COVID Emergency and Scare
As I watch my Dad in his emergency room hospital bed, masked up, attached to an IV drip and vitals monitoring machine, my mind drifts to the circumstances that led us to this dubious place and time.
Memorial Day was another COVID-19 holiday. I FaceTimed with Dad – me at home and Dad at his facility. He was smiling and pleasant, but seemed sleepy. In an attempt to find out why, I asked him whether he’d gotten a good night’s sleep. As usual, he didn’t answer; but I knew something was awry because he kept nodding off during our conversation.
Tuesday brought more questionable behavior. Dad, a very good eater, ate very little for lunch but ate well at dinner - leftover BBQ and trimmings seemed to stimulate his appetite. But during the day, he had napped for two hours and was so drowsy that the resident aide sat him in his wheelchair.
This was definitely abnormal. When Dad’s sitter arrived at 9:30 Wednesday morning, Dad was still in bed. Apparently an aide tried to awaken him at 7:30; because he was twitching and didn’t want to get up, she left him in bed. At the sitter’s insistence, they got him up and once again sat him in his wheelchair because he was weak. He ate very little breakfast. Baffled by what she saw, the sitter asked facility staff to check Dad’s vitals. His blood pressure was normal, his temperature slightly low and heart rate elevated. The results did not concern the facility nurse.
Dad ate very little lunch, too. Meantime, I called Dad’s gerontologist and told him that Dad was lethargic and had been sleeping more than usual. I gave the nurse Dad’s vitals, but she wanted up-to-date vitals before providing a summary to the doctor. I told the nurse I should have current vitals by 1:00 because the facility nurse had gone to get more vitals during lunch.
An astute gerontologist is a prize possession, especially in emergencies like this. Before I heard back from any facility staff, the gerontologist’s nurse called to update me. She had spoken to the facility directly and given the facility nurse verbal orders. First, send new vitals - immediately. Second, send glucometer results - immediately. And lastly, observation instructions for the next week.
That did the trick. Dad’s vitals were consistent; normal blood pressure and temperature, elevated heart rate. But his blood sugar level? It was too high for the over-the-counter glucometer to measure. Get him to the hospital right away, the gerontologist told us. Dad was scooped up, put in the back of an ambulance alone and rushed to the emergency room (ER). The sitter had to follow the ambulance in her car. Novel coronavirus made its presence known again.
Thankfully Dad’s usual hospital allowed one visitor per patient in the ER, either the sitter or me. The ER team confirmed that Dad’s blood sugar level far exceeded normal. They began an IV drip and insulin drip to counteract the high glucose level; they also drew blood, ordered a urinalysis and did a cat scan. Given Dad’s condition, hospital staff decided to keep him overnight for observation. They informed me that once Dad went to his hospital room, I could not join him. He would have to heal alone. Another coronavirus wrinkle.
As his gerontologist expected, Dad had a urinary tract infection (UTI), the most frequently diagnosed infection amongst long-term care seniors. Urinary tract infections can lead to sepsis (infection in the blood) and possibly death.
Did you know that:
Urinary tract Infections account for over 1/3 of all nursing home-associated infections?
Urinary tract infections are second only to respiratory infection as the leading cause of hospitalization in patients over 65?
Approximately 25% of adult sepsis cases are caused by urinary tract infections?
Seniors are 65% of hospital sepsis cases?
Seniors are 13 times more likely to develop sepsis and twice as likely to die from sepsis?*
We could be in for a long, hard road in the hospital and post-discharge given
current COVID restrictions. Nevertheless, we are celebrating victories thus far - identifying from afar that Dad was ill, and getting Dad help before he became septic. I’m prayerful the hospital team is effective and quickly gets him back on his feet - despite my absence.
Golden Nuggets:
√ Know your loved one’s baseline, vitals and behavioral
√ Become familiar with UTI symptoms
√ Make UTI testing a top priority when your loved one’s vitals or behavior deviate(s) from baseline
√ If your loved one is acting differently, dig deeper to identify potential problems
o If necessary, identify professionals or hire a caregiver to assist in your evaluation
√ Always have a primary care physician or gerontologist on your health care team
*Sources: Love, Theresa A., et al. “Urinary Tract Infection in Older Adults,” Aging Health, 2013 Oct 9
(5); Peach, Brian C., et al.“Risk Factors for Urosepsis in Older Adults: A Systematic Review,” Gerontology & Geriatric Medicine, 2016 Jan – Dec, 2016 Apr 6.
Live. Grow. Repeat.
