BM Full Stat Day:

A.M. Blood Glucose:     Time:  1308     Reading:  114	A.M. Blood Pressure:     Time:  1315     BP:  147/77     Pulse:  80
A.M. Arterial Temp:     Time:  1316     Reading:  99.7	A.M. Oral Temp:  Not taken     Time:       Reading:

P.M. Blood Glucose:     Time:  2109     Reading:  83

    Bowel Movement: Fair volume; easy elimination; good consistency.
    Yellow Sputum Report: Of all the coughing she did, which was a fair amount, only one load of sputum, in the morning during bathing, had a bit of very light yellow in it.
    Medication Changes:  Got only two breathing treatments in, both the dual Albuterol/Ipratroprium treatments. This happened because there needs to be at least 4 hours between Albuterol treatments and a bit longer between Ipratroprium treatments, although it depends on whether she's having difficulty breathing. Also got a third glipizide at dinner because we had dessert, cherry pie.

Full Stat Day:

A.M. Blood Glucose:     Time:  1418     Reading:  150	A.M. Blood Pressure:     Time:  1425     BP:  154/81     Pulse:  68
A.M. Arterial Temp:     Time:  1423     Reading:  98.9	A.M. Digital Oral Temp:     Time:  Not taken

P.M. Blood Glucose:     Time:  2121     Reading:  146

    Yellow Sputum Report:  Although she coughed about as much as usual, especially during the first half of her day, she spit up very little sputum, all of which was clear or white.
    Altered Medications:  A third glipizide was administered in the evening to cover a serving of cherry pie and home whipped cream. I'm expecting that, even so, her Blood Glucose will be higher than usual in the morning.

Current Medication & Supplement Schedule

7/11/08: Several changes in Med Schedule, since it's been over a year since I updated it. I'll indicate changes and a bit of history in the Notes section.

UPON AWAKENING BEFORE BREAKFAST:

Med/Dose	Administration	Explanation
Albuterol/Ipratropium	inhaled upon awakening before breakfast	to address lung congestion
Niferex-150 Forte [150 mg elemental iron] Rx with extra B12 and folic acid	1 tab upon awakening before breakfast	to keep her iron deficiency anemia under control
Protonix/40 mg; Prilosec/20 mg	upon awakening before breakfast	standard pre-breakfast med; protects her intestinal lining to prevent ulceration and bleeding; will be switching to Prilosec (per Hospice) when the Protonix is gone
glipizide ER/10 mg	1 pill before breakfast	if her blood sugar is high enough so that it doesn't drop too low in the 45 minutes or so before she actually eats breakfast; OTHERWISE, given at meal

BREAKFAST

Med/Dose	Administration	Explanation
Niferex-150 Forte [150 mg elemental iron] Rx with extra B12 and folic acid	1 tab with breakfast	to keep her iron deficiency anemia under control
100 mg Macrodantin	with meal	to prevent UTIs
Daily Senior Multivitamin	with breakfast	standard breakfast supplement
6 tsp Benefiber	with meal, in orange juice	promotes timely, easy bowel evacuation; may occasionally be given in lower or higher doses
1/4 tsp cinnamon	with meal, sprinkled on toast	said to increase cell sensitivity to insulin

BEFORE NAP:

Med/Dose	Administration	Explanation
1 Niferex-150 Forte [150 mg elemental iron] Rx with extra B12 and folic acid	before nap	to keep her iron deficiency anemia under control

AFTER NAP:

Med/Dose	Administration	Explanation
Albuterol/Ipratropium	inhaled upon awakening from nap	to address lung congestion
1 Niferex-150 Forte [150 mg elemental iron] Rx with extra B12 and folic acid	upon awakening after nap	to keep her iron deficiency anemia under control

DINNER:

Med/Dose	Administration	Explanation
1 tab glipizide ER/10 mg	with meal	to control Type 2 diabetes
1 Niferex-150 Forte [150 mg elemental iron] Rx with extra B12 and folic acid	with meal	to keep her iron deficiency anemia under control
1 tab calcium-vitamin D/500-200 mg	with meal	believed to be an osteoporosis preventative; although current research suggests that it does not perform well in women; I give it to her anyway because I doubt that it will hurt her and the extra Vitamin C is probably good for her

