1) Interim nurse (Luanne Baker, RN, BSN) was here, she's back on Friday. She tended the newest skin tear (happened last night when Pam on duty). Skin tear is major, was definitely not spontaneous, could have occurred by some bumping unnoticed by Pam as skin is so fragile. The bleeding did not look like it was going to stop (looks ok now, though) Luanne applied special compound, dressed tightly with gauze, says to monitor bleeding, call Interim off-hrs if it does not stop. She examined the earlier skin tear, it is healing well. She examined the bed-sore on left foot, it is healing well.
2) Speech therapist was here, no speech problem, no swallowing problem. she will not be returning unless loss of skill occurs and is filed thru Pugh/medProfessional ... e.g., cannot swallow at all. Currently, swallowing is fine, since Ensure, water, chopped-up-meds-in-applesauce are all going down ... getting her back to swallowing whole meds is not considered as eligible for her services. fyi ... this lady was a doll ... basically conversed with H for about 1/2 hour before remarking that she was puzzled by submission of diagnosis code (for speech problem) since speech was so good ... that is when she discovered that she was supposed to be there for swallowing and not for speech ... after that, lots of questions about solid/liquid intake and then the drill on whole-meds problem is not considered a skill loss. fyi, one comment was about H's mouthful of her very own teeth ... you know how proud H is of this, I could feel her glow across the kitchen ...
3) interesting pattern observed by nurse and Maggie: H's hollering is amplified and more dramatic if there is a kid present ... e.g., nurse remarked that on Monday (her first visit), H was very quiet, no complaining, even tho she was doing basically same as today when there was much vocalizing. Maggie confirms that she has noticed such a pattern.
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