Monday, July 7th - Big Changes!!!

When I arrived today I found out that Kinley has made a decision. (And A LOT of changes.) Kinley has decided that she does not like spending time away from her mommy and she is going to pick up the pace on going home. If you remember, today is Kathy's first full day back at work since Kinley was born on May 25th.

I cannot say that I am a huge fan of listing Kinley's changes, but she wants to make sure that everyone can see how many she did today. Please remember that all of the changes that Kinley made were done with the full approval of Dr. C, Kinley's new attending doctor. Also, most of these changes were actually done by Katie (Kinley's day nurse) because Kinley is trying to rest.

1) No more versed (sedative) drip. Kinley wanted to go cold turkey, but Dr. C convinced her to replace the versed with ativan to help control her withdrawals. (Thank you Dr. C. Kinley can get so cranky when she is "craving.") Kinley's versed drip will be stopped at 6:00 pm and her ativan doses will be given every 6 hours.

2) No more IPPB treatments. Kinley hated her IPPB treatments and they were not the most enjoyable thing to watch either, mainly because Kinley got so upset during them. IPPB does do a lot of good though. It is a pulmonary treatment used to help break up and move the secretions in her lungs. They did this by placing a gas mask (which is providing 100% oxygen) over her face and then force her to take deeper breaths than she would on her own. The way they make her take a deep breath is that the gas mask over her face was connected to a bag that they would squeeze, like the ones you see in medical shows where the doctor or nurse is doing the breathing for the patient. They will do a chest x-ray in the morning to make sure her lungs are staying open.

3) No more scheduled blood gas tests. Blood gas test will still be done, but only when Dr. C orders one. They can now draw blood through her new PICC line, but Kinley did have to get poked a few times to draw blood and that was enough for her to try and put a stop to blood gas tests entirely.

4) Lowering the flow on my oxygen support. Kinley is tired of having a ton of air blown up her nose. The oxygen flow through her nasal cannula has been at 4 liters per minute, but it will now be lowered to 3 liters per minute. Kinley has been and still is breathing "room air" (21% oxygen) and the last thing to wean her off of will be her flow support.

5) No more tubes in my mouth. Kinley's OG (mouth to stomach) tube has been pulled and a NG (nose to mouth) has replaced it. This is the first time that Kinley has not a tube in her mouth. Until Kinley learns how to eat the NG tube will be used to feed Kinley, putting the food directly into her stomach. And once she does eat for herself, it will be used to give her any feedings that she does not finish herself.







6) Let the feedings begin. Kinley's first feeding ever was today at 11:00 am. It was only 5 ccs, but we all have to start somewhere. Kinley's feedings will continue every 3 hours, but before any feeding they will need to check the residual. Checking the residual means that they will suck out the contents of Kinley's stomach to see how much of her previous feeding is still in her stomach. If the residual is too great they may skip some feedings in order for her stomach to get caught up processing everything. The residual before Kinley's 2nd feeding at 2:00 pm was 4 ccs, but it was not entirely milk. It was a mixture of both milk and saliva/mucus. Katie notified Amber (the nurse practitioner) about the residual from Kinley's 1st feeding and Amber gave the approval to move forward with the 2nd feeding. So Katie put the 4 ccs of residual back in Kinley's stomach, through the NG tube, and then proceeded to give Kinley her 2nd feeding of 5 ccs, once again through the NG tube. Before Kinley's 3rd feeding today she had 6 ccs of residual, but it was mainly saliva and mucus. So Amber approved her 3rd feeding of 5 ccs at 5:00 pm.

Overall, a very productive day with many steps in the right direction of going home. We know that going home won't be very soon, but at least we know that Kinley is moving down the right path.