The following bullet points summarize Julie Karr RN's visit to the house:
General
Julie measured the circumference of Maureen's arm—27.2 inches. Last time, it was 27.5. Based on these measurements, Maureen has not lost any weight. The difference has to be at least a 1/2 inch to certify Maureen using weight.
Maureen's lungs are clear. Blood pressure was 120/80.
Julie approved both versions of the Robitussin cough medicine we have in the house: daytime and nighttime. She does not believe using the nighttime version is necessary at this time.
According to Julie, the optimal bed angle is 10-30 degrees. She recommended a 20 degree angle. If the bed angle is greater than 30 degrees, it can cause shearing.
Since Maureen coughed a few times during the home visit, Julie asked us to do a COVID test. The result was negative.
Maureen's first hospice evaluation will be sometime in March of 2022. It is possible that she can "graduate" out of hospice if her overall condition plateaus—i.e it does not continue to deteriorate.
Coughing, chewing and swallowing
We spent the large balance of our time discussing coughing, chewing and swallowing. Please review the following bullet points:
Julie said Maureen's ability to chew and swallow will most likely decline gradually over time. It is inevitable.
Julie is going to send some thickener to the house for use with liquids if Maureen experiences materially increased difficulty swallowin. There are three levels of liquids with thickening, 1> nectar, 2> honey and 3> pudding.
Thickener is designed to be tasteless. It is used in solids and liquids.
The three types of diets are: A> general, B> mechanical and C> puree. Maureen is somewhere between a general and mechanical diet based on what she consumes right now. Julie characterized Maureen's overall diet and "mechanical soft."
Based on the increased level of regular and "red face" coughs we have observed recently, Julie said Maureen's swallowing muscles have weakened.
A key for all caregivers is to never force food on Maureen.
Overall, Julie advocates a small and slower approach to eating. Reduce portion sizes. The current standard is the size of a die. Try to make each serving a bit smaller than that. Slower is obviously self explanatory. We all simply need to take our time when feeding Maureen. Slow and steady will always win the race.
The fact that Maureen is coughing more is not all bad. Julie said, "As long as Maureen is coughing, her body is doing the job."
Aspiration pneumonia is the biggest danger Maureen faces. The most obvious sign that a patient is aspirating is constant coughing for extended periods of time—say 10-15 minutes. Julie also said that patients can silently aspirate.
JourneyCare does not have speech therapists like Christina Padilla of NorthShore on staff. We are free to request a speech therapist such as Christina or another professional to come to the house to evaluate Maureen.
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