Non-Stat Day:

Medication Changes:

• 0810: .125 mL morphine sulfate; her breaths per minute were at 24, I needed to run backed up errands and I wanted to make sure that we did not have a repeat of yesterday morning, when she was so breathless that she awakened and began experiencing the middle back pain that goes along with her lungs working too hard. When I returned from errand running at 10:50 she was breathing easily, her breaths per minute were 23, and she was sleeping comfortably.
• None of her regular medications were given. Her morhpine and acetaminophen doses are being recorded in hard copy morphine and tylenol logs.

Sleep:

• She slept most of the day. She was in bed all day. My guess is that she was awake for maybe five hours in all, between pain episodes, recovering from them and awakening for a regular morphine/tylenol cocktail that she received every 2-5 or so hours throughout the day from noon on

Full Stat Day:

AM Blood Glucose:     Time:  0840     Reading:  200	AM Axillary Dig Temp:     Time:  1120     Reading:  96.0
Blood Oxygen:     Time:  1115     Level:  93%     Pulse:  95	Breaths Per Minute:     Time:  1445     Reading:  20
Breaths Per Minute:     Time:  0115     Reading:  28	Breaths Per Minute:     Time:  0135     Reading:  32

PM Blood Glucose:     Time:  2210     Reading:  184

PM Blood Pressure:     Time:  2220     BP:  142/70     Pulse:  79

Medication Changes:

• 0850: 500 mg acetaminophen for middle back pain from labored breathing
• 0945: .125 mL morphine sulfate for air hunger
• between 0945 and 1015, all regular medications except iron
• 1015: per Hospice RN, .125 mL morphine sulfate for continued air hunger and 10 mg furosemide for feet swelling
• 1145: 300 mg iron
• 1700: .25 mL morphine for air hunger
• 1715: 1 Ducosate Sodium pill in order to attempt to head off morphine constipation
• 2220: Probably about .20 mL morphine sulfate (some drops of it squirted out of her mouth when I gave it to her)
• 2245: 325 mg acetaminophen, general purposes, she asked for it, saying she thought it would help get rid of her "coldish" feeling
• 0140: .25 mL morphine sulfate per Hospice RN on call

Food:

• Between 0850 and 1100 ate two pieces of multigrain toast with Fleischmann's margarine and cinnamon and a drained can of Mandarin orange slices
• At about 1715 ate a piece of ham, a boiled egg and 14 oz of 40% OJ and 60% water (this is mostly her normal breakfast; the toast was served earlier in the day)
•  
• At about 2300 ate a piece of Costco Double Chocolate Cream Pie

Sleep:

• Up at 0830
• Back down at 1145
• Up again at 1630
• Down for nap at 1930
• Up from nap at 2200
• Down for night at 0145
• Awake 10 hours

BM Full Stat Day:

AM Blood Glucose:     Time:  1348     Reading:  154

AM 60" Dig Temp:     Time:  1359     Reading:  97.5

PM Blood Glucose:     Time:  2133     Reading:  189

Medication Changes:

• 325 mg acetaminophen for breakfast
• .125 mL morphine sulfate at 2340 for air hunger at 6/lpm
• .125 mL morphone sulfate at 0045 as a maintenance dose for air hunger
• Skipped prune juice because of high BG number in evening

    Bowel Movement:  Occurred during bathing. Excellent volume; good consistency; very easy elimination; somewhat challenging clean-up.
    Dinner:  Grilled cheese and pepperoni sandwich on cracked wheat sourdough bread, 3 garlic stuffed olives, 3 pimiento stuffed olives, 3 sweet peppers
Sleep:

• Awake at 1330
• Down for nap at 1815
• Up from nap at 2100
• Down for night at 0115
• Awake 9 hours

Full But Switched Stat Day:

AM Blood Glucose:     Time:  1457     Reading:  211	AM 60" Dig Temp:     Not taken

PM Blood Glucose:     Time:  2136     Reading:  214

Other Temp:     Time:  0100     Reading:  98.4

Medication Changes:

• 325 mg acetaminophen at breakfast; general purposes and "I don't feel good all over"; I asked her if she wanted it with breakfast and she said "yes"; she, however, refused my offer of acetaminophen or ibuprofen before her nap or with dinner
• Skipped the prune juice again tonight to see if this impacts her high BGs

    About 2 cups sauerkraut and polish sausage; about 3/4 cup loaded (with sauteed veggies) stuffing
Sleep:

• Awake at 1400
• Down for nap at 1915
• Up from nap at 2100; this was a short nap for her but a bout of dry hacking awoke her
• Down for night at 0130
• Awake 9.75 hours

Contents of Hospice Comfort Pack

    At my request, the Hospice RN who visited yesterday went through the contents of our refrigerated Comfort Pack and explained the Hospice purposes of all the meds therein contained. Following is what I learned:

