Home Health Nurse

A Home Health Nurse visited today.  She spent a lot of time going over E.'s history, his medications, his discharge instructions and the services they would be providing.  E. slept on and off throughout her visit and wasn't thrilled with having to answer the same questions for yet another person.  He is frustrated because he feels like there are too many people involved in his case.  (He'll really be thrilled after the Certified Nursing Assistant, the Physical Therapist, and the Occupational Therapist all visit next week too.  Oh, and throw in the  Palliative Care folks too.)

I expressed some concern about his diabetes medications.  His oral diabetes medications were discontinued because of his poor liver function, so he is strictly on insulin currently.  With how little he is eating, I was unsure of how much short and long-acting insulin to give him.  The Home Health Nurse called the Primary Care Doctor to get some clarification, so now I have guidance there.

There's also a general concern about dehydration.  E. is simply not drinking enough liquids to stay hydrated.  She recommended 16 to 24 ounces of liquids per day at a minimum and we're lucky if E. has 8.  The nurse and I both agreed that IV hydration would be beneficial and we discussed the apparent need for a picc line since E.'s veins are so horrible and don't maintain peripheral IV's very well at all.  Since it's the long weekend though, we won't be able to get a doctor's order for a picc line until Monday.  The nurse wasn't sure he'd make it through the weekend without some IV hydration, which would mean a trip to the Emergency Room and undoubtedly another admission to the hospital.  Groan.  (After the nurse left, she spoke to her supervisor and found out that she could start a peripheral IV and slowly run a bag of IV hydration overnight.  I suggested this to E. and explained our reasoning behind it, but he grumpily opposed it in very colorful language.  So, we cross our fingers and hope he drinks enough to stay hydrated enough to stay out of the dang hospital.)

There appears to be some fluid collecting in E.'s abdomen.  It is big and hard.  The nurse measured it and will continue to monitor it.  It may possibly need to be drained.

E.'s blood pressure continues to be good.  His oxygen saturation rate was 93, which concerned me, but the nurse said it was okay.  When it was that level at the hospital, they put him on a couple liters of oxygen.

Getting in and out of our bed (we have a big tall log bed) is proving to be too difficult.  E. slept in Grandpa's bed in the guest room last night as it is easier for him to get in and out of, although he still needs assistance.  (It was worse than having a newborn baby at home last night, as I was trying to listen for every sound.)  I think it is time to bring in a hospital bed and align it next to our bed.  That way, he can be comfortable and I can still be next to him.  I think having the hospital bed with the ability to raise the head will help too.  It will make it more comfortable for him and make it easier for him to get out of bed.  The hardest thing for him is to get into the sitting position when he's been laying down.  When I suggested it might be time for a hospital bed, E. said, "probably."  I always know I am on the right track when I don't hear cuss words or a big argument from him.

So, we continue to try to push the fluids and keep him out of pain.