A 56-year old maintenance worker, with a past medical history of insulin dependent diabetes, CHF, and hypertension, presents to the emergency room with lightheadedness, lethargy, and periods of confusion. Patient family members found him unconscious outside. Wife states, “he’s been at it for over a week now” Medications: Insulin, Lasix, Digoxin and Vasotec: were: Temperature Pulse Respirations 36.7C 118 18 On examination, the patient has slurred speech with decreased upper and lower motor strength bilaterally 4/5. While examining the patient, he experienced loss of consciousness that lasted less than half a minute. The nurse, drew labs, administered oxygen via NC, Established IV line access and placed patient on a monitor. Lab results Vitals on admission Blood Pressure 103/61 Electrolytes – in emergency room Hematocrit – Potassium Sodium Phosphorus 2.6 mg/dL Bicarbonate Calcium Creatinine Serum Osmolarity Glucose 38% 3.3 mEQ/L 147 mEQ/L 21 mEq/L 7.6 mg/dL 2.4 mg/dL 321 mmol/kg 389 mg/dL Hemoglobin 12 gm/dL Chloride 95 mEq/L BUN 46 mg/dL Magnesium 1.3 mEq/L Albumin 4.1 g/dL Urine Drug Screen - Negative 1. State the medical diagnosis described in the scenario above that is likely causing these symptoms 2. Define the medical diagnosis stated in question #1 2b. What are the signs and symptoms? 3.Discuss the primary medical management for the diagnosis stated in question #1 3b. What are the nursing actions for this patient?
A 56-year old maintenance worker, with a past medical history of insulin dependent diabetes, CHF, and hypertension, presents to the emergency room with lightheadedness, lethargy, and periods of confusion. Patient family members found him unconscious outside. Wife states, “he’s been at it for over a week
now” Medications: Insulin, Lasix, Digoxin and Vasotec: were:
Temperature Pulse Respirations
36.7C 118 18
On examination, the patient has slurred speech with decreased upper and lower motor strength bilaterally 4/5. While examining the patient, he experienced loss of consciousness that lasted less than half a minute. The nurse, drew labs, administered oxygen via NC, Established IV line access and placed patient on a monitor. Lab results
Vitals on admission
Blood Pressure 103/61
Electrolytes – in emergency room Hematocrit –
Potassium
Sodium
Phosphorus 2.6 mg/dL Bicarbonate
Calcium
Creatinine
Serum Osmolarity Glucose
38%
3.3 mEQ/L
147 mEQ/L
21 mEq/L 7.6 mg/dL
2.4 mg/dL
321 mmol/kg 389 mg/dL
Hemoglobin
12 gm/dL
Chloride
95 mEq/L
BUN
46 mg/dL
Magnesium
1.3 mEq/L
Albumin
4.1 g/dL
Urine Drug Screen -
Negative
1. State the medical diagnosis described in the scenario above that is likely causing these symptoms
2. Define the medical diagnosis stated in question #1
2b. What are the signs and symptoms?
3.Discuss the primary medical management for the diagnosis stated in question #1
3b. What are the nursing actions for this patient?
4. Calculate the serum osmolarity for this patient
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