MOST

Cheryl and I went to a care planning meeting about Rick at the nursing home this morning. It was mainly to complete the advanced care directive called MOST (Medical Orders for Scope of Treatment). It is just a more detailed ‘Do Not Resuscitate’ form. The following are the directives we chose.

• ·       Comfort Measures” Keep clean, warm and dry. Use medication by any rout, positioning, wound care and other measures to relieve pain and suffering. Use oxygen, suction and manual treatment of airway obstruction as needed for comfort. Do not transfer to hospital unless comfort needs cannot be met in current location.
• ·       Determine use or limitation of antibiotics when infection occurs.
• ·       IV fluids for a defined trial period
• ·       No feeding tube

They said that his disease is progressing and each time he gets sick, like with pneumonia, he more than likely will not return to his pre-sick condition. Just like with his last bout of pneumonia. They said that it is not ‘if’ he gets pneumonia again, it is ‘when’.

They did a swallow test this morning at High Point Regional Hospital. It showed that he is having ‘silent aspiration’ when he drinks thin liquids. They recommend he be on nectar thick liquids, pureed meats and mechanically soft sides. If we want to give him regular foods, we have to sign a form saying that we know the recommendations and are refusing to cooperate and adhere to the diet and take responsibility for any adverse affects that might happen.

Then they recommended he be referred to Hospice. I asked if they thought he was ready for that now and, without hesitation, they said yes. So we will be hearing from Hospice shortly to get him enrolled. 

I just got a call from United Hospice and our initial visit is Thursday morning, July 12. 

Update continued

This morning when I went to see Rick, Leslie already had him up on the toilet and he had peed. He ate all of his food. They haven’t had any thickened juice so I’ve had to go ask for regular juice for him the last 2 days. He drank all of his prune juice and orange juice. I tried to give him the thickened milk (or whatever it was – maybe Mighty Shake) and he didn’t swallow it. He would hold it in his mouth. He walked well this morning from the bedroom to the dining room without any difficulty. Standing up straight and looking at people in passing.

The sore on his right arm is a hard knot today. I’m not sure what it is. While we were eating the lab tech came in saying she had to draw his blood for a CBC and blood cultures. I spoke to Angelica, who said that she noticed the knot yesterday and told the doctor about it. The doctor ordered the culture. It seems that I’m the last one to know what is happening, when I should be the first one to know. But then I’m glad they are checking into it.  (Angelica said “I’m glad you are here. Otherwise I was going to have to call you today to tell you about this.”)

Update

Rick is no longer in the merry walker. He has fallen in it twice. The first time was the CNA’s fault. She was pushing him in it like a wheelchair and the seat broke and he fell. The second time, 062112, he was leaning over the front of it and his weight was too much for the walker and it tipped over. He fell and knocked out his right front tooth, root and all. I took him to the dentist, who said we have to wait until the gum heals up before we can do anything to fix it. So Rick is now snaggle – toothed. We have an app’t to get it fixed on 071212. 

The night shift is supposed to be getting Rick up before they leave to bath and dress him. It doesn’t seem to be working very well. Some mornings he is in the bed with a hospital gown on, sometimes with his clothes on, sometimes dry, sometimes wet. Most of the time I have to wash him again and redress him.

This morning when I went in, he was in the bed, lying on the sheet with a protector under him. He had a hospital gown on and a diaper. The diaper was dry but the hospital gown was wet. When I went back to the bed to see what was going on, the protector was laying on top of a wet spot. The problem being that it wasn’t covering the entire wet spot and Rick had been laying in it long enough to soak the hospital gown. It wasn’t that he had wet the bed after he was washed up. They put him back in the wet bed and he laid in it. Therefore I had to wash him again and dress him. 

It worked much better when day shift was getting him up. 

Today, he has a sore on his right arm on the inside of his elbow. I took a picture of it.