Guest Writer
July 24, 2018
My morning report from the night nurse before she left for the day: Dana was awake a lot during the night. (By “awake” I mean that she opened her eyes and looked around but was unable to talk and she is still pretty doped up.) The nurse asked Dana if she wanted the music turned off and she shook her head no. Her temperature went down, then up, so she was given Tylenol.
(Did you know one dose of Tylenol administered through an IV is $500?)
Her blood pressure is fine. The respiratory nurse brought the amount of oxygen being delivered through the tube up as her oxygen level was sitting at 92 to 93. Urine output is great at 100 ml an hour, but she has a lot of fluid to get rid of.
Her bed was put in a sitting position but can’t be left that way for long because her legs are so swollen that it’s uncomfortable to bend them. Still no bowel sounds but abdominal CAT scan doesn’t show any problems.
There’s a gap in my Messenger notes. It seems like there was talk of removing her oxygen tube.
July 25, 2018
7:06 p.m. I wrote: They are starting the pressor again. Her BP fell to 86.
9:22 p.m. BF wrote: All is good. Stats are good. She is still on the pressor. She wants someone with her at all times.
I wrote: So she’s really alert?
BF wrote: Yah, pretty alert.
I wrote: Is she coughing? Have the nurses been suctioning her throat? Did the respiratory nurse visit?
BF wrote: They tried suctioning and got some stuff out. She is communicating that her stomach is upset. She had to poop like 10 minutes apart.
I wrote: Does she still have the food tube in her nose?
BF wrote: Yes. Are you having a bit of anxiety? Restraints are good also. Dana was given fentanyl (which makes her sleepy).
NOTE: Occasionally, doctors and nurses would talk to us about ICU delirium. It is an interesting and much-researched topic. From the site ICUdelirium.org comes this information: “Delirium is common. About 2 out of 3 patients in ICUs get delirium. Seven out of 10 patients get delirium while they are on a breathing machine or soon after. Experts think delirium is caused by a change in the way the brain is working.”
From ACPhospitalist.org comes this: “Preventing delirium in the ICU doesn’t have to involve sophisticated medical interventions. Doubling the length of family visiting hours halved rates of ICU delirium, according to one study. And twice-daily occupational therapy cut the risk of ICU delirium even more dramatically when added to standard preventive measures, such as avoiding restraints and benzodiazepines, according to another trial.”
