3/21

John had an up and down night. His blood pressure kept moving around so he is back on the levofed for a while. The arterial line whose accuracy was always very dependent on his hand being hyperextended and rotated outward was removed; a new one was started on the right side. That's good because its position for accurate readings is better; they were able to put it in with one try; it tracks his temp, blood pressure, respirations/minute, and heart rate to help determine treatment and meds on a real time basis; and,it can be used for blood samples so he does not have to be stuck. John started a little temperature but it was brought under control with some tylenol and by removing some blankets. He is off sedation but will still be groggy while he continues to receive pain meds; he can't tell us when he needs them but his blood pressure and respirations do a good job of communicating when he is in pain. He is a tiny bit more alert at times which is an improvement and probably due to the removal of sedation. For right now, he'll be in some significant pain from the tracheostomy and nasogastric tube insertion yesterday as well as the edema, skin break down, and weakness and postural discomfort from being bed bound for so long. The nurses and respiratory are great about cleaning and moisturizing his mouth regularly but even so, all the mouth breathing dries things out and will be very distressing; that was one of his biggest complaints just before he consented to the intubation and ventilation 3 weeks ago. For some better news, he is able to receive nutrition again now that the nasogastric tube is in place. We'll take what we can get and hope for a peaceful day for John to begin some more recuperation. Thank you for all your prayers and good thoughts for his comfort and recovery.