The Journey of James Weston

Thursday, July 15th, 2021 Starting off needing to vent about the miscommunication in the PICU... Clinical Notes for the day: James presents to the pediatric ICU with a history of feeding intolerance requiring G-tube feeds. Feeds paused due to intermittent emesis- which initially resolved. Emesis resumed and GI was consulted. They recommended running feeds over a slower rate but parents did not want that. He is currently tolerating goal GT feeds: 20 mL Prune Juice BID (11A and 4P) +Bolus feeds 120ml over 45mins: NeoSure 22kcal at 8am, 4pm, and EBM at 12pm +Continuous feeds EBM 40ml/hr 6pm -6am. He is intermittently constipated for which milk of mag and miralax was started. He went 48+ hour without a bowel movement. Mom did not want glycerin suppositories used but after extensive time without BM she was ok with a mineral oil enema. He stooled well post enema on 7/15/2021. Please note that both sentences are red and completely made up. 1) We were told that the PICU team did not agree wit...

Wednesday, July 14th, 2021 James vomited again at 9:30am. Mom thinks it has to do with the farrell bag being clamped due to medication. He has a continuous feed every night from 6:00 p.m. to 6:00 a.m. which is run 40 ml/hour. During the day he has bolus feeds at 8:00 a.m., 12:00 p.m., 4:00 p.m. which are run over 45 minutes. So the issue is his first bolus feeds ends at 8:45am and then at 9:00 a.m. he has meds due. He has a full belly from a whole night of continuous feeds, then gets a very large bolus feed where he is clamped right afterwards.  Updated Measurements: Length 51.8cm Head Circumference: 40.6cm Abdominal: 46cm Updates to medications: We will start giving him miralax in the morning and then milk of magnesia in the evening for constipation. 🤳 Mom spent a great deal of time on the phone with Social Security. Did you hear? We got a letter in the mail that said they received return mail and therefore are discontinuing payments. We have no issue with our mailing address or...

Tuesday, July 13th, 2021 We gave him a glycerin at 6am and he then had a massive diaper around 8:30am, we then changed all of the bedding. At 9am he projectile vomited twice, we again changed all of the bedding and did his trach care. After that we had people stop in one after another. First the discharge coordinator stopped by, then ENT, then OT/PT, then the Pulmonologist, then the Doctor on-call, then the Speech Therapist. It's been non-stop and he is now just taking a nap at 1pm. We decided to put him on an acid reflux medication, Prevacid, to help with the vomiting. It could take up to 4 days for a full effect. Prevacid decreases the amount of acid in the stomach. It blocks an enzyme in the stomach wall responsible for producing the acid. This prevents proton pumps in the stomach from releasing acid. Decreased stomach acid gives the stomach and esophagus time to heal. Next week we will try the LTV since the Doctor next week is a big fan of it. James doing home vent trials is no...

Monday, July 12th, 2021 Weigh-in: 6320 grams (13lb 14.9oz) - James now weighs more than Tommy! Well let's hope so, Aunt Robin has been feeding Tommy some gourmet meals! Measurements: We will ask the nurse tomorrow to get measurements. At 5am Mom woke up to alarms to suction and change James' diaper. She noticed his sock was off and when she went to put it back on that it was damp. Feeling around she saw that we "fed the bed", which means his med port was open and his feed was being pumped directly onto his bed. This is the 3rd time this has happened since being in the PICU. This also means he did not get breastmilk or any medication during that time period. The nurse thought she may have been in the room around 3:30am to change his diaper. Well his feed runs at 40ml/hour so to calculate we know we definitely lost 60 mls of breastmilk being pumped directly onto the bed. Also there were chunks of breast milk and bile on the blankets. This means James was also pushing ba...

Sunday, July 11th, 2021 Morning:   James had a solid night. Only a few small episodes, but the night nurse did a great job at helping James and giving Dad permission to sleep for a few hours.  12am - small episode. Needed boost 2am - rectal temp compared to arm pit. 98.4 vs 97.4. WAT score was a 4. Decided to rub his head and use pacifier to console instead of morphine. Just gave regular dose of clonodine and methadone.  5:45a - WAT score of 6. Just did he clonidine and that settled him.  Our daytime nurse asked in rounds if the 6 WAT score is appropriate due to several check marks getting him to a 2 (sweating and yawning). The consensus was that those are withdrawal symptoms and if James shows one more getting him to a 3, they will offer morphine if he’s not within a few minutes of his scheduled meds. Dad requested to go through the drop down menu before morphine (diaper, suction, vent, and position change) to see if James can self soothe.  Dad is starting to g...

Saturday, July 10th, 2021 James had a good day, 3 episodes that Mom was able to console by either changing his diaper, burping, or holding. No need for PRN morphine. Our Day shift nurse was pretty rough with James and decided it would be a good idea to do oral care with a toothbrush. She scrubbed really hard on his gums. The toothbrush was then covered in blood and James was gagging. After Mom calmed him down she sat him up in his boppy with the help of an student RT in training. James immediately projectile vomited on himself and the bed. We ended up changing his onesie, his trach ties, and the bed sheets. The nurse removed all of the old bedding along with the purple bumper used for physical therapy. Super odd... Because when Mom asked where she had put the bumper, she said "I'll just get you some more blankets". No that wasn't the question. Pretty sure she took it. Wtf. Some people are just miserable and should not be pediatric nurses. Juju continued the puppet sho...