BEFORE BED AT NIGHT:

Med/Dose	Administration	Explanation
glipizide ER/10 mg	1 pill with dessert or after a high refined carb meal	Rarely given; only in cases of lots of carbohydrates throughout the day; otherwise, see DINNER MEDS
Albuterol	inhaled just before bedtime	to address lung congestion
1 Niferex-150 [150 mg elemental iron]	just before sleep	to keep her iron deficiency anemia under control
lisinopril/15 mg	1 10mg tab + 1/2 tab more	Given to lower her blood pressure and protect her kidneys; works by relaxing the blood vessels.

OTHER TIMES:

Med/Dose	Administration	Explanation
Concentrated oxygen, 4.5/lpm continuous	when sleeping	to make sure she doesn't become breathless
Tanked continuous oxygen, 3/lpm	24/7when she's sitting	to make sure she doesn't become breathless
Tanked oxygen, 4/lpm continuous	when she's moving or exercising	to make sure she doesn't become breathless

    The following are prescribed meds, treatments or supplements (all the rest are OTC supplementals which, although approved by her PCP, were not suggested by him):

• Niferex-150 Forte: 900 mg; 300 mg 3x/day (Rx)
• Protonix: 40mg 1x/day (Rx); will be switched to Omeprazole 20 mg while on Hospice
• Glipizide: 10 mg; 2-3x/day (Rx)
• Lisinopril: 15 mg 1x/day; if necessary, I can increase this dose by scattering other low mg doses throughout the day (Rx)
• Macrodantin: 100 mg 1x/day (Rx)
• Oxygen, 2-4/lpm pulse and continuous-may titrate (Rx)
• Oscal: Calcium/Vitamin D combo 1x/day (recommended by the nursing home; although research has since shown that this supplement does not alleviate the possibility of breakage or weakening bone structure, I continue it anyway, since it seems likely that it couldn't hurt

    The following are administered occasionally and/or daily, as needed:

• Opcon-A for itchy, weepy eyes
• Phillip's Milk of Magnesia to break through constipation; Tbl dose at a time
• Ducosate Sodium if a little more help is needed to break through constipation
• Extra Strength Tums for very occasional upset stomach
• Desitin and/or Level 3 Barrier Cream (used every day on thigh creases) for urine skin irritations and rashes.
• 2% diphenhydramine cream used for skin rashes due to urine irritation and/or sweat-heat rashes. I use this when the oil based zinc creams don't do the trick (which is fairly often). This cream isn't oil based and allows the skin to breathe better; it also stops itching and heals more quickly.
• Extra Strength Acetaminophen or Regular Acetaminophen for occasionally unusual aches and stiffness
• {Rx} Furosemide 10 mg once to twice a day for very occasional water retention; when I give this to her I note it in these daily reports.
• {Rx} Metoclopramide 5 mg administered 1/2 hour before meal in the case of very occasional nausea. When I give this to her I note it in these daily reports.

ADDITIONAL NOTES:  You may notice that some of her previous supplements have disappeared from the schedule. I am no longer adamant about making sure, for instance, that she receives a cup of Detox tea a day as, during her stay in the hospital and facility when she didn't drink this it became apparent that it had no effect. I still make her a cup a couple times a week for her after breakfast tea but I vary it with one of the variety of teas we have on hand. She usually receives a cup of tea before bed, as well. Usually it's Ginger tea, as, when I used this a while back to help allay nausea she really enjoyed it. However, I vary her before-bed teas, as well. Sometimes, after breakfast, I'll give her a caffeinated tea if she seems unusually tired and is complaining about her tiredness. I did this yesterday and it did the trick.
    The garlic, vitamin E and daily aspirin were discontinued after her blood transfusion in September of 2007 by the ER doctor's orders in order to keep her blood from becoming too thin. I may reinstate two garlic pills (500 mg apiece) in order to add a natural antibiotic to her schedule; at the moment, though, I'm waiting to see if she continues to host lots of infections, as she seems to have been doing, lately. I decided to eliminate the Vitamin C because she's getting plenty in her supplements.     I still use Aloe Vera gel in the morning but I haven't been able to get my hands on the pure stuff for a couple of weeks so she hasn't had that since 5/14/08. I also continue to use, for instance, curry powder in this and that fairly often to help control her Blood Glucose.

