PICU Post-Op Day 1

 Wednesday, August 29, 2012-The 1st day following Diego’s PA band surgery. 


PICU Post-Op Day 1

 

Mom & Diego

Diego seemed to be in some pain so they continued to keep him heavily sedated.  They did a chest x-ray at approximately 5:00am.  The day nurse, Tony, shift began at 7:00am.  The x-ray showed that the stomach tube was not secreting enough of the mucus so they made some adjustments to the tube and suctioned more of the mucus from his stomach. For obvious reasons, Diego did not care for this procedure. 

The surgeon, Dr. del Nido, visited Diego around 8:00am.  He ordered an EKG and an echo cardiogram.  He wanted to view the results of the 2 tests before he made a decision about removing Diego from the ventilator.  Dr. Marx, the cardiologist, visited Diego at approximately 9:30am.  He mentioned that they did notice some leakage in the mitral valve after the band was placed on Diego’s pulmonary artery.  They will definitely watch this for any possible concerns. 

By 10:00am, Tony had started the EKG and the echo was performed at approximately 1:00pm.  At 3:45pm Tony increased his pain medication to take out the chest tube.  The chest tube is inserted below his incision and its purpose is to remove excess blood from around the heart.  By 4:45pm Tony and another nurse had quickly and successfully removed the chest tube. 

After that, she began reducing sedation medicine so Diego would start to wake up.  The plan at that point was to start weaning him off the ventilator.  The goal is for Diego’s body to start doing the work rather than the medicines and machines.  By 6:30pm Dr. del Nido had checked in and made the final decision that he did not want Diego off the ventilator tonight.  He did not feel that Diego’s left ventricle was quite ready to handle the work load on its own.  So, for the night, they started him back on his sedation medicine. 

Unfortunately, Diego had started to arouse from being off the sedation medicine.  The night nurse, Jay, came in around 6:50pm and the two nurses together were working to get the right combination of medicine to sedate Diego again.  However, Diego had a different plan.  He was awake and planning to stay that way and was becoming very frustrated with all the tubes.  He was trying desperately to tell me what he wanted.  Of course, he was unable to speak and I could not read his lips because of the tube.  By this point, he was disgusted with everything.  I said, “Diego, I know you are angry” and he shook his head “no”.  So, I said, “Are you frustrated” and he nodded his head “yes”.  I tried to calm him, but I could see his frustration was seeping out of his pores. 

Dr. Marx, the cardiologist, stopped by to check on Diego around 8:30pm.  We were still struggling to get Diego heavily sedated again.  Dr. Marx reported that the tricuspid regurgitation changed from severe to mild because of the band.  He said, “It is impressive to say the least”.  Also, his left ventricle has really expanded and pushed the right ventricle back over.  The band is doing impressive work, but Diego just isn’t quite ready to do the work alone.  He feels it will get there and possibly even be ready to start weaning him off the ventilator tomorrow.  He agrees with del Nido that it is important to take it slow.  



Diego writing to communicate




100 Speech...Dr. Jay



I asked Dr. Marx if he had a minute to view Diego’s speech before he left.  He was very enthusiastic about the video.  Then, Diego began trying to tell us something and he became overly frustrated again because we did not understand.  Jay was working to calm him and to figure out what Diego was communicating.  He concluded that Diego wanted a pen to write it down.  Since Diego was becoming so upset Jay got the pen and paper and Diego began writing.  As hard as we tried, we could not figure it out.  It was difficult to read because Diego was drugged from the sedation medicine. At that point, Diego began crying and started throwing up a little.  Jay had to suction his breathing tube, which didn’t go over too well with Diego.  He gave him something for anxiety and that seemed to help a little.  It was challenging, but finally Jay was able to get Diego heavily sedated again. After everything calmed down, Cesar and I were able to translate Diego’s writing.  It reads, “100 speech (arrow pointing) Dr. Jay.”  The arrow was pointing at Jay.  Diego wanted us to show Jay the speech.  We now realize that Diego is very fond of his night nurse…Jay, you are awesome!