Day 3 ~ Room 421

Concerns

 -Oxygen: Today has been a rough day for Bob. Although he was doing well Tuesday after Monday's surgery, today (Wed) he's taken some steps backwards. His oxygen saturations kept dropping during the night, which indicates his blood isn't getting enough oxygen from his breathing. They've added a nasal cannula for oxygen. He has been using the spirometer exactly as his surgeon and the respiratory therapist instructed, but the concern is that pneumonia may still be settling in, so they want to do a chest Xray. Due to the lower oxygen sats, he is staying in the hospital at least one more day - hopefully going home on Thanksgiving!

 -Hiccups: The pesky hiccups are becoming more frequent and lasting for longer periods of time. In post-op, the surgeon shared that he had to remove a great deal of adhesions and scar tissue, so we're wondering if it's possible that the diaphragm was irritated in some way, causing it to spasm, leading to painful hiccups. Bob's being a trooper and riding them out, but they certainly increase his pain when they happen.

Timeline

 -12 noon: Taken down for chest Xray.

 -2pm: Returned from Xray. He was in intense pain, unable to even sit up. They began pushing Morphine IV and increased his Percocet from 7.5mg to 15mg.

 -4pm: The pain continued increasing, even with the morphine. He became very pale, and they kept him in bed, alternating heat packs with cold packs on his abdomen. Likely the increased pain was due to gas beginning to move through the intestines, which is a very good thing, but also extremely painful.

 -6pm: Chest Xray showed some diffusion in the very bottom of his right lung. They started keeping the head of his bed at 30degrees minimum, and increased the oxygen flow in his cannula from 2 to 3 units.

 -9pm: He continued to receive Morphine, Percocet and they also added acetaminophen, since he began to run a very low grade fever (about 100F).

 -11pm: Had his first bowel movement, which is one of the goals needed to complete before he could go home. Even with all the pain, this was a great milestone, so we still were pretty optimistic!

Vitals/Stats

 -Fever: Temp began climbing throughout the day, eventually reaching 38.4C/101F by the middle of the night.

 -Hemoglobin: Hemoglobin was 8.8 (normal is 13.5 - 17.5), which is expected after an extensive abdominal surgery.

 -WBC: White Blood Cell count was 4.8 (normal is 4.5). Only very slightly elevated, so nothing was concerning at this point.

 -Fluids: Since Monday's surgery, they had him on IV fluids (saline only) but after Tuesday night, he no longer needed them. So by Wednesday he was drinking sufficient quantities of water and chicken broth to have adequate urine output, and they disconnected the IV fluids.

 -Blood Sugar: Due to his body's increased stress, his sugar levels started climbing, hovering around 200. They continued giving him insulin accordingly.

Morphine, Percocet, Tylenol, heating packs, ice packs - 

nothing takes away the pain and his fever continues to rise.