Day 121 - Urine Culture & Increase in Pressure Support

April 30, 2021

Friday, April 30th, 2021

Overall James had a good day and another great nurse who was very familiar with trachs and g-tubes. It was great to have James active during the day. A few episodes but very short lived.

9:00am Doctor Bedside Report & Hands On

Increased the pressure support above PEEP from 20 to 22. (We think this has helped today to recover sooner.)
We think James may have a UTI so he needed to get a urine culture done. Unfortunately that involved getting cathed. It will take a few days on the results.
Increasing his feeds to 90ml (2 oz).
Tomorrow we change Doctors, one that we've had in the past. Wonder if she'll recognize James. Lol

10:00am Tummy time on Boppy with baby mobile and YouTube Lullabies

11:00am Sterile Procedure

Urine catheter placed for culture.
So far by 6pm no bacteria has grown, but we will want to wait the full 48 hours.

1:15pm Physical Therapy

PT stopped in to work with James. He was held for a short bit, focusing on him sitting up and holding his own head up. He was having a spell on top of his pulse ox not working, so we changed that out.

1:30pm Mom held and James slept.

3:00pm Trach Tie Change

Went well but James did brady and desat during!
Need to figure out a more efficient way to cut the right length. Mom does not like attaching in the back and would rather have it premeasured and then attach the sides. Unfortunately with James growing every day this will be hard to guess! The problem is this velcro is very rough on one side and we don't want that rubbing on his neck. Ouch!

3:30pm Nap time. Mom got a quick 45 minute nap but needed to set an alarm to pump. 🐄

5:00pm Time in the swing.

6:00pm James napping in his crib while Mom discussed immunizations with the Doctor.

James is due for his 4 month shots now. Normally it would be 2 months in between shots, but the CDC says that 4 weeks is okay if the baby is playing catch up.
He received his first shots on 3/20 which was late. So he will probably get back the 2nd round here on Sunday (just waiting on that urine culture to come back first).

Night Shift

8:00pm Mom got a quick bite to eat and she walked back in the room to find him bradying and desating. Oh boy! Hopefully that is not a sign of how the night will go.

9:15pm Mom was just informed that James will be getting his monthly MRSA nasal swab test.

Supposedly this has been happening on the 1st of every month....? There is nothing in the clinical records on our Hospital portal showing this happened on the 1st of every month. We have also not been informed if this has been happening. Mom doesn't think it did... how are they sticking a regular size cotton swab up a baby's nose who is 1 lb.
James did have this test done 3/30 (arriving in the PICU) and on 4/6 (arriving back in the NICU). The blog is actually very convenient for looking things up quickly.

11:00pm James bradyed and desated then had a full on episode. He pooped and peed through 4 diapers in one diaper change. Changing the diaper fast helps end the spell.