210916 - ..
210917 - Moved into a room next to the Nursing Control Center.
210919 - ..
210920 - The patient in the same room was watching television, with the volume
210921 - turned up. Ethel had to ask a lot of questions required for the
210922 - medical chart to admit new patients. We had difficulty communicating,
210923 - so she went to the next cubical and turned the television off, since
210924 - the patient seemed to be sleeping. However, the patient opened his
210925 - eyes and complained he could not hear the television. Ethel turned
210926 - the television on, and explained she needed to turn the volume down in
210927 - order to speak with another patient. The patient complained he cannot
210928 - sleep without the sound of the television, and that voices from the
210929 - adjacent cubical make it difficult to follow the television dialog.
210931 - ..
210932 - There was discussion about moving to another room, so the patient
210933 - would not be disturbed watching/listening to the television, and so
210934 - the nurses could talk to the new patient without distraction from the
210935 - television.
210937 - ..
210938 - This presented a dilemma. Having 2 patients in the same room is more
210939 - efficient than 1 to a room. The Charge nurse was consulted. She
210940 - approved moving the patient to another room. The only room available
210941 - was at the other end of the hall, the longest distance from the nurses
210942 - Control Station. As a result, was moved to that location to a room
210943 - for only 1 patient.
210945 - ..
210946 - Met Nancy, another nurse who handled this end of the Med Surg patient
210947 - area.
210949 - ..
210950 - The room is actually, next to the main double doors leading to the
210951 - rest of the hospital, and it turns out about 10 feet from the room
210952 - where Isagani and Graciela work supporting Doctor Stewart in Surgery.
210953 -
210955 - ..
2110 -
2111 -
2112 - 0512
2113 -
211301 - By this time it was over 4 hours since Jessica completed debridement
211302 - surgery in the ER. Nancy was assisted by the Charge Nurse to change
211303 - the dressing on the wound.
211305 - ..
211306 - Shortly, after the dressing was changed, another nurse came to do the
211307 - daily blood draw.
211309 - ..
211310 - Was then able to sleep for awhile.
211311 -
211312 -
211314 - ..
2114 -
2115 -
2116 - 0731
2117 -
211701 - Doctor Lucy Kornblith and Jason visited, accompanied by a student
211702 - learning to be a doctor, could have been the person who was with Lucy
211703 - when we met in the Medical Practice (Primary Care) waiting area
211704 - yesterday evening, reported on 150923 1530. ref SDS 11 05HC
211706 - ..
211707 - Jason and the student changed the dressing on the wound again,
211708 - showing the big bulge has now been resolved leaving a large open
211709 - wound from debridement surgery last night...
211710 -
211711 - 
211712 -
211713 - 
211715 - ..
211716 - Lucy proposed a work plan for the patient to be discharged later
211717 - today, and that the dressing would be changed 3 times each day by the
211718 - patient.
211719 -
211720 - [On 150925 0336 Doctor Kornblith revised the work plan from
211721 - the patient changing wound dressing 3 times per day, to
211722 - having a home care nurse change the dressing once-a-day.
211723 - ref SDS 12 UI6L
211725 - ..
211726 - Discussed logistics that would prevent the patient from changing the
211727 - wound dressing, based on observing Jason and the student change the
211728 - dressing this morning.
211730 - ..
211731 - This process involves using a long wood stick to push "string" gauze
211732 - to pack the dressing between the wound bed now about .25" below the
211733 - skin and the overlapping skin tissue surrounding the wound opening in
211734 - the leg. This requires applying delicate pressure at an angle well
211735 - below the knee, which would be difficult, even impossible, to
211736 - accomplish by one person, since the 2 doctors were having difficulty
211737 - working together this morning. They had to start over because Lucy
211738 - did not feel the initial packing was adequate.
211740 - ..
211741 - Proposed changing the dressing once a day, and coming into the VA so
211742 - professionals could do the work correctly?
211744 - ..
211745 - Lucy said not to worry, because the patient will be given training to
211746 - perform the wound dressing, before being discharged.
211748 - ..
211749 - After this meeting, slept some more.
211750 -
211752 - ..
2118 -
2119 -
2120 - 0810
2121 -
212101 - Met Ericka who took over from Nancy for the day shift. Also met
212102 - Alona, the day-shift Charge nurse.
212104 - ..
212105 - 
212107 - ..
212108 - They explained that Doctor Kornblith ordered the dressing on the
212109 - wound to be changed again for some reason. As a result, the 2 nurses
212110 - removed and applied a new dressing.
212111 -
212112 - 
212114 - ..
212115 - Thanked Ericka and Alona, and then slept some more.
212116 -
212117 -
212119 - ..
2122 -
2123 -
2124 - 1043
2125 -
212501 - Woke and decided to walk through the ward to aid healing.
212503 - ..
212504 - Took about 10 minutes for the pain to subside on changing from laying
212505 - on the gurney to standing position, in order to place weight on the
212506 - left leg.
212508 - ..
212509 - After that, could walk around the hospital for about 30 minutes or
212510 - so.
212512 - ..
212513 - Returned and slept some more.
212514 -
212516 - ..
2126 -
2127 -
2128 - 1345
2129 -
212901 - Ericka and Alona came and changed the dressing on the wound again.
212902 -
212903 - We discussed the doctor's work plan earlier today, for the patient to
212904 - change this dressing 3 times per day at home, per above. ref SDS 0
212905 - LF7I
212906 -
212907 -
212909 - ..
212910 - Alona said she will work on this issue.
212911 -
212912 - [On 150925 0336 Doctor Kornblith revised the work plan from
212913 - the patient changing wound dressing 3 times per day, to
212914 - having a home care nurse change the dressing once-a-day.
212915 - ref SDS 12 UI6L
212916 -
212917 -
212919 - ..
2130 -
2131 -
2132 - 1403
2133 -
213301 - Doctor Kornblith and Jason visited. The doctor said the patient will
213302 - stay in the hospital another day, because lab this morning indicates
213303 - continuing infection shown by elevated WBC.
213304 -
213305 -
213307 - ..
2134 -
2135 -
2136 - 1431
2137 -
213701 - Kathy arrived from Sacramento for a visit. We went for a walk on the
213702 - 2nd floor, after going through the struggle with pain to stand up, and
213703 - allow pain to subside.
213704 -
213706 - ..
2138 -
2139 -
2140 - 1513
2141 -
214101 - Alona visited. She has talked to the Discharge Manager about
214102 - challenges for the patient to perform a complex wound dressing change
214103 - 3 times per day. The Discharge Manager just called Alona back and
214104 - reported the dressing only have to be change once per day, and that
214105 - the Discharge Manager can order Home Care nursing to perform this
214106 - dressing change.
214108 - ..
214109 - This seemed like a miracle.
214110 -
214111 - [On 160817 1010 was in Telemetry to see Mike for
214112 - scheduleing meeting with Doctor Stewart; happened to see
214113 - Alona, and gave her a hug. ref SDS 13 RQ9I
214114 -
214115 -
214117 - ..
2142 -
2143 -
2144 - 1821
2145 -
214501 - Finally got computer set up in order to get some work done...
214502 -
214503 - 
214505 - ..
214506 - Could not do much. Very tired from long day yesterday.
214507 -
214508 -
214509 -
214510 -
214511 -
214512 -
214513 -
214514 -
214515 -
2146 -