Claudia began mom’s day early this morning and mom was wide awake and alert. She set her up in bed, put her hearing aids in and glasses on. She placed the lap table on the bed with a magazine opened to a bread recipe—which mom seemed interested in because she lifted her eyebrows and opened her eyes widely when she looked at it. Claudia put the TV on too. Lenny and I arrived to mom shortly thereafter. She was asleep. As I spoke to her, she tilted her head in my direction and furrowed her brow. I opened her eyes and she looked at me and sort of smiled. She yawned and tried to cover the yawn with her right hand but didn’t quite make it all the way up to her mouth (only made it to just below her neck area). Lenny did mom’s full physical therapy/range of motion exercises. Dad came next and asked mom how she feels, and mom said, “Fine.” Mom smiles (her new slight smile) at dad when he talks to her. Pop has become a strong, respectfully assertive advocate for mom. Our Team Meeting went well. Productive. We came back from the meeting to find that mom was asleep in her chair but both her mitts were on the floor!!! Lenny had pressed the call bell and asked the person who came in to put mom’s gloves back on—the person did that but not well (obviously). We immediately told the Supervisory Nurse who then came in and left to go yell at one of the nurses we love—who didn’t put the mitts on!!! When we told her that—she said she didn’t care—he was in charge!!! The nurse asked us again for us to tell only him to remove and put back on her mitts. Lenny was discouraged and apologized and the nurse told us again to just tell him only. When mom woke up, I worked with her while dad and Lenny went to lunch. Lenny told the nursing supervisor that this is precisely why we are hesitant to tell people in charge about problems we are having because the wrong people are reprimanded.
First, mom and I practiced sitting up straight in her chair. I held her hands and pulled her forward until she was straight. Then I asked her to breath deeply and she did. She smiled a lot and had a sense of accomplishment and pride on her face. She held herself up straight using assistance with one hand (I held one hand). Then she sat straight with my support (holding 2 hands). Mom followed the command to “Take a deep breath” about 4-6 times. She also sat without help, forward in the chair alone. She also sat alone while holding onto the chair with only one hand (I wasn’t helping!!). I left for lunch and dad and Lenny worked with mom. Lenny tried to get mom to do the nut and bolt but she couldn’t. Then Lenny and Dad wrote all the letters of the alphabet on the dry erase board and had mom hold the pen and did hand over hand prompting to write the numbers 1-10 and the whole alphabet. Then they said words for each letter as they drew it. I called JoAnn from mom’s room and she began to talk to mom on the phone. Mom listened intently and then, I asked mom, “Hey, is that JoAnn on the phone?” and mom shook her head “NO” and mouthed it too. I told JoAnn that mom said it wasn’t her and JoAnn said that it wasn’t her – it was her mom, Madeline, on the phone. Then, cousin Angelo called mom and spoke to her on the phone and mom did one of her new smiles as he spoke. After dad and I left, Lenny worked with mom and did the farm animal wooden puzzle, pegs and pegboard (with hand over hand prompting) and flashcards (he showed her the card and then stated the item for her to see and hear). Claudia and I joined Lenny later on and began to show mom pictures of the family---mom smiled a lot at the pictures, especially of the pictures of her and Dad!! We left to eat dinner and Claudia came back later in the evening to relieve Lenny and I. Mom was out like a light asleep. Claudia used this time to do one last physical therapy/range of motion on mom and stretch her really well. She took out mom's hearing aids, and took her glasses off, and tucked her in and prayed over mom.
SOME THOUGHTS CLAUDIA BROUGHT UP: Fifteen minutes before the decanulation of the trach, a CNA saw our mom and she was fine. If mom was double tied and the tube was connected to the trach, how did mom pull the trachh out??? How did she pull it out with the expanded balloon at the bottom??? How was mom able to demonstrate the fine motor ability to be able to pull the trach out???? Especially, since the trach is supposedly also approximately 12-14 inches long---how was mom able to pull out the trach of that length??? Where does the bag go when someone is on a trach??? Over the trach or over the mouth and nose??
"God has surely listened and heard my voice in prayer" Psalm 66:18
Team Care Plan Meeting for Mom MINUTES 1/13/11 Thursday 11:30 a.m.
