Okay...what exactly is a "thoracentesis"?? This is the next "fun" thing my mom gets to do...while still getting used to that dang swan catheter!!!!

BTW...she's stable and has been moved out of ICU. But she still cannot talk to me 'cause of the G.D. ventilator!!!!!

-- Anonymous, October 02, 2003

Answers

Why would you be sorry? Most of us don't know either.

Oh, it's good to be out of ICU.

Wildman, (wondering)

-- Anonymous, October 02, 2003

Poking a hole in the thoracic cavity (chest) with a big syringe and drawing out fluid (or draining out fluid - depends on why they're doing it). Fluid building up and putting pressure on her heart/lungs etc now??

Sorry, didn't see the note about the swan - it is, as you said, a catheter (open line) into usually the first chamber of the heart. It measures a lot of different things - arterial pressure, etc.. Almost standard in ICU cardiac cases.

(I won't be back home til about 9pm tonight)

-- Anonymous, October 03, 2003

Thanks, Polly. I've gone to some medical sites for explanations...but no one seems to explain these things in English the way you do :-)!!

The swan catheter revealed that her cardiac arrest wasn't due to congestive heart failure. So now they're trying to drain off fluid to see if that will prevent it from happening again. Frankly...I'm wondering if they're just experimenting and don't really know what else to do!!

-- Anonymous, October 03, 2003

Marcia, there are days when I think anything beyond an aspirin is a medical experiment! And then there are days when I wonder about the aspirin...

There can be a lot of things that causes fluid to build up where it isn't supposed to be - "third spacing" they call it. Fluid is supposed to be in the tissues, or in the blood (running around in the vessels); not gathering in the lungs, or the lining of the chest or abdominal cavity, or the legs... I'm not good at cardiac stuff, so I can't tell you much beyond: if there is fluid where it shouldn't be and it's causing problems, then they've got to get it out of there whether they know why it's there or not. If it comes back, then they need to let you know why it's coming back. I'd bet first on some sort of an electolyte (chemical - sodium, calcium etc) imbalance, and then on a inflammation, possibly caused by an infection. Could have something to do with her blood sugar, even.

Here is the bad news - and I'm not trying to worry you unduly - in fact, I don't want you to worry; I just want you to know what you are up against. Stuff they may not have told you type of thing. Since your Mom has been in a nursing home, they will not keep her very long in the hospital, because a lot of the things that are done in the hospital (even IVs and vents) can be done in the nursing home, so medicare won't pay for her to stay long in the hospital. The difference is - Hospital: 1 nurse to 6-12 patients. Nursing Home: 1 nurse to 20-40 residents. Do you have Health Care Power of Attorney? A form that states if your Mom is not able to make her decisions, you are legally allowed to make them? If not, get it; or have someone in the family get it. It's a simple form, your Mom can fill it out there in the hospital, you don't have to be there, case management can do it over the phone. Also, does your Mom have a Living Will? A form that states what she does and does not want done in case of cardiac or respiratory arrest - Full Code, No Code, CPR but no vent, Feeding tube or no etc...this is also available at the hospital. Better to have and not need than need and not have type of thing.

When she gets back to the nursing home, you need to stay in regular contact with the nursing staff/asst administrator/Director of Nursing (DON). When you call the first time, ask them when is a good time to call and try to stick to it. When the nurse is trying to pass meds, or meal time when she is helping feed are not good times and she will be more rushed. Think about it - do you really want someone's food to get cold so the nurse can run down a long hall to answer the phone? Be respectful of their job load and they will love you and do what they can to help you. Shift change is not good either. If you don't get a good repsonse from one nurse, try at a different time of day. (Nurses are like mechanics - there are good ones and not so good ones - keep trying til you get ahold of a good one!) If you get a good repsonse; ask that person their name and when you would have the best chance of getting ahold of them again. Have a list of questions ready - not just "So, how's my Mom doing?" More like "This is Marcia XYZ, I'm calling in regards to my mother Mrs. ABC, for who I am heath care POA. Could you please give me a condition report. I'd like to know her recent vital signs, including oygen saturation. I'd also like to know if her lungs are clear, if she is having any difficulty breathing, if her heart rate is regular and if she has any edema noted (if so, has it increased or decreased). Could you please tell me if she is taking in an adequate amount of food and fluid; and is she able to urinate and have bowel movements without difficulty? Has she been incontinent of bowel or bladder? How long was she up out of bed? Has she attended any activities? Did she participate in the activities, or just attend? Has she been confused, anxious, tearful? Has she been sundowning (awake at night, confused etc..)? Is there any information I can give you? Thank you for your help; I really appreciate it. (Nurse's are the dogs of the human race - pat me on the head and I will be your buddy for life!) Got a fax machine? Get her fax number and offer to fax your questions and have her call you back or for you to call back when she has had time to round up the answers.

