03/10/2019 – Sleep shift – carla cornelius

Shift Report:

Sorry this is late. The community nurse and social worker came to ours to meet Fela and have a brief chat, after which I had to rush off to an appointment.

Fela was in bed for 22:30 having completed his evening routine with no problems. He was pulling and guiding my hand a lot to start actions even the ‘simple’ task of asking me to remove empty dishes – simple to us but as with many on the autistic spectrum, he often struggles to initiate tasks himself. Staff will need to keep reminding him ‘gently’ but realise that he also struggles with this concept at times.

I rubbed him with tiger balm on his chest, back and forehead. He seemed to enjoy this. We said prayer and sensory lights were switched off with hymns playing softly in the background. When I checked on Fela at 22:45, there was no sound.

I checked on Fela again at 1:45 and 3:00, and there was no sound coming from his room. I didn’t hear Fela again until 5:00. He dashed to the loo, then was back in bed by 5:25. I had to be very patient with Fela as he went through all his moving rituals in the loo. He also requested cake and ice cream twice – in the loo and on return to bed. I could still hear him a bit on my return to bed so I decided to give him a banana at 5:45 because I wanted him to settle and get another 1.5 hours sleep if possible. Michael heard him at 7:15 and took him a cup of tea and a pear after prompting him to the loo.

When I went in to greet Fela it was 7:45. He was still waking up. I brought him a pear not realising Michael had already done so. As he finished his refreshments, I did the upstairs board with him. Today Fela took the bags of cards and chose ‘church’, ‘cinema’ as well as ‘chocolate’ and ‘chocolate brownie’. I quickly put ‘Sunday’ above church and cinema in order to manage his expectations.  I also put dinner above the dessert choices so I hope someone gives him a bit of one of them after dinner this evening.

Fela was also clearly not happy with the breakfast card showing a bowl of cereal so I showed him a ‘fried egg’ card instead, and he was happy. It may be that it’s because he is used to a cooked breakfast at Green Pastures, or he simply prefers a cooked breakfast. We may need to start giving him the option.

Michael gave Fela his pre and post-breakfast supplements, filled in the food log and welcomed Zoe, Maxine and our visitors. Fela had been given a social story about the visitors so the visit went smoothly, and he had a full belly which also helped. Fela and all left just after 11:00.

Arousal States – Start: 1 Baseline End: 1 Baseline Did his state change? Yes to Fela had two episodes of agitation:
1. At 5:00 when he dashed to the loo, and was 'stuck' in there doing his OCD rituals and being very noisy for 20 minutes.
2. During his shower he became agitated after using the soap bar about 4-5 times. I removed the soap bar in the dish and it was as if he became 'stuck' psychologically, went up to a level 4 agitation, and didn't allow me to help him out of the shower until it occurred to me to return the dish with the soap to its original located. This lasted for 30 – 40 minutes. Did he have a bowel movement? No Bristol score: Was Fela incontinent?: No Did he have vigorous exercise?: No – Why no exercise? Sleep shift