Friday, December 12, 2008

More Encouraged

I just talked to his resident and in that conversation I found out that his spells last night were all clustered in one 2 hour block. Once they repositioned his body, he didn't have any more the entire night. That's important information, and more encouraging. He had one episode this morning at 7am and they put him on his belly. He hasn't had a single one since then. Also encouraging.

I also found out that even through these episodes where his saturation tanks and his heart rate plummets, he is continuing to breathe. He wasn't doing that a few days ago, so this is an improvement because it's no longer full apnea, just bradycardia and desats (which are alarming enough). I wish he didn't have so many rotating nurses who don't know anything about him. I really believe it compromises his care. He has two primary night nurses, who don't work all the time, and one of them was the one who came up with the feeding correlation. Who knows what tests and other interventions they would have subjected him to before they thought of that without her help? His one primary daytime nurse doesn't work many days either, so there just isn't very much consistency for him at this hospital and it annoys me.

His poop output is too high, probably due to the high calorie fortifier they just started adding. He isn't putting on any weight, nor probably absorbing enough nutrients. They are going to let things ride through the weekend to see how it shakes out. It's not alarming at this point, but will be if it continues very long or gets any worse.

I found out this morning that his resident (you know, his primary care physician) didn't have it in her file that Crew was born at 28 weeks but measured 26 weeks in size and development. I know the nurses have that information and I have seen his age listed differently depending on what papers I am reviewing. This morning when the resident kept saying "he's 32 weeks", I finally stopped her and said, "now you know that he is really only 30 weeks because he measured only 26 weeks at birth, right, not 28?" Silence. She said that that information actually changes a few things, including her expectations of what he could/should be accomplishing right now. Ugh. Kind of an important detail, don't you think? I don't really blame her for not having the information, but I'm a little horrified that she didn't have it, nonetheless. How does the information not get to everyone involved with his care? It got passed to the nurses; how did it not get passed to the doctors at the same time??? I think that's pretty critical information.

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