Day 2 CV-ICU March 22, 2017

I am writing this entry a day late as we had a busy day and a rough night....but for the sake of sharing---

Yesterday morning started off with the team making rounds and letting us know that they were pleased with the way things looked on all the monitors. Nicholas had a few episodes of nausea from gagging on the tube and they determined that the tube could come out as soon as the echo confirmed that his heart was still holding up as well as the day before.

Echo to check LV function

 

After the echo determined that Nicholas was holding steady, the respiratory therapist came in and started prepping for removal of the ventilator tube. This tube goes all the way into the lungs and breathes for Nicholas with 100% oxygen pumping in. After the tube was pulled, Nick's voice was very raspy and he could only really whisper. After about a half hour, he started having "stridor", which is kind of like croup. It might have had something to do with the cough he had before surgery, or the air tube might have caused some laryngeal inflammation. At any rate, breathing became more labored and his oxygen saturations dropped dramatically into the 70's and 80's, even with a nasal canula. So the respiratory therapist ordered albuterol treatments to open up his airway and that helped raise his oxygen levels back to higher 80's and low 90's. The unfortunate thing about using albuterol is that it causes the heart rate to speed up and the blood pressure to rise. So in order to reduce those back to a safer level, the doctors prescribed morphine to follow the breathing treatments. The morphine lowers the heart rate and pressure, and this was the routine all day. As soon as the albuterol opened the airway, the blood pressure elevated, the morphine was administered, the blood pressure lowered, the airway tightened, again and again and again...

Yay, no more ventilator

During the stable periods of time, Nicholas had his rectal temp tube pulled along with his Foley catheter in his bladder. They followed this with a dose of lasix to get some of the excess fluids out of his system. Nicholas didn't feel the urge to pee for at least 3 hours and our nurse said he was not allowed to get out of bed until one specific monitor was pulled from his heart. This monitor is inside his chest sending information to the outside regarding the function of his left ventricle. Our nurse explained that it is a really great tool to have for the real-time information, but the patient cannot move out of the bed while it is in because it could dislodge and cause severe internal bleeding. 

Back to the pee issue. Our nurse was off duty after 6 hours of the Foley catheter coming out. She explained that if a patient has not urinated in 4-6 hours, they would have to re-catheter to get the urine out of the bladder. She had already been dealing with the blood pressure thing all day and did not want to cause Nicholas more stress which would further elevate his blood pressure. At the fourth hour, she tried to get Nicholas to pee. He could not get anything to come out so his nurse sprinkled warm water on his belly, we played a waterfall sound on my phone, we fed him some ice chips to see if the cold going down his throat would start the flow. But nothing worked. After 15 minutes or so, she suggested he try to relax and try again in an hour or so. It was nearing end of her shift, and she was worried the night nurse would have to re-catheter him so just before she left, she let him dangle his legs over the edge of the bed to see if getting him verticle would get that urine flowing. It did not work. She expressed her concern to the night docs and got permission from the team to give him few extra hours to get the urge to pee. Meanwhile his little belly was getting bigger and harder with fluid that had nowhere to go. This is when the shifts changed. 

Later in the afternoon we were told that Nicholas was changing rooms. So I packed up all our stuff and the nurses brought him into a shared room. There is a little boy a smidge older than Nicholas on the other side of the room. He initially had a breathing tube but it was pulled and now he's very vocal; quite the opposite of our Nicholas. 

The nurses change shifts every 12 hours and the parents are not allowed in the room during shift change. When I came back from the shift change, our night nurse was a male. He did not look like a nurse, more like a skateboarder with funky hair and noticeable scent of cigarettes. I felt like there is no way that Nicholas is going to communicate with a guy who looks like this, so I stayed in the room all night long. I was not very happy with the way he interacted with Nicholas and I felt like if Nicholas needed something, the nurse might intimidate him. He was unlike all the female nurses we've had, who are very nurturing and explain everything they are doing. At one point I had drifted off to sleep in my chair and next thing I know, the nurse is sitting Nicholas up to STAND up to pee. I knew that he was not supposed to get out of bed yet because he has that cardiac line in his heart that is taped to the outside of his chest. Nicholas lost all his color and looked like he was about to pass out or crumble to the ground. The guy nurse called the nurse in the other side of the room to help get Nick back in bed. They got him back in and thankfully the cord stayed put, This was the start of all the nausea. 

After Nicholas was back in bed, he started heaving and then vomited. He was nauseous all night long and threw up 3 or 4 times (I lost track because I would wake up from dozing off). The guy nurse kept giving him doses of anti-nausea medication but it didn't work, apparently. Poor Nicholas has not felt well pretty much the entire time he has been off sedation.