I know this stuff is kind of overwhelming. If you need me, get ahold of me and I will help as best I can.

-- Anonymous, October 04, 2003

Polly, is Marcia going to have any problems with HIPPA when she calls and tries to get info on her mom? I'm guessing that with a POA they should be able to talk to her, right?

Marcia, I used to be one of those people who worked in the lab and tested the blood. Polly's your go-to gal for explanations about procedures, I can explain the lab results.

Another thing I thought of that I may have mentioned already in regards to trying to locate your sister. Didn't you say you thought your nephew was in the navy? If you call the Red Cross and tell them there is a medical emergency in the family they will contact him (as long as he's still active duty). It's a long shot, but who knows?

More big hugs, and call me if you need anything. :)

-- Anonymous, October 04, 2003

No problems with HIPPA as long as she is HCPOA, POA or if her mother gives written permission or witnessed verbal permission.

Healthcare Information Privacy Protection Act, or something like that. I hate acronyms.

-- Anonymous, October 04, 2003

Marcia, when Sandy's brother was in the hospital, he signed the form so Sandy could get all the information while he was in ICU. We found out that when he went to the floor, that form wasn't any good. Had to do it again. Each department had to have their own form!

I heard on one of the television shows that it's not a bad idea to take a tape recorder with you. They say you'll be amazed at the things that were said that you don't remember. I know, our doctor and pharmacist either know or have forms that Sandy can have any information on me that she wants. I usually tell the receptionist, the nurses and the doctor, hell, I tell the janitor. We're in a small town and they were giving her the information before she signed the forms.

When I go to the doctor, I usually wait until I can't go anymore without going to the doctor so Sandy always goes in with me. It's amazing the information she can provide that I've forgotten or don't remember or couldn't care less about. Give me a shot, make me feel better and quit asking all those stupid questions. Then, there's two of us to remember what was said. It also keeps us from having to remember it to tell the other.

Hope she's improving.

Wildman, (telling everyone)

-- Anonymous, October 04, 2003

Thanks for all the suggestions, folks!! Especially Polly and Sherri! Gosh...I'm overwhelmed with all the support, but things are not going so great. Believe me, it's been a lllooonnnggg weekend!!!!

Remember the thoracentesis procedure? Well, in the process of doing that (which I gave permission for!!) they nicked part of the lung causing some collapsing. 'Course they didn't say why this happened when they called me yesterday asking for verbal permission to go back in and reinflate part of the lung that had collapsed!! Then they put her on dialysis which seems to have stressed her body even more...even though it was necessary! To make a long story short, her physical condition is becoming weaker and she is sedated most of the time.

The plus side of this is that my oldest sister (from Cape Cod)...who has had "problems" in the past with my mom and consequently has not got along with her AT ALL...has gone down to N.C. to be with her!!!! I can't tell you all how happy and relieved this has made me feel. Anyone who has a big sister or brother knows what it's like when they come along to "fix" things!! Deep down I know that the end is near....but I'm soooo glad that Pam is there with her and I know my mom is glad even though she's heavily sedated!

Polly...I've relayed all the suggestions you gave me. My half-brother, Ken, has Power of Attorney and can make decisions for her if she's unable to. She does have a living will so that's all set. Pam will be staying there for as long as needed and so will be in contact with the doctors on a daily basis. She'll also be calling me regularly!!! I am so hoping that in a few days she will call and tell me that my mom wants to talk to me! I'll let you all know when she calls :-)!!! Thanks again!

-- Anonymous, October 05, 2003

Our thoughts are with ya, Marcia. It is wonderful that your sister is there; like I mentioned in my own family, barriers sometimes start to melt when one of us in hurtin. Hang in there........

-- Anonymous, October 05, 2003

Gee, E.M...I'm sorry. I've been so wrapped up in my own problems, I've forgotten to ask about your dad!! How's he doing??? Better, I hope :-)!

-- Anonymous, October 05, 2003

Thanks Marcia.....my dad is doing much better! He's just on ibuprofen now (and actually taking milk thistle three times a day to protect his liver......I can't believe it!!). Still hard on them both cuz he's housebound and she has to help him with personal hygiene and anything that requires turning or bending. My sis and her daughter or I and my two still go over there most days, and at least check in every day. He's healing, he's a survivor, he's amazing!

-- Anonymous, October 06, 2003

Hugs to you, Marcia; and I hope Mom takes a turn for the better and is able to talk to you soon. I'm also glad for you that your family is pulling together. Let me know if you need anything.

-- Anonymous, October 07, 2003