Full Stat Day + Normal Temp Ranges:

A.M. Blood Glucose:     Time:  1329     Reading:  150	A.M. Blood Pressure:     Time:  1349     BP:  137/71     Pulse:  77
A.M. Arterial Temp:     Time:  1332     Reading:  99.2	A.M. Oral Merc/Oral Dig Temp:       Time:  1344/1346     Reading:  97.8/97.4

P.M. Blood Glucose:     Time:  2242     Reading:  70

    I won't always be publishing three, or even two temperatures. I did that today because I was testing all our thermometers to see if they worked fairly well. It seems they do. In case any of you are curious, here is a listing of Normal Body Temperature Ranges at Various Measurement Sites, taken from the Exergen Oral Thermometer Instruction Booklet:
    Arterial:  97.4 - 100.1 F/36.3 - 37.8 C
    Oral:  96.6 - 99.5 F/35.9 - 27.5 C
    Oronasal:  96.6 - 99.0 F/35.9 - 37.2 C
    Axiliary:  95.5 - -98.8 F/353 - 37.1 C
    Esophageal:  98.4 - 100.0 F/36.9 - 37.8 C
    Rectal:  97.7 - 100.3 F/36.5 - 37.9 C

    One change in medication schedule: I cut her morning Benefiber back to four teaspoons from six. She's been having daily fecal expulsions every time she goes to the bathroom and sometimes just before she arises. I think I've been overcompensating for the enforced constipation she experienced in the hospital and the facility due to dehydration and extremely low fiber diet. It looks as though she's getting enough fiber in her diet, now, to keep her very regular, so I'm trying to dial her back to merely regular.
    Nothing unusual about her meals. She had a can of Mandarin Oranges in light syrup, drained of the syrup, after dinner. I did not give her a third glipizide, though, and didn't bother to check her Blood Glucose before she went to bed. As I recall, these usually work themselves out before she awakens the next day. We'll see if this still remains true.
    I've been noticing that her blood sugar readings in the evening are lowering themselves. Might be a good idea to beef up breakfasts, a bit, if I can't get her to snack after her naps, which she typically doesn't do anymore.
    Sputum Report:    Sometimes white or clear, sometimes white or clear mixed with a little light yellow. The yellow seems to be clearing up. Still keeping an eye on this, though.

BM Full Stat Day:

A.M. Blood Glucose:     Time:  13:43     Reading:  156

A.M. Blood Pressure:     Time:  1400     BP:  117/67     Pulse:  70

P.M. Blood Glucose:     Time:  21:07     Reading:  101

    Bowel Movement occurred during morning bathing, sometime between 1415 and 1445: Fair volume, good to soft consistency, easy evacuation, fairly easy clean-up.
    I gave her a third glipizide before bed in order to assuage the effect of some lemon sorbet we had after dinner.
    After her nap and her breathing treatment she coughed up a load of sputum that was yellow. First time she's done that since she's been home. I'll keep an eye on it but won't report it to the Hospice nurse unless this continues for another day or so.

    Well, here I am, reinstating these daily reports a year to the day (considering that I'm actually typing this a few hours after the close of the day I'm posting them for) after I stopped. Seems like a good idea to keep track of this stuff, again. I may add more as time goes on. I definitely need to add a new medication list, as well, and link it to the main journal. Some of the information might come in handy as she continues in Hospice for her lung cancer.
    I have been taking her temperature in the morning but this morning I discovered that the digital "9 second" thermometer we've been using may be malfunctioning. When I took the thermometer out of her mouth, the digital reading jumped a tenth of a degree. This evening when I took her temperature I didn't pull it out immediately after the beeping and noticed that her temperature was continuing to rise after the thermometer was supposed to be done. I guess I'll be scrapping the digital thermometer and purchasing another one shortly. Until then, I'll try taking her temperature with our old mercury thermometer and see what readings I get, beginning tomorrow morning.