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Focus: Psychoneuroendocrinology

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Patient Update

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Mrs. Stevie-Rose Davis has been in a motor vehicle accident today. Although she had no apparent injuries, she was a bit unsteady on her feet, nervously wringing her hands and pacing. She was also confused and unable to give a recount of the accident to the emergency medical technician who tended to her at the scene. Because of her age, her confusion, and the difficulty that EMT Wallis had assessing her, Mrs. Davis was transported to the hospital for further assessment. (To review Mrs. Davis's condition at the scene of the accident, you can listen to the Chapter 2 opening scenario on DavisPlus Audio.)

 

Mrs. Davis arrived at Fayette General Hospital 2 hours ago, and all of her initial assessments have been performed. A few diagnostic tests remain to be completed. She has a small bump on her forehead, high above her right eyebrow. She has a light-colored bruise forming over her left kneecap that was not visible at the scene of the accident. At present, she remains in the ER, and she appears to be sleeping. It's approximately 3 pm now, and the nurses and care aides are changing shifts. Listen as RN Marnie hands over the care of Mrs. Davis in her report to Caroline, the RN on the afternoon shift.

"Hi, Caroline. Good to see you," said Marnie, smiling warmly.

"It looks busy here this afternoon," said Caroline.

"Yes," Marnie replied. "It's busy, but not really too hectic. Not like a Saturday night can be," she laughed. The two nurses take their seats in the Report Room of the nursing station. "Let me tell you a bit about our new patient, Mrs. Davis, before everyone else arrives for Report, okay? You'll be taking over her care now." Caroline nodded.

"The patient, 72-year-old Mrs. Stevie-Rose Davis, was brought in around 1330 hours by EMS. She'd been in an MVA. The EMT found her walking around at the scene, confused. Dr. Jensen attended her and did the initial workup. No major injuries. Her right knee is bruised, and she has a minor concussion where she struck her head on something. She was moderately confused on arrival. Admission vitals were T 98°, P 100, R 18, BP 130/88. Neurologically, she is alert, she responds to voice and pain stimuli, and her pupils are normal and reactive.

"Because her vitals were slightly elevated but her neurological signs were stable and she seemed to be telling us she was a diabetic, the doctor ordered a glucometer test STAT. Her sugars were low at 55 mg/dL. We immediately gave her some orange juice. Her confusion began to lift within the half hour, but it hasn't completely resolved. We got a second blood sugar value on her and it was up to 75, which is within normal range. The patient was able to tell us about herself and was oriented to place and person. However, she is confused about time and some ...

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