Today has been especially difficult for Nanette. In the last few years, she has given birth to 6 babies vaginally with no pain medication at all. So it is fair to say that she has a high tolerance to pain. However, today's post-op pain has been very intense (8/10) even though she is getting a substantial amount of pain medications, including narcotics. She is getting antibiotic treatment for a possible skin infection. But we are worried about the possibility of a uterine infection. She is on close watch. Update: Nanette just measured a high temperature, which is an indication of infection. . .
Zeke did well today, although his stomach is not emptying his breast-milk meals very well. They always check the stomach before a feeding. Often, the milk is withdrawn by a tube, observed to be laden with bile, and then not returned to the stomach. So this is on watch. Other than that, the rest of his vitals have maintained their positive levels today. Nanette helped the nurse change his diaper and got to "hold" him a little bit by clasping her hands around his head and legs.
Gabriel continues to do very well considering his history. Most of his key indicators have trended positively today. He uriniated 40mL and then 20mL this morning, indicating that his kidneys have finally kicked in and have started to work. This is fantastic news! His output slowed down the rest of the day, but is still coming. I sat in during the rounding today and thoroughly enjoyed it! I saw how the team discussed his care and made plans to improve his condition. Their decisions led to the complete weaning of one blood pressure medicine (norepi) and the dialing back of the other (dopamine) to 7 ug/kg/min (it was as high as 20 just yesterday). His blood pressure has responded positively and was in the low 30s (which is great for now). The other positive step was the decrease in his potassium levels which removed the necessity of his insulin drip. The pulmonary culture came back today and E. coli was confirmed to be in his lungs. The final results for the blood culture are not back yet. His blood gases looked good this morning so the intensity of his ventilator settings has decreased (mean pressure of 8-9cm) and his ingoing oxygen levels are at 27%. The preliminary result from the head ultrasound shows some brain bleeding (intraventricular hemorrhaging, or IVH). We will find out how severe it is when the final report is shared with us tomorrow.
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