After a relatively peaceful weekend, Dad continued to display fearfulness and suspicion. No longer actively aggressive, he was still very resistant to care from the staff. Finally in the middle of the week, the neurologist suggested trying a small dose of anti-psychotic med. This would hopefully relax Dad enough so that he wouldn't be so tense whenever the staff approached him. We discussed two possible meds, and decided on Zyprex. In larger doses this med has the side effect of affecting one's balance and gait. Since Dad is no longer mobile, we agreed that this was something we didn't need to worry about. The other med had the side effect of being sedating, and we felt he was already sedated through the effects of the Trazadone he was taking 3 times a day. Our pastors happened to be visiting when the very first dose was administered, and one of the pastors recognized Zyprex as a med her father-in-law had taken during late stage dementia for aggression. She said it had been very helpful, and hopefully it would be for Dad as well.
For the next couple of days it seemed as though Zyprex was having its intended effect. Day 1 Dad was much calmer, although VERY sleepy. Day 2 he was even calmer, but much more alert, and even allowed the LNAs to feed him his meals. However, we went to see him on Day 3, which was yesterday. As soon as we arrived we knew something was wrong, because Dad was not in the common room, where he had been during the day, for the last few days. One of the LNAs told us he was in his room and had not been out all day (it was after 4pm). When asked about his meals she said he had eaten very little. We found him in bed, with the lights off, and the shades close, exclaiming to himself. He looked pretty bad. The LNA said he had taken his morning meds, but did not want to eat the previous two meal. When I checked his mouth, it was fully encrusted with bits of his morning meds. Mom was pretty upset and asked why he wasn't given any water with his meds to wash it down. Since it was after 4pm, the second shift was already well underway and the nurses would have to look at the records of the first shift to determine what happened in the morning. We had a few bad moments when we couldn't find any sign of his pain patch, but eventually the nurse found it on his shoulder, dating the previous day. The pain patch works for 72 hours, so it had just been changed the previous day and should have been working as usual. Records show that all of his meds had been checked off as given that morning. So Dad was fully medicated, but perhaps optimal care hadn't been given. I have lost count of the number of times Mom has told the staff that Dad needs water after he takes his meds because he needs to wash everything down. Evidently that didn't happen in the morning. Otherwise everything seemed to be in order, he was just not having a good day. One of the nurses on duty told us this is very common. The patient can have a good day for 5 days, then suddenly boom, for no explanation, they won't.
Mom and I stayed for a few hours, feeding him dinner, giving him as much water as he would take, washing his hair, and generally cleaning him up. He was a little quieter after all that, but I noticed that when we had the nurses move him up and down the bed, he would freak out, looking at them wildly. So it was definitely a fearful response day. This is something I will ask about when I follow up with the social worker this morning. As of last Friday, we have already discussed not taking his vitals anymore with Palliative care doc. We were present when the LNA came to do them and Dad HATED it. Trying to get him to unclasp his hands and loosen his arms just enough to get the BP cuff around his arm took a long time. All told it took at least 15 minutes just to get his BP, temp, heart rate, and oxygen levels because he was so resistant. Palliative care doc agreed that these checks were intrusive for Dad and the data they got from them every day wasn't going to make much difference to his care, if any. As agreed during our team meeting, our goal was to decrease the number of intrusive interactions each day. I also saw on his med record that they were still giving him a multivitamin, which has to be crushed and given with applesauce. The nurse who was present at the team meeting told us even with that help vitamins taste terrible. So we agreed he didn't need to be given them anymore. I don't know why after more than a week he is still being given the vitamins, and will ask about that as well.
It is very difficult during these times to take the long view, simply because Dad's day to day condition is so unpredictable. A couple of good days make us think, "Great! things are working!" Then suddenly he has a bad day, even though the care hasn't changed, and we need to take a step back and reassess. The only thing that seems to be clear is that Dad is going to be in the GPU for some time, some time meaning as short as another week or as long as, I have no idea. The social worker told us that the patient has to be calm and relaxed for 3-5 consecutive days, and we have not seen that yet.
No comments:
Post a Comment