Evening of Friday August 7 to Saturday August 8, 2009
The evening after Jenna's surgery was pretty quiet. They wanted to try to wean her Versed and Fentanyl drips and start her on Morphine and Dex drips for sedation and paralytic. Dr. Chima stated that it was fine to remain on the Dex for a couple of days, and extubation is planned for Wednesday. They just want to make sure she is relaxed because that want her to begin healing asap. She began taking Methadone and Ativan for in between sedation doses every 3 hours alternating to keep her relaxed also. They lowered her Nitric Oxide down to 10 too. Her potassium was low for most of the evening so they kept replacing it with bolus amounts of extra. It has seemed to improve finally by Saturday afternoon. She was given back her blood from the bypass machine-BTW she was only on the bypass in surgery for 15 minutes and he never stopped her heart. They began to push her nutrition by increasing her lipids and TPN doses. In rounds on Saturday am her chest xray looked hazy on the left. They stated that if it did not improve then they would do an ultrasound on Sunday and she would possibly have to have another pigtail on that side to drain the fluid. The Fentanyl drip was almost off and her Morphine was to be increased. She only received 5 as needed doses for sedation through the night shift-which is a record, she was averaging 15!!!! They chose to stop draining her stomach and began her feeds again, which would increase every so many hours. Her Nitric was to be dropped to 5 over the day. They pulled her chest tube from surgery because she was not having much drainage from the day before, her pacer wire was also pulled. She was having some extra beats, but in her arterial portion of heart, which would not be beneficial from the wire because it paced her ventricle-so it was pulled.
So throughout the day various updates occurred. They began a bowel regiman to help her since has not pooped in over a week (she has not ate anything so they are not surprised), Miralax and Colace. They feeds through her tube began at 5ml and increased 5 every few hours, to meet 1/2 of her goal by Sunday. Her blood pressure was spiking out of nowhere most of the afternoon, so they stopped the epinephrine in hopes to help regulate the pressure and increase the heart to squeeze blood. They kept rock sedation on hand in needed for her to keep calm and still. THe plan is to eventually stop the Viagra (nitric med for lungs), but remain on the Bocentin for some time. She is going to be going home on an increased amount of diuretics from before because they would like fluid to not place pressure on her heart. Her mucous from her bronchoscopy the other day came back as gram + cocci, which is indicative that it is possible something is growing in her lungs. To be safe they began an antibiotic regiman of Vancomycin and she will remain on it for some time just to make sure she is safe. We are to find out soon if there is anything there. Her oxygen saturation levels began to dip on Saturday evening and the chest xray showed that she had some collapse on the right side. They put her on her side to move around the secretions and her breathing regulated and her oxygen went up. Her blood pressure was really low most of the afternoon, which they wanted her to not get too low so they put her back on the epinephrine to help increase her levels. This happened about 3 times throughout the day, start and stop. Later that evening her oxygen levels dipped down again and her heartrate went up and she began to breathe really hard-up to 60 breaths/minute. Her xray did not show that she was worsening, but improving. To be safe again they increased her antibiotics, did blood cultures to make sure she is not septic. This was because of her irregularity of her blood pressure, heartrate and her temperature was really low. There was still question of a pigtail in the morning, which was to be discussed in rounds and possibly another bronnchoscopy. She was only peeing quite a bit when she was given diuretics, but not otherwise, which she has been doing since surgery. Her nitric is down to 3 at this point and her Fentanyl drip is stopped. Her score for the day went to 90 down from 102 on Friday.
She had more visitors today-Chad, Shannon and family and Nonny (Justin's mom). This was nice that everyone could come up and see her and give us support, this helps right now. We also made posters today for Jenna's room to help make it pretty! This was great. Anyway, we will keep everyone posted on her status. Keep us and her in your thoughts and prayers. Thanks for everything!!
Love, Jenny, Justin and Jenna