The client is a 52-year-old male that arrived at the Emergency Department

The client is a 52-year-old male that arrived at the Emergency Department accompanied by his wife 12 hours after he completed a vigorous exercise regimen in the midday heat followed by a dinner of hamburgers, French fries, and beers with his longtime friend who was in town visiting. The client states that he has been experiencing increasing shortness of breath, lethargy, dizziness, and muscle twitching. He also reports very dark yellow urine.

Client reports a medical history of hypertension, early onset type II diabetes, coronary artery disease, obesity, and recently quit smoking after 25 years. 

Medications: lisinopril 40 mg orally once per day, aspirin 81 mg orally once per day, and naproxen 250 mg four times per day as needed.

Focused client assessment completed. Client is lethargic but is oriented to person, place, time, and situation. Client’s work of breathing is labored, even, with accessory muscles in use. Lungs are clear bilaterally on auscultation. S1 and S2 auscultated. Radial and pedal pulses palpable, alternating strength between normal and thready. Capillary refill greater than 3 seconds in lower extremities. Skin color pale, warm to touch in all extremities. Mucous membranes dry. Muscle strength graded as weak in the upper and lower extremities, equal bilaterally. Hyperreflexia appreciated in the upper extremities bilaterally. 

EKG: Sinus Tachycardia with peaked T waves and prolonged ST segment.

Complete Blood Count, Basic Metabolic Panel, Urinalysis, A12-lead Electrocardiogram, insert intravenous line, vital signs per protocol, cardiac monitoring per protocol.

Vital Signs: Temperature 37.4 ℃, HR 122, BP 90/56, RR 32, O2 saturation 95% on room air.

The client is a 52-year-old male that arrived at the Emergency Department

The client is a 52-year-old male that arrived at the Emergency Department accompanied by his wife 12 hours after he completed a vigorous exercise regimen in the midday heat followed by a dinner of hamburgers, French fries, and beers with his longtime friend who was in town visiting. The client states that he has been experiencing increasing shortness of breath, lethargy, dizziness, and muscle twitching. He also reports very dark yellow urine.

Client reports a medical history of hypertension, early onset type II diabetes, coronary artery disease, obesity, and recently quit smoking after 25 years. 

Medications: lisinopril 40 mg orally once per day, aspirin 81 mg orally once per day, and naproxen 250 mg four times per day as needed.

Focused client assessment completed. Client is lethargic but is oriented to person, place, time, and situation. Client’s work of breathing is labored, even, with accessory muscles in use. Lungs are clear bilaterally on auscultation. S1 and S2 auscultated. Radial and pedal pulses palpable, alternating strength between normal and thready. Capillary refill greater than 3 seconds in lower extremities. Skin color pale, warm to touch in all extremities. Mucous membranes dry. Muscle strength graded as weak in the upper and lower extremities, equal bilaterally. Hyperreflexia appreciated in the upper extremities bilaterally. 

Complete Blood Count, Basic Metabolic Panel, Urinalysis, A12-lead Electrocardiogram, insert intravenous line, vital signs per protocol, cardiac monitoring per protocol.

Vital Signs: Temperature 37.4 ℃, HR 122, BP 90/56, RR 32, O2 saturation 95% on room air.

The client is a 52-year-old male that arrived at the Emergency Department

The client is a 52-year-old male that arrived at the Emergency Department accompanied by his wife 12 hours after he completed a vigorous exercise regimen in the midday heat followed by a dinner of hamburgers, French fries, and beers with his longtime friend who was in town visiting. The client states that he has been experiencing increasing shortness of breath, lethargy, dizziness, and muscle twitching. He also reports very dark yellow urine.

Client reports a medical history of hypertension, early onset type II diabetes, coronary artery disease, obesity, and recently quit smoking after 25 years. 

Medications: lisinopril 40 mg orally once per day, aspirin 81 mg orally once per day, and naproxen 250 mg four times per day as needed.

Focused client assessment completed. Client is lethargic but is oriented to person, place, time, and situation. Client’s work of breathing is labored, even, with accessory muscles in use. Lungs are clear bