Focus: Endocrine System: Diabetes and Post-Traumatic Stress Disorder
When we left Mrs. Stevie-Rose Davis in Chapter 7, she was struggling with some bouts of confusion. Specifically, she was not oriented to time and place. Dr. Jensen in the emergency room (ER) ordered a battery of tests to determine if the patient's state of confusion had a medical cause. As evening approached, Mrs. Davis's daughter Angie arrived and was able to remain with her mother until she settled down. The patient was kept in the ER overnight for further assessment. She was given PRN lorazepam (10 mg PO) at 2100 hours to promote relaxation and reduce symptoms of anxiety. This medication was effective, and its calming effect enabled the patient to sleep.
The patient was scheduled for blood glucose testing at 1900 and 2300 hours last night and again at 0600 hours this morning. Mrs. Davis was alert and oriented before she received sedation. Her neurovital signs were taken routinely until 2100 hours, when Dr. Jensen called in to assess the patient and discontinued these orders. He also ordered the nurses to do a urine dip for ketones on Mrs. Davis each time she voided and to continue with scheduled glucose testing with the use of a glucose monitor; the nurses have done so.
Dr. Jensen has arrived for his morning rounds. He has spoken with the nurses caring for Mrs. Davis, and he is aware that her glucose levels have been erratic since her admission. A pattern is emerging that concerns him, and he worries that the patient may no longer be able to manage her diabetes without medication. He is going to speak to Mrs. Davis about this, as well as about her lab work and her other assessment results.
"Good morning, Mrs. Davis," said Dr. Jensen as he entered her room. He noticed a family member at her side and nodded to her. "Do you remember me?" he asked the patient. She nodded and confirmed that she did by using his name. "And who is your guest, Mrs. Davis?"
"This is my daughter, Evangeline." Mrs. Davis smiled and waved her hand toward her daughter in a gesture of friendly introduction.
"Please call me Angie," came the equally pleasant response. "Everyone does, even my mother, from time to time," she laughed. "Pleased to meet you, Doctor … Doctor … ." She paused for a moment, awaiting the doctor's reply.
"Dr. Jensen," the physician added warmly. "Now, Mrs. Davis, how was your night? Were you able to get any sleep?" The patient reported that she had and was aware that he had ordered her sedation to help with that. The patient also explained that she'd gotten out of bed to void at least five times during the night and that she had felt quite dizzy and unsure of herself at those times. She also noticed how thirsty she felt and wondered ...