Fantastic day, rough night... SBs birthday was incredible. She appeared to be very happy the entire day. The sitter last night brushed her hair and got it ready for the day. Of course with all of SBs moving around it had to be redone before she went out. We got Sara Beth in a really nice blue sundress so she could feel pretty when she went outside. Before we went out and about she was able to use the walker and a person on either side of her to help her walk to the restroom. After that they helped her to the wheel chair. We wheeled her down to the ICU to see old nurses and CNAs. They were thrilled to see how much progress she had made. Next we went down stairs and surprised her with her puppy. I dont think SB remember her, but it was still an adorable puppy so she obviously loved her. She looked so happy she almost cried. All of this excitement was followed by a nap. The physical therapy team came to work with her and had her walk all the way to the end of the hall with her walker and them on either side. The still have her degree of bend set at a max of 30. They are being extra protective over her and will only let her get out of bed to walk if they are present, since none of the nurses are trained specifically in her type of knee injury. We can always call the lift team to come put her in a wheel chair if need be. Speech therapy came by as well. He worked with SB for a little bit, but still hasnt cleared her for thin liquids yet. He also said we need to try to do a better job of limiting her stimulus periods. No more than 3 active visitors in the room at one time. If someone is sitting in the corner not talking or moving about then that doesnt necessarily count as active. They said to try to limit the random conversation between people not talking directly to SB during a time when she is trying to receive instruction or is being asked questions. The nurse went out of their way, spent their own money, and even came in on their day off to wish SB a happy bday and decorate her room for her. It was something out of one of those heart warming Patch Adams type of movies. The speech therapist did say that for these type of brain injuries at this stage it is best to have as little stimulus as possible and that with her room double decorated it might be a little much. So we started taking a few things down. They recommended having at least one wall that was blank and calming. For those of you that are like I was when I first walked into this place, speech therapists do more than just work with speaking. They are her primary cognitive therapists right now. So other than the neurologists and neurosurgeons they are our current best way to help Sara Beths brain heal as we try to get her back to the way she was. Sara opened a few gifts and loved them. The flowers brought a smile to her very swollen face. And she devoured an entire cupcake. Like I said it was a very exciting and happy day for SB overall. It was by far the best possible way to spend your birthday if you were confined to a hospital. After all of this SB took another even longer nap. One of her chest tubes came this evening. The one they pulled was the one that was in at an angle and apparently was responsible for blood drainage. Standard procedure required a chest X-Ray before they could pull the other one. After this double check the second chest tube was supposed to come out. However, with the night came new challenges to overcome. This standard procedure X-Ray happened pretty quickly when the respiratory nurses and respiratory therapists noticed air bubbles in her fluid collection container when they made her cough. This meant that the had another pneumothorax. I was given a brief lecture on what this meant and will try to explain the best I can. What happens is that there is a small hole in the lung (SBs left lung). This hole cause air to leak out as she is breathing and her lung to partially collapse in on itself. Maybe a better way to say it would be to say that it doesnt fully inflate. If they just pull the chest tube the way it is, it wont heal properly. So we had to take a baby step backward. We had to hook suction back up to the chest tube. This puts a very tiny vacuum on her lung, which makes it fully inflate. They monitor her lung on a daily basis until the lung has repaired the small hole itself. This is when they leave the chest tube in for another day or so, but have it off of suction and just on a gravity drain called water seal. If they are happy with how the water seal held up then they make the call to pull the chest tube. SB was on water seal (one step away from removal and possibly discharge) when they discovered the air in the pleural space. They said that this small hole could have been caused by a number of things. It is sometimes common to have a previous hole in the lung (which she had when she came in to the ER) reopen. Think of a scrap on your knee that is healing and forms a scab. This scab is protection while the healing process finishes, but is also easier to open than normal skin. Scabs can get knocked off and the wound can reopen a little. It is possible that something like this may have happened in lung. It could have been from the surgery when they were messing around in there on Monday, or the chest tube getting jarred as SB rolled around in bed, or coughing too big or too much. Does one ever really know how a scab gets reopened? Not me, I just look down and sure enough Im bleeding slightly again. They arent too concerned with how it happened, just that they fix it. They will monitor her for another couple of days to try to work toward water seal again. This will most likely be followed by more monitoring and then removal. We have been pretty lucky so far that any steps backwards that we have had to take have been small ones. It is easy to forget when you look at her, her room, or the medical facts, which have mostly been positive, that we are still in the TRAUMA unit. This is only one step below the INTENSIVE care unit. Weve gotten a little spoiled with how many consecutive positive things we have had happen since Oct. 1st. If this goes smoothly and her bladder infection continues to clear up, barring any unforeseen circumstances, we will be cleared to continue rehab at a specialized facility. Tonight was rather rough on SB. She got a little anxious and agitated. More than I had ever seen. She refused to take her meds for quite awhile. She even refused the nurse, which she had never done. It is expected that eventually she will get fed up with me and not want to listen to me anymore; I got kicked out 4 times tonight. However, I could really tell she was in a foul mood when she told the nurse no. I read to her and that calmed her down for awhile. It just seems that she is slowly becoming more aware of small things, but is unable to figure them out. She will tell me that she is scared, frustrated, and/or mad, but will then say that she doesnt know why. The brain is a very interesting and complex thing to deal with. We finally got her meds to her and she is sleeping like a rock right now. I hope she sleeps through the night because after a very festive birthday her brain needs the rest. Tomorrow we will shoot for low stimulation other than that done by the doctors, nurses, CNAs, and various therapists. This will lead to shorter day naps, which in turn should lead toward a less anxious night and therefore a better nights rest. A lot of what I just typed is me listening to a medical professional one time hours ago and trying to regurgitate it the best I can. So for anyone that is more medically trained than me or anyone currently attending Google University, I apologize if I dont have it exactly correct.
Posted on: Sat, 19 Oct 2013 05:16:23 +0000
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