told the ward manager that Rachael
needed to be cleaned and change of her pad.
Rachael was waiting over 30 minutes
- S complained to the nurse. Dr E
visited.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-57064365376297629412013-11-17T00:10:00.001-08:002013-11-17T00:10:40.367-08:00Hospital stint..<div class="MsoNormal">
20<sup>th</sup> September<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Rachael is once again not tolerating drugs, water or
feed. She is in absolute agony and seems
to be producing huge amounts of yellow bile which is leaking from the rig when
left open. When we go to syringe air
from the rig to try and minimise Rachael’s pain, it is pulling yellow bile out
into the syringe. The thought of having
a feed is causing Rachael distress. She
simply cannot tolerate another bolus feed today. Even Oramorph is not helping with the
pain. C left a message with dietician to
call back urgently to try and help remedy the situation.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
N rang re: message left and asked for specifics of Rachael’s
current condition. After running through
a list of questions, N said that it sounds like Rachael is suffering from
either chronic constipation or gastric reflux.
N said to get Rachael to see a doctor so they can review the
situation. N said she would ring back on
Monday to see how Rachael got on over the weekend.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Spoke to Dr O who asked how Rachael was. Explained Rachael was in constant agony
today, with the pain peaking when anything is put through the rig. Explained Rachael was also losing a lot of
yellow bile through rig when its open.
Dr O said she could come and assess Rachael when surgery is finished, at
around 6.30/7.00pm. Dr O did say that
she thought Rachael needed to go to hospital to be assessed.<o:p></o:p></div>
<div class="MsoNormal">
Brother got to Rachael’s for 5.30pm. Rachael was in a lot of pain in her
stomach. Dr O (GP) came at 6.30pm and
examined Rachael. Dr O said that Rachael
was particularly sore on the stomach. Dr
explained that she could treat Rachael with other drugs however as this hasn’t
worked before she recommended going to hospital. Rachael said she hates the idea but she can’t
go on like she has been. Dr gave Rachael
the option of a local hospital or SR. Rachael
chose SR. Rachael, S and E
arrived at the hospital at 8pm. Rachael
was seen by triage and her blood pressure, pulse and temperature were
taken. We were then taken to a room in
Majors. Rachael had blood taken from her
although the first attempt made her vein swell and possibly bruise. Temperature, pulse and blood pressure were
taken again. We were then moved on to
the Emergency Assessment Unit room 20.
We were asked to put Rachael in a bed and they were told no as she can’t
go into the bed as it affects her respiratory system. Rachael needed to change her pad so we asked
for the hoist which they brought but didn’t know how to use it. 3 nurses lifted Rachael into the bed which
she was fine with for a few minutes. The
nurses with E supervising changed Rachael’s clothes, pad and dressed a pressure
sore on her bottom. She was then lifted
into the chair. S and E enjoyed a cold
McDonalds meal. At 5 am Rachael woke in
pain and asked for pain relief. The
nurse told S and R they were giving her 2.5 ml or 5 of another
measurement. Rachael felt woosey and was
unable to communicate. Rachael then
slept. At 6am Rachael complained of gas
in her stomach which was syringed. At
6.45 R arrived and took E home. At 8.00
am a new nurse introduced herself and carer arrived. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The new nurse informed us Rachael had been given 5 ml of
Oramorph not 2.5 ml as they were told. S
told the nurse that Rachael can’t communicate if she is given more than 2.5
ml. The nurse informed Rachael that she
would need to go on a trolley for the x ray.
She said that it would be 5 – 10 minutes. Rachael said that she would be fine with
that. At 8.45am I gave Rachael her
morning drugs. At 9.10am Rachael was
transferred to a trolley and taken through to X Ray. It was very traumatic for Rachael especially
when they tried to lie her back.
Eventually they decided to X ray Rachael sitting up which worked. Once back in the room the nurses and I washed
Rachael and then transferred her back to her chair. The hoist was used to lift Rachael to change
her pad and straighten her blanket.
Rachael was transferred to ward L2 at 10.30. She was placed on a main ward with 7
beds. Rachael had 4 loose bowel
movements throughout the day and night.
