[Jinny]

My sister now has been moved to a rehab facility and continues to have a struggle. Her blood pressure remains very high, 200/97 and they are giving her lasiks (not sure about spelling), to try to rid the fluid. She seems to be angry now she says they are hurting her when they suction her vent and that one of the nurses/aids was a little too rough with her and hurt her. That is what we had to handle today. She is receiving nutrition through a feeding tube, and she asked me why they are not bringing her any meals. I asked, and was told that the doctor has her on a "feed for comfort". So, I asked that it be explained to her. Also, they said she is an "isolation" patient, so I noticed everyone in gowns and gloves that came into the room. Is that for her benefit or their benefit? I guess I was confused about that. They were giong to try to start to wean off the vent today but since her blood pressure continues to be high, they don't want to put undue stress on her. Her spirits are poor. Can you shed light on what is going on with the isolation and the high blood pressure I wish I knew a prognosis as it seems to me that this is one awful way to live.

[Davy9]

Isolation... Either your sister has an organism they are trying to keep from spreading outside her room or she is susceptible to getting infections from others so they guard her from the outside. I suspect that she has an infection that requires her to be in isolation. Ask them why she is in isolation and how they are working to treat the problem. The various gowns and masks are just part and parcel to this procedure. Hand washing is part of regular hospital procedure and should be done before and after every patient is worked with.

Lasix.. Lasix is a diuretic medication that will help control fluid balance. Fluid balance in end stage COPD is important to maintain within controlled levels. She gets fluids through her feedings and perhaps through intravenous hydration. The Lasix guarantees a certain level of urine output.

High blood pressure.... This could be due to a number of things. She could have high blood pressure as a primary problem of the heart or vascular system. She could be responding to the stress of her care situation. It could be related to her infection. They do not want to institute additional stress while the BP is high so they will not attempt weaning until it is better understood and hopefully controlled. Find out if it always elevated or only when she is stressed. Ask if they are using medications to try and manage it.

Suctioning... Is one of the more difficult parts of being on a ventilator and/or using artificial airways. It is done to remove secretions from the airways. It is very irritating. It can be done too aggressively. Ideally it should be done when needed and with as little trauma as possible. It also has to be done using sterile equipment and procedures.

Feeding/nutrition... For her to get better she does need adequate calorie intake so they are seeing to it that she gets this by using a tube placed into her upper digestive system. Is the tube one that is placed through her nose (a nasogastric tube) or one that goes through her abdomen (a gastric tube)? It maybe that at this time feeding her a more normal diet would only add problems by placing too much stress on her stomach. The feeding method being used ensures a proper amount of intake and of the proper type.

Yes, medical care at this level does involve a lot of things. As she gets better some of these will be able to be reduced or eliminated. She should be able to get back to eating but they may still augment her diet with feedings. Her fluid balance was part of her care before this happened and will continue. Hopefully her high blood pressure can be controlled. If she remains trached and on the vent the suctioning will probably still be part of her care.

[Jinny]

My brother in law just called me and told me that she has a bacterial infection and now we all have to wear gowns and masks. My questions is, will she be able to fight off an infection or is this one of those "complications" that could arise that I had not thought of. Also, not sure how long she has had this infection, I had not been wearing a gown or mask when I visited. Is it common for people in her situation to get a bacterial infection? Thanks.

[Davy9]

Yes, secondary or opportunistic infections happen in these situations. When you mentioned earlier that she was in isolation I somewhat assumed that she has some sort of infection. Now what is the organism (its actual name), where is the infection (if they know), and how is being treated???

[Jinny]

Ok, so now I find out it is MRSA and that it is in her bladder and inside her body. Is there a way for me to get tested since I have been up there visiting with her for weeks before I found this out???

[Davy9]

The MRSA infection sounds like a consequence of urinary tract catheterization. Those catheters can act as wicks for bacteria and she has a urinary tract infection (UTI) with MRSA. Unless you were handing the catheter lines or in very close unprotected contact with her or exposed to wet (contaminated) bedding/clothes you were not likely exposed to the organism. The healthcare workers do commonly handle those items and the isolation procedures protect them and will keep the MRSA from being transferred to other patients.

Other than this how is she doing? Has her blood pressure calmed down?

[Jinny]

They have her on isolation for caplets, contact and aspiration. She is still struggling with the blood pressure and the fluid retention, but they are trying to still wean her off the vent. She went about 15 minutes yesterday. Regarding the MRSA my brother in law said that the medicine that they give for it has not proven to be effective.

[Davy9]

I do not entirely understand your last post. MRSA is a difficult organism to treat because it is resistant to many antibiotics. That is why they work to keep it from spreading by isolating the patients who do contract it.

The weaning technique that seems to be getting used is asking her to accept her work of breathing in bouts. The other way to view that is that the ventilator is used for resting. She breathes until she tires and then the ventilator is returned to provide her some rest. She can increase her time off as she gains more stamina. Help her by telling her to stay calm and relax. It is, after all, just breathing. Bring her things to do or read while she's on her own. This will distract her from focusing in the work. Remind her that the ventilator is not going away. She won't be left without it and there's no need to panic. Just try and motivate her to lengthen her time off the vent a little more each day. It helps too if she will get out of her bed even if just to a chair. If she starts acting healthier she will feel healthier.

[jennyj1979]

Any updates Jinny??

[Jinny]

Due to my work I had to be out of state for a week, and today is the first day I have been able to see my sister. In one week, I think that she has really gone downhill. They had tried her off the vent today, only went 10 minutes, and my brother in law was discouraged. The first thing she said when she saw me is that she is dying and that her husband doesn't understand. Frustrating. Anyways, she is still swollen, and does not seem improved. If anything, she seemed less aware of the day of the week or the time of the day, and she did know me and asked where my husband was, so she knew that much. When I asked her how she was really doing, she said, the calm before the storm. Blood pressure is still fluctuating. I would really like to know what those numbers on the vent machine relate to. I saw one that said CO2 and it said 30. There were other numbers and words but I had no idea what they mean. I would appreciate it if you could tell me what the machine says, and what numbers I should pay attention to. She just seemed a bit more out of it today.