I just came from visiting with my Dad. Apparently when they turned off his sedation this morning to evaluate his mental status (they call it a "sedation vacation"), he still didn't follow any commands, had some tremors, and seemed fairly agitated so he will continue to be on the ventilator for now. The doc said he thinks the cooling blanket and ice packs they were using to get his fever down were likely a contributing factor in agitating him and making him uncomfortable so I guess it's a good thing he stays sedated for at least another day while he rides this out. I just hate to see him on the vent and I'm very much wanting to see how he's going to be when he finally wakes up. Due to the agitation, he's on a higher dose of Propofol today and is more heavily sedated so he didn't move much at all when I was in there and did not grab my hand this time. However, the doctor said it's a very reliable and good sign that he grabbed my hand on command several times last night when he was only lightly sedated.
Still waiting on the official EEG reading, but the doc said it looks to be normal and without any seizure activity. Lungs are fine, heart is fine, kidneys are fine. It seems the only thing currently affected is his neurological status from the presumed encephalitis.
I don't like his nurse today. It all started when she snapped at me for closing his door so that I could visit in private (which I did all day yesterday), she said she needed to be able to see his ventilator at all times to make sure it didn't alarm. I really tried not to be a smart-ass and say as sweet as possible "isn't that what the alarm bells are for?" and assured her that I could hit the call bell if his vent alarmed. She did finally agree to that and shut the door with an audible "harumph". She won't let me visit outside of visiting hours, like the nurses yesterday and last night did. Visiting hours are very narrow windows, you can only be at the bedside 10-11a, 1-2p, 5-6p, and 9-10p. Four hours a day isn't very much, especially when you have no where else to go. So right now I'm just sitting in the waiting room until I can go back in.
Then she gave me misinformation about my Dad's lab results. I specifically wanted to know about his sodium level, which has been low. Low sodium can cause a lot of things, like confusion, headache, irritability, muscle spasms/weakness, restlessness, etc. It can have some very serious effects if it gets too low. So I just want to make sure he's trending in the right direction or maintaining. Normal sodium is 135-145. On arrival he was 125 and last night he was 130, so definitely going the right way. The nurse told me this morning it went back down to 121. This was very concerning to me and she blew it off completely. I had her call the doctor (which took forever, since she apparently had a priority to sit at the desk and drink coffee), when he came he explained that his sodium was not 121, it was 127. I could have chucked a chair at that nurse. It may not sound like a big difference, but it is. 127 is hovering where he has been, which tells me that he's basically maintaining. 121 is a clear shift in the wrong direction. So there's a big difference. The doctor even said he would be very concerned if it had been 121 and we would have made some changes based on that. So yeah, the nurse should probably not be giving out inaccurate lab information. UGH.
Then, she hung his IV Acyclovir (antiviral medicine) at the wrong rate on the IV pump. She took down his other medicine, which was going at a rate double what the Acyclovir was, and forgot to adjust the rate for the new medication. I pointed it out and she fixed it, and it would not likely have caused much problem if he'd gotten Acyclovir at double the rate he was supposed to, but sheesh. Like we need any other potential problems right now. All the nurses up until now have been fantastic. But I'm going to watch this one like a hawk.
So basically in a nut shell, no real change yet. But he's definitely not getting any worse, he's maintaining. The doctor said with patients like my dad, who he has a strong optimistic outlook for, we also need to start thinking about the complications that can come about from spending so much time in the bed. He showed me how to better position his head and stretch his neck muscles so that he doesn't get muscular issues from having his head tilted in the same position for too long. And as a nurse, I already know a lot of interventions for overall positioning so I'll work on some of those things too. I guess I was hoping to see some marked improvement after last night's uplifting visit, but I think I need some patience. Patience has never been my strong suit!
No comments:
Post a Comment