I did not miss rounds, but Diane (Kinley's nurse today and one of her previous ECMO nurses) does gets me caught up on everything else that I missed this morning. Delores, the nurse practitioner, came by early and put in an order to increase Kinley's continual feed from 19 ccs per hour to 20 ccs per hour. Also, Amy from OT (Occupational Therapy) had already been by and fed Kinley her first bottle of the day. That's right, I said "first bottle of the day." Kinley is now scheduled to receive 2 bottles a day, each one with 10 ccs as a goal consumption. Diane said that Kinley took her bottle pretty well, but she did gag a little bit. The funniest part (mainly because I didn't have to clean it up) of Diane's morning update is that Kinley had a major blow out. When Diane went to change Kinley's poopy diaper this morning, Kinley decided to keep going once the diaper was off. Kinley got it all over her bed, her clothes and she even stepped in it. Diane had to get Megan, another one of Kinley's previous ECMO nurses, to hold Kinley while she completely changed her bedding. I am glad that Diane is a good sport because I thought that her story was hilarious. And yes, I know that this will soon be something that happens to Kathy and I once we get Kinley home.
During rounds there were a few changes with Kinley's medications. Her ativan (sedative) and erythromycin (for stomach and intestine motility) will stay the same, but her methadone (pain killer) doses will move from being given every 6 hours to every 8 hours. The methadone dosage will stay the same, only the time between doses is changing. The dosage of Zantac (for acid reflux) that Kinley is receiving will be increased. Not because Kinley is showing any outwardly signs of acid reflux, but because Kinley is a CDH (congenital diaphragmatic hernia) baby and they are basically guaranteed to have acid reflux due to the fact that their intestines had been out of place for so long. To finish up rounds, orders are put in that will allow nurses to bottle feed Kinley. The reason for this order is that OT does not work over the weekends and they do not want Kinley to have to wait until Monday for more bottle feeding.
I try to work with Kinley on rolling over and giving her some tummy time, but it is kind of hard with all of her "attachments." It will be nice when she does not have as many wires, cords and IVs attached to her.
Right before shift change Delores (nurse practitioner) stops by to talk with Kathy and I about some future changes to Kinley's care. Delores is very confident that Kinley will only be receiving TPN (IV nutrition) for 2 more days because by then Kinley will be receiving all of her needed calories through her feedings. Once the TPN is stopped they will begin to give Kinley vitamin D and iron supplements since neither are in breast milk. Along with the supplements, they will begin to fortify Kathy's breast milk. This will give it a little extra "punch" of nutrition that will help Kinley heal faster. They are also planning on changing Kinley's feeding schedule. She is currently on continual feeds. This means that Kinley's stomach always has food in it and she does not ever feel hunger throughout the day. They will begin to compress the amount of time that Kinley receives food so it will be more like a real feeding. So her belly will be more full during feedings and then she will go through periods of time where she does not receive any food. And lastly, Kinley will be 2 months old next week so they will need to give her her 2 month immunizations. That should be a fun filled day of screaming and crying (sarcasm again)!
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