If a patient is awake, confused, and disoriented, how would you grade her using the AVPU scale?

The AVPU scale is a tool used to measure a patient's level of consciousness, where each letter stands for a different level of response: Alert, Verbal, Painful, and Unresponsive. In this scenario, the patient is awake but exhibiting confusion and disorientation.

When using the AVPU scale, a patient who is alert and oriented would be graded as "A" for Alert. However, since this patient is confused and disoriented despite being awake, they do not fit neatly into the "A" category. The confusion and disorientation indicate that the patient is not fully alert and may not be able to respond appropriately to verbal stimuli. This would generally suggest a "V" for Verbal, indicating they may respond to verbal communication but are not fully oriented.

To summarize, the patient's presentation does not meet the criteria for "A" on the AVPU scale due to the evident confusion and disorientation, which typically suggests a lower score on the scale than alertness alone. Thus, the appropriate grading would reflect their confused state rather than an alert status.