Friday, July 1, 2016

July 1, 2016

The rest of this week has been up and down. Zeke gained 650g (1lb 7oz) in the span of 48 hours, due to all of the fluids he'd received - saline boluses, blood transfusions, albumen, platelets, etc...
The blood cultures came back positive for a gram-negative bacteria called Acinetobacter. Once they found the type of bacteria, they were able to start him on antibiotics specific for that infection.
His blood pressure got pretty high again on Monday, so they started weaning the dopamine Monday evening, and were able to get him completely off the dopamine by Tuesday. He's been on and off of it the rest of the week, depending on what he needs to keep his blood pressure good.
The pressure in his dialysis lines got really high Monday afternoon and the pump wouldn't run. They put tpa in his lines for about 45 minutes to try to clear them, and tried to flush the lines. They didn't want to flush. They put more tpa in for two hours and tried to flush again, and it was still more sluggish than they wanted, so they decided to leave the tpa in overnight and hook him back up this morning. They didn't have any issues getting him on the new pump Tuesday morning, which is good. Today was another pump change day. They were able to get him on the new pump with few issues, but, as usual, his lines are extremely positional, and he's had to have them flushed a few times today (and several times over the week). Due to good blood pressure most of the week, they've been able to remove a good amount of fluid, and he's lost quite a bit of weight (he was at 3560g today, down from 3920 on Tuesday).
The incisions on his abdomen were extremely red and inflamed, as well as a large portion of his abdomen, so they ordered an abdominal ultrasound on Monday afternoon. Urology came in that afternoon, after reviewing the ultrasound. They don't really have a plan other than wait and see at this point. They couldn't place a new superpubic catheter due to the lack of fluid in his bladder (he said the ultrasound showed maybe 2ml), and he was obviously not stable enough for surgery with an infection. Since his bladder was empty, they're just going to do weekly ultrasounds to watch for fluid in his bladder, see if it's becoming distended, etc... Since then, he has had a small amount of urine drain from his mucus fistula, but nowhere near the amount of urine he had been producing. The ultrasound also showed some dilated bowel, but there was no extra free fluid in his abdomen, no abscess, etc...
They started weaning his Versed (sedation/anxiety med) on Tuesday, and weaned his Fentanyl down some today.
A few times on Wednesday, Zeke was pretty agitated, but as soon as I opened the top on his bed, he calmed down. We left his bed open, to see how he'd do with just the radiant warmer, and he did fine. So today, he got to move to a new bed! No more plastic box for him!
This morning was pretty eventful. Zeke had the dressing on his PICC line changed, he had pump change, got the new bed, had a head ultrasound, and just had a lot of people in and out of his room. He got really agitated, and we were having a hard time calming him, even after a dose of Fentanyl. We requested an abdominal xray, because he was arching his back and seemed extremely uncomfortable. We re-positioned him so he was completely on his left side, and he seemed a lot more comfortable. Everything looked ok on the xray. There is still stool backed up in his intestines above his colostomy, but they're hoping that by weaning his Fentanyl and continuing with the Mucomyst, things will start moving and he'll be less uncomfortable. We're going to try to talk to surgery and see if there's anything else we can do to try to loosen up the contents of his intestines to make things move more easily.
They're also trying to extubate him tomorrow! They've started him on a steroid to help alleviate the swelling in his throat caused by the tube, and they're trying to wean his vent settings a bit tonight, and after he gets his third dose of steroids, they're going to try to extubate, as long as he's doing well. They tried to wean his vent pressure this morning, but he kind of freaked out after everything that was going on, and they bumped it back up. He's currently at a rate of 20, and his pressure is 22/5.

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