Day +18, Wednesday, April 20th. Dad was transferred out of ICU back to the BMT (Blood & Marrow Transplant) floor.
WBC: 1.04 k/uL LOW H: 8.8 g/dL LOW P: 16 k/uL LOW BUN: 69 HIGH Cr: 3.4 HIGH Na+: 147 HIGH
Mentation: During the night, Dad was extremely restless and pulled at his various tubes and lines. A sitter was assigned to sit bedside. He became so restless that he had to be restrained. When Mom arrived in the morning, she was shocked and angered by the restraints and what had transpired overnight. Dad was mildly confused, bothered, and continued his attempts to remove the his tubes and lines.
Doctors wondered if Dad’s altered mentation was due to increased sodium or ICU delirium. Dr. Baluch, BMT infectious disease, changed how Zosyn was administered and also considered adjusting free water amounts via Dad’s tube feeds.
Blood. After multiple attempts, a PICC line was placed. Dad was officially declared engrafted with an absolute neutrophil count (ANC) of 1040. Dad was to receive neupogen for an additional day due to his recent sepsis. Due to the tip from the broken forceps during Dad’s central line catheter removal, the catheter site was monitored for new infection.
Graft versus host disease (GvHD). Dad continued to receive sirolimus via feeding tube. Acute GvHD assessment resulted in an overall grade of 0.
Skin = Stage 0
Liver = Stage 0
Gut = Stage 0
Mouth & Throat. Dad’s mouth continued to be dry. The nurse and Mom were regularly wetting his mouth with a green, water-saturated oral swab. Dad continued to have pain and thick secretions from mucositis, grade 1, and used magic mouthwash to treat.
Lungs. Dad no longer was on supplemental oxygen. His was breathing on his own. He continued to have a productive cough from the thick secretions resulting from the mucositis. Continued voriconazole and acycolovir.
Abdomen. In the wee hours of the morning, diarrhea was back, and a lot of it. Poor Dad had a rectal tube inserted. Ugh…how awful!
His tube feedings were discontinued due to the diarrhea since the doctors believed the diarrhea started the same time the tube feedings were initiated. Unfortunately, Dad continued asked for food and water. He was desperate for a popsicle and ice chips.
Speech therapy came by to test Dad’s ability to swallow properly. He was unsuccessful, and the feeding tube remained in place.
Kidneys. Dad had no dialysis. Dr. Chemaly, nephrology, was concerned about the rising BUN:creatine ratio and high sodium (Na+) level. Dr. Chemaly requested a renal function panel to determine free water amount.
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