01/01/2013/01/02/ – Tuesday/Wednesday

Discharge from Hospital - The hospital doctor needed to stipulate that mom does not participate in PT or OT until the pneumonia is cleared up and breathing is returned to normal.  She will return to Skilled Nursing Facility and continue on the 100 days of Medicare, expires March 15^th.

Breathing issue is still number one. She is on antibiotics (Vancomycin & Aztreonam ends 2/28/2013) since Dr. Frank B.r (760-489-1458) came on board and found the pneumonia as of 12/29. Why could the ER not find that? Or Dr. G. or Dr. H. (760-739-2371)?  What other breathing support does she need? Oxygen and change the Albuterol to Xopenex if possible; it will not make her shaky.

Coughing- this needs to be monitored with re: to choking and swallowing hazards.

Bleeding from the rectum or vagina. No one seems to know exactly where the bleeding is coming from or why. The stool and urine continue to have blood in them. Treating the bleeding is important b/c we cannot treat to prevent more strokes with blood thinner agents until the bleeding is stopped? Or go ahead and treat and then stop if we see it causes more bleeding.  There was a doctor’s visit set with her primary for 12/27 but she was in the hospital. Now, we will hope she can make the Dr. L. (OB/GYN) appointment on the 11^th of January.

UTI- this has been an on again off again diagnosis since the stroke (11/16/2012). Treating it with Levaquin (since 12/25, she was on CIPRO 12/20-12/25 from Palomar emergency) and get rid of it to see if the brain fog improves.

Probiotics – added a daily does on 12/16 at 5:45 PM ok per Dr. G. (Palomar) Had to stop this as they thought she was aspirating food, will continue ASAP.

Incontinent – is this a result of the stroke weakness or laziness? Either way; it will contribute to sores, disease and possible continued UTIs. I asked Skilled Nursing Facility to do something towards getting her off the diaper; they were supposed to ask her every two hours to go to the bathroom. I have no report on how that was progressing, other than the obvious that she is still in diapers.

Swallowing meds and vitamins – problems reported at SNF; we now find out that she could not swallow due to breathing problems and the gunk that was in her mouth; it was choking her.

Daily hygiene- dentures need to be cleaned, mom is not capable of doing it all herself. She arrived at the hospital with a major yeast infection in her mouth. Hospital treating with Niastatin swish and swallow.

Regular Meds- has she been restored to all daily meds? Thyroid – yes, Amalodapine- yes, Colase – yes, Ritalin? Meghase?  All have been restarted.

Yeast Infections - The nurses at Palomar found that mom has a severe yeast infection in the groin area. They are treating it with Niastatin powder, the same medicine they are using as a swish and swallow for the yeast in her mouth.

Is there an external test to see if she is reactive to penicillin?

Skilled Nursing Facility issues - Spoke to Ann at Skilled Nursing Facility 12/27/2012 and Gloria A., the head of Nursing today (01/02/2013) about these issues.  Gloria has been on vacation and not aware of any issues. I told her Ann was going to move mom to 109 but Gloria says it is not available now, so what is the new plan to prevent a reoccurrence of the poor attention mom was receiving?

Dental hygiene and no breathing treatment administered, she suffered another stroke that went un detected until we arrived on 12/25 at 10:00 AM

Gloria said she would investigate and get back to me.  I have little confidence that mom is getting adequate care at their facility. I spoke to Sadie 12/19 about my concerns and she told me that mom was getting her meds for sure. I have my doubts. These concerns must be addressed before she can be returned to the facility.

Skilled Nursing Facility 7:00 PM mom arrived at Skilled Nursing Facility  The orders came over for her to continue IV antibiotics but the nurse at Palomar did not read the orders and removed her IV. Joel at Skilled Nursing Facility called the IV team and got her a new IV and started her antibiotics at 9:00. He called just to let me know, that was very comforting.

·       In today’s meeting we want go over the plan to prevent the health risks that occurred that sent her to the hospital. Move her to station number one if not right now ASAP a bed is available.

·       We want to set up a meeting with the doctor to make a new health plan to prevent stroke even before we get the OBGYN appt.

·       Discuss the personal property that was stolen.

·       Get her nails trimmed and haircut and dandruff address on a weekly basis.

·       I don’t want to be the police. I want to come in a visit my mother daily but not have to monitor your staff.

·       In the event I cannot come daily or need to take a couple of days off, do you know of reputable agencies where I can hire people to check in and visit her?

Questions for Debbie:

Re: hospice and treating her pneumonia? And what impact does that have on the 100 days and after? And can we start and stop? And what does that do to Medicare benefits?