• Morphine Sulfate:  See Morphine Manual
• Acetaminophen Suppository 650 mg:  For difficulty swallowing and/or end-of-life fever
• Haloperidol 2mg/ml:  For nausea or severe agitation
• Ativan (loracepam) 1 mg:  For anxiety, usually, in the case of respiratory patients, due to difficulty breathing; often used with morphine
• Prochlorper 10 mg tablets and 20 mg suppositories:  For nausea
• ABHR:  Suppository for nausea
• Hyoscyam 0.125 mg/ml:  To quiet death rattle at end-of-life; when the RN told me this I immediately asked, "Is this for the patient's comfort or for the family's comfort?"
  "You're on the button," she replied. "It's for the family."
  "Ah," I said. "Then I probably won't be using it. Over the years I've gotten used to a variety of noises coming from my mother. If she's comfortable and peaceful, I can't see any reason to quiet her death rattle."

    Please note, these explanations, above, are not extensive and there is a lot of information they don't include. I wasn't looking for a PDA explanation...merely a thumbnail sketch of why we have them and how we might use them. The RN underlined that before using any of them, at least for the first time, I should always contact Hospice for approval and direction, and, of course, I will.

Partial Stat Day:

AM Blood Glucose:     Time:  1332     Reading:  198

AM 60" Dig Temp:     Not taken

PM Blood Glucose:     Time:  2059     Reading:  219

Medication Changes:

• 200 mg ibuprofen with breakfast
• 200 mg ibuprofen with buttered, cinnamoned toast before nap
• 200 mg ibprofen at dinner
• Extra glipizide with toast before nap because of high "am" BG
• Extra glipizide with dessert because of high "pm" BG
• 4th breathing treatment able to be administered at 0145 just before bed
• Skipped Prune Juice; see Miscellaneous BG Notes below

    Dinner:  Roast chicken thigh, about 1/2 cup Brussels Sprouts with Greek Veta Vinaigrette dressing, about 3/4 cup loaded stuffing with lots of added, sauteed vegetables; 1 slice Costco Double Chocolate Cream pie
    Miscellaneous BG Notes:  I've decided to try a few strategies to attempt to lower her BGs:

1. The first, which I did today, is to administer two extra glipizide when both her BGs are very high, as they were today.
2. The second is to switch from Prune Juice to ducosate sodium (Colace) as a stool softener. I thought I'd start with an every other evening dose, see how that works and increase it, if necessary. I did not administer it this evening since last night was a Prune Juice night. As well, our supply of ducosate sodium is expired so the nurse ordered us more.
3. I may try cutting out desserts, but this is going to be difficult, since my mother is so used to dessert, now, and so loves it that, generally, if I don't get around to serving it sometime after dinner, she asks for it. I may scale back to desserts like canned Mandarin orange slices, which she loves and considers a legitimate dessert, and/or "do" rich desserts maybe only two to three times a week. As well, I pretty much agree with the Hospice philosophy: "Why not?" when it comes to desserts, and other things. I wasn't able to discuss Hospice's medical philosophy behind the assumption that her glipizide will eventually be discontinued, but I will next week.

Sleep:

• Awake at 1300
• Down for nap at 1715
• Up from nap at 2100
• Down for night at 0200
• Awake 9.25 hours

BM Partial Stat Day:

AM Blood Glucose:     Time:  1509     Reading:  194

AM 60" Dig Temp:     Not taken

PM Blood Glucose:     Not taken

Medication Changes:

• 200 mg ibuprofen at breakfast for general purposes and a feeling of "aching all over"
• 500 mg acetaminophen with dinner for same feeling as above
• 3rd breathing treatment was accidentally given an hour early; somewhere during the evening I booted myself up into yesterday evening and counted the hours down wrong
• 10 mg furosemide for continued (a couple of days) and rapid (today) feet and leg swelling

    Bowel Movement:Occurred at 1445, during bathing. Excellent volume; fair consistency, turds were large and hard; surprisingly easy elimination; easy clean-up
    Dinner:  Tuna fish salad sandwich on toasted Multigrain bread
Sleep:

• Awake at 1400
• Down for nap at 1600
• Up from nap at 2100
• Down for night at 0100
• Awake 8 hours

Partial Stat Day:

AM Blood Glucose:     Time:  1233     Reading:  123

AM 60" Dig Temp:     Not taken

PM Blood Glucose:     Time:  2028     Reading:  234

Medication Changes:

• 325 mg acetaminophen instead of 200 mg ibuprofen for breakfast (general purposes)
• 325 mg acetaminophen before nap (for general stiffness and low level discomfort)
• 325 mg acetaminophen at dinner (for lower back pain)
• 325 mg acetaminophen before bed (for lower back pain)
• Extra glipizide with dessert
• Detox Tea in evening
• Got in a 4th breathing treatment today

    Dinner:  1 slice home made beef pot pie and 1 slice Chocolate Mousse cake
Sleep:

• Awake at noon
• Down for nap at 1630
• Up from nap at 2000
• Down for night at 0130
• Awake 10 hours