She was in pain through hoisting on all but the last hoist.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Rachael saw a doctor at 6pm (approx.) and after discussing
her options with him she decided to go with his recommendation of staying the
night and then going home in the morning so that she could spend her birthday
at home. This option did involve Rachael returning to the ward
Sunday evening so that she could be seen by a Gastro-Enterology specialist on
the Monday morning.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
As Rachael is currently suffering with an upset stomach the
suggestion was made by J, the night nurse, that Rachael would maybe have to
move to a side ward but this would require input from the Doctors.<o:p></o:p></div>
<br />
<div class="MsoNormal">
Rachael has currently got a dressing on a bed sore on her
bottom. This area is very tender and
requires ongoing care. Rachael would
like the District nurses to provide a daily drip for her as it vastly improved
things for her.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-71466158356583084482013-11-17T00:01:00.000-08:002013-11-17T00:01:31.833-08:00Visit from GP (19th September)<br />
<br />
<div class="MsoNormal">
A Doctor came to visit as R has been suffering from stomach
pains and there’s a bright yellow fluid coming out of her rig. The doctor was concerned about the pain that
R was in and suggested a stay in hospital until the cause was found. This was not an option so she took a swab to
be tested and altered a few drugs. R
thinks it is maybe due to the latest new drug Erythomycin so she said to stop
taking that and to start taking Domperedone again. She also prescribed Ramilidine – this should
help any acid.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-62177868848176005352013-11-16T23:59:00.002-08:002013-11-16T23:59:04.663-08:0017th SeptemberA visited Rachael with a rep from Miller Care and a rep from
The Chair Company. They had brought a
chair for Rachael to try.<br /><div class="MsoNormal">
<o:p></o:p></div>
<div class="MsoNormal">
After being hoisted into the chair, the chair was adjusted
to make Rachael as comfy as possible and the rep took some measurements so that
a chair could be made designed specifically for Rachael.<o:p></o:p></div>
<br />
<div class="MsoNormal">
Alison then said she would put in an application to purchase
the chair for Rachael and would inform her as soon as she had anything.<o:p></o:p></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-6619492149627379842013-09-12T21:00:00.000-07:002013-09-19T14:25:36.502-07:00Visit from GP<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Rachael called her GP to come for a home visit because she was struggling to clear her chest and the Cough Assist machine was not helping. Dr H checked Rachael's chest and he recommended that Rachael should increase the dosage of Erythromycin from 2.5ml to 4ml.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Dr H said that Rachael should contact the surgery if the condition gets any worse.</span></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-59269318071291711192013-09-10T11:30:00.000-07:002013-09-19T14:24:44.005-07:00Visit from Palliative Care Nurse<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">C visited Rachael to monitor her progress. C and Rachael discussed Rachael's well-being over the last week.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Rachael told C that she still had not received her anti depressant medication. C phoned the GP's surgery and arranged for another prescription to be left for collection.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">C also phoned the MacMillan team to arrange another visitor for next week. C will call again in two weeks time.</span></div>
<br />tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-84516310314310898302013-09-09T08:34:00.000-07:002013-09-19T14:22:28.512-07:00Follow up letter from Dr P<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Rachael received a follow up letter from Dr P after her appointment with him at S Hospice. He wrote about the problems that Rachael is having with her feed and that he recommended Erythromycin to help with these problems.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">He then mentioned that Rachael's ventilation seems to inflate her stomach and he thinks that this is contributing to her discomfort when she tries a feed.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">He then wrote about the discussion that he and Rachael had had regarding her bowel problems. He thinks that Movicol would be helpful for Rachael in the long term.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Dr P was also concerned about Rachael's sleeping problems but after some discussion he and Rachael came to the conclusion that they could not resolve this problem at the moment as Rachael is worried about the effects of night sedation. </span></div>
tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-37460500713223572092013-09-05T05:40:00.000-07:002013-09-07T06:20:20.748-07:00Appointment at S Hospice<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Rachael attended her appointment with Dr P at S Hospice. Dr P asked how things are with Rachael. They then discussed Rachael's ongoing problems with her stomach pain, saliva and feed. </span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Rachael told him that she will be having investigations into her stomach pain and that the suction machine helps with her saliva problems. </span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Dr P tried said that he doesn't know the answer to the feed problem but he said that there is some medication that will move the feed from the stomach to the intestine.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Dr P then asked if Rachael would like something to help her to sleep. Rachael was not sure if this would help. She said that she worries about her alarm not working or that her PAs will not hear it. Dr P suggested that Rachael could build some sleeps into the daytime. Rachael told him that she catnaps. She also has some feed if she goes to sleep in the daytime.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Dr P said that an antidepressant such as Prozac in liquid form may help to improve Rachael's mood in general which may help her to sleep.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Dr P asked if Rachael wanted to discuss anything else. Rachael said that was all and it is just good to go over things. </span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">Another appointment was made for a month's time.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;"><br /></span></div>
<br />tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-11117872780071160832013-09-04T12:00:00.000-07:002013-09-06T04:28:09.259-07:00Phone Call from Lung Clinic Specialist Nurse<span style="font-size: large;"><span style="font-family: Verdana,sans-serif;">D rang to discuss Rachael's bowel movements and feed. She requested Rachael's GP's telephone number. D will be writing to Rachael's GP requesting an enema.</span></span>tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0tag:blogger.com,1999:blog-6425292515866607066.post-5506653941197043902013-09-02T12:30:00.000-07:002013-09-06T03:50:22.218-07:00Visit from Occupational Therapist<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">A visited Rachael to see if Rachael could still use her bed. After Rachael was hoisted onto the bed it was very clear that the bed was not safe as it does not provide any support to prevent her from falling out.</span></div>
<div style="font-family: Verdana,sans-serif;">
<span style="font-size: large;">A said that she will investigate the possibility of getting a chair for Rachael to sleep in. She will be in touch about this as soon as possible.</span></div>
<span style="font-size: large;"><span style="font-family: Verdana,sans-serif;">A also said that she will order some small slings to replace Rachael's old ones.</span></span>tabbycat8http://www.blogger.com/profile/15770884243468778158noreply@blogger.com0