Laura here. Dan's super-busy at work this month so I told him I would fill everyone in on the weekend past.
We visited early on Saturday morning and found Estelle to be quite agitated. She's been picking at her arm for awhile but on Saturday she'd moved to her facial area and was continuely rubbing and striking herself in the chin and mouth area. She'd managed to rub her chin almost raw with the center portion of her hand splint. We talked to the nurse immediately and she called the doctor while we were there to see if there was anything we could do to prevent this. Dan and I tried applying lotion and neosporin to her chin and arm because she had replied "yes" when Dan asked her if something was itching her but it was to no avail. She replied "yes," to anything we asked her....did it hurt, did it itch, did it sting? It was impossible to tell what was going on - if anything. The movements seem randomless - her arm goes places and whereever it lands that's what gets picked at.
We again asked that a urinalysis be done because she's not normally this agitated unless she's got an infection and the nurse was getting permission from the doctor to run one. (UPDATE) I just spoke to Angelica, Estelle's weekday nurse, and she got the result back today - and yes, she does have an infection - Strep B, this time, and they are running a culture and sensitivity as I type this to find out what antibiotic is needed. Medication will start as soon as they have the results.)
Dan visited alone on Sunday and said she was a bit more talkative than she was on Saturday but still agitated. I believe she talked to Viv for a bit on the phone. Dan said Estelle was answering some of his questions but that she wasn't as alert as she has been before last Thursday when I was there for her care plan meeting and first noticed that she'd become lethargic again. Again, now that we know she's got another UTI that probably explains both the mental lethargy and the increased physical agitation.
Angelica also said that the had cultured her feeding tube site due to increased leakage and it, too, is infected but seemingly only on the surface. They are currently treating that with a topical antibiotic and a sterile dressing.
We discussed various means of preventing her from hurting herself (the arm scratches, the chin bruising and reddening - and Angelica also said that she's trying to prevent them from taking care of the tube site and hooking up the feedings.) The hand splints are becoming more of a hinderance than a help at this point, they have a solid core which fits in the palm of her hand and she is using that solid part to rub and hit with. I remembered there were mittens that we sometimes used in the ER and mentioned them to the nurse and she said that they do occasionally use them and that would be a good solution. It would not restrain her arm (we don't want to restrict her movement if we can avoid it - it's good to know she's using the arm at all - we just don't want her to injure herself in the process) and yet it would do away with the ability to scratch herself raw or to hit herself with the splint. She could still rub, which may be a problem, but it won't be as bad of a problem. Hopefully once she gets a few doses of antibiotics the agitation will disappear and it will be a moot point.
Anyhow - a setback and disappointing but we're glad they've quickly diagnosed the problem and are hopeful that it will not take long to clear up the infections and Estelle will be back to where she was 2 weeks ago.
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