Present: Kathy, Dad, Lenny, Claudia, plus 8 staff members (PT, Head of Therapies, Head of Respiratory, Head of Nursing, Nutritionist, Recreation Therapist, and 2 Social Workers)
Our concerns:
1. Keep curtain open when we are not there so that she can be viewed from the hallway
2. Make sure the mitts are removed every 2 hours and kept off for 15 minutes as per her plan so that her fingers can be stretched out (CNAs and nurses should stretch them)
3. Can an Occupational Therapist come in to assess the mitts and brainstorm on ways to keep her hands from curling in the mitts
a. Purchase something
b. Use something other than mitts
c. Add something to the mitts
d. NURSING MITTS WITH FINGERS!!!! ASK NURSING!!!!! Finger separater mitt---splint…Gave us long rolls of sand covered in material for inside mitts so mom's hand can only curl so far
4. If anyone walks into room any time after 7:00 a.m. (whether mom is awake or asleep), please open the blinds fully, turn on all lights in the room—we have been trying to establish, and help mom distinguish between, DAY and NIGHT so that we can work with her during the day.
a. Whenever we are not able to get to mom early in the morning and arrive later in the day (twice after 1:00 p.m.), the room is dark and the lights are out, the blinds are closed.
b. DAY/NIGHT difference helps to establish favorable mental health and well-being
5. Can mom receive any type of Occupational Therapy doing hand over hand prompting (full manual prompt)—to model all that we are doing with her?
6. Can mom have a swallow test? Kareem: Modified Barium Swallow Test outside facility
a. Hospital commented that mom is clearly swallowing and able to swallow well---they asked us, “WHY IS SHE ON A FEEDING TUBE??”
7. Change the BEHAVIOR PLAN---remove old derogatory, inaccurate plan from her files!!!
8. If a person cannot advocate for him/herself, is it the role of the ADVOCATE to approve or oversee all such reports
9. Can PT come in and look at the chair mom sits in and find something to keep mom’s feet perpendicular while sitting in the chair so her feet don’t drop? DAN WILL BRING A STOOL
a. Can we put something on the floor for her to lean her feet on? A stool???
10. EXPLAIN THE PLUG and BREATHING SITUATION:
a. Phlegm/Mucus plugs were being dislodged during PT and extra movement (after 6 months of being still)
b. When plug dislodges, the average person is able to cough it up (like with a cold) but the vent patient is not always able to
c. During the TWILIGHT hours, mom was experiencing difficulty dislodging/coughing up plugs and would have a panic attack because a stuck plug blocks all other fluids from being expelled
d. The built-up fluids make the person feel like he/she is drowning----when this happened to mom, she panicked
e. Mom was clammy on her arms and forehead in the evenings and some mornings because of this event
f. The test was to suction her---if she calmed and stabilized after the suctioning, it was a plug and the plug was dislodged
g. Sometimes the plugs needed saline solution to dissolve them then dislodge them (one respiratory person felt uncomfortable doing this the night before the incident of the trach removal)
h. The vent alarm didn’t always go off when this happened at first
11. If any staff member, at any level, has a problem with any of our family members, please address the issue with the particular family member in question—don’t go to another family member to address the concern (ex. Don’t go to dad about Anthony, don’t go to Claudia about Kathy…)
12. How does the trach work??? When trach is pulled out, most often the hole stays open
PILOT BALLOON = cuff at the top of trach gives right amount of air in….it is a tool you use with the trach to inflate/deflate the balloon at the bottom of the trach
: Straight vents…already started weaning modes SMIV times when she breaths over the breath and times when she doesn’t right now she has the opportunity to do so…more often than not, she is not breathing on her own…Obstructive Sleep Apnea can’t occur --- Neurologist said it is NOT Central Sleep Apnea---respiratory therapist (head) says yes--- Neurologist says it is totally Obstructive Sleep Apnea--- Weaning process entails process in breathing without apnea---straight vent to SMIV….she moved to Trach collar….she got to the Trach collar 24/7 due to unknown improvement--- Secretions in this population sometimes lead to infections commonly--- we asked, “How do we prevent this??” Secretions here at facility are different color than in hospital…hospital secretions were more clear. Paradoxical motion from bottom of lung to upper part of lung…
Physically—physical movement can it change her breathing??? They don’t know. All speak only from their own backgrounds. PT/OT was reevaled. When she got here last week---NOTHING….no tracking…but they see improvement in attention and alertness now this week already… physical therapist will watch her and reevaluate weekly… physical therapist plan is to progress her back to wheelchair…and maybe PT again next week or so
It seems to us like the language and cognition is coming back before the phsycial…TELL physical therapist ABOUT PHYSICAL MOVEMENTS!!!!
HEAD NURSE --- Will work on mitts now
COMMONLY bagged to raise levels of breathing----in hospitals and/or in facilities
FACILITY STAFF SAID HER LUNG WAS NOT COLLAPSED AT ALL WHILE IN THE FACILITY---no signs or symptoms in the facility that her lung collapsed.
WHAT happened in transit
A lung can collapse externally or internally---
The facility said no shots were given that day---even though the nurses at the hospital said she wasn’t given anything or a shot…they said to check with the ambulance company….
TELL SOCIAL WORKER ANY PROBLEMS---SHE WILL TAKE CARE OF THEM----ANY PROBLEMS
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