Friday, April 15, 2011

Friday Update For Ben

This morning I called Ben's nurse Catheryn around 8:30 AM. Since I am going to my first "care givers support group" at our senior center in Santa Clarita, I could not get over to see him until this afternoon. She said he was ok except for he has a fever of about 101°. Other than that, she said his numbers were good. She had not seen a respiratory therapist yet, but she was going to call them about doing his breathing trials. I got to the hospital around 1:30 PM this afternoon. Bens vitals were still good and his color was good, plus he had no fever. I was very disappointed when I noticed that his stomach was once again distended. Dr. Yang from Internal Medicine came in while I was there. She asked me if his stomach looked bigger to me than it did yesterday after they did the Paracentesis. I told her that yes it was plus it was feeling harder again and I asked her why his stomach keeps bloating up like that and becomes distended. She explained to me that it was because his "Albumin" levels get low. Albumin is any protein that is water soluble. She said that they are commonly found in blood plasma. When someone is being fed so much through tubes and IVs the fluid starts to come out of the blood vessels and distributes itself in the body like in his stomach. This fluid causes his stomach to distend. So at least someone has now explained to me why his stomach keeps bloating. Dr. Yang said it is NOT a dangerous occurrence, but that it does cause discomfort for the patient and can press on his lungs which makes his breathing harder for him. She told me that they will probably have to do another Paracentesis on him go remove more fluids, but they do not like to do it all at once because it causes the blood pressure to drop if they do. She said their goal is to get Ben off of the TPN and back on the tube feedings full time and hopefully his Albumin levels will stay up. Although, I know when he was in ICU, they had him on the tube feedings for awhile and his stomach was still bloated. Ben was asleep when I walked in. He did open his eyes when I said hi to him. I was there for a little over an hour this afternoon and he was asleep most of the time so I don't even know if he realized I was there. I asked his nurse Catheryn if they had tried to do any ventilator weaning this morning. She said they tried but he only lasted about 40 minutes. She explained to me that they were wanting to have him go a little longer because they wanted to do what is called "trach piece" therapy or "T-Piece". They remove the ventilator hose and put an aerosol mask over the plastic trach tube that comes out of Ben's throat and it makes him breath more on his own. I guess they tried this with him last night for a couple of hours. Ben has to be able to do the regular breathing trial for at least 2 hours before they can do the T-Piece Therapy, but today when the Respiratory Therapist Bert came in this morning to try it, and again this afternoon, Ben could not do the regular breathing trials long enough. He did another 15 minutes this morning and that was it before he started gasping and they had to put him back on the ventilator. So all he could tolerate today was 55 minutes. I found out today that they refer to the breathing trials as Pressure Support Ventilation. Pressure support is a method of assisting spontaneous breathing in a ventilated patient. It can be used as a partial or full support mode (1-3). The patient controls all parts of the breath except the pressure limit. The patient triggers the ventilator – the ventilator delivers a flow up to a preset pressure limit (for example 10cmH2O) depending on the desired minute volume, the patient continues the breath for as long as they wish, and flow cycles off when a certain percentage of peak inspiratory flow (usually 25%) has been reached. Tidal volumes may vary, just as they do in normal breathing. After they put him back on the ventilator, the repositioned him in his bed and he fell asleep, so I decided to come home. I was with him for a little over an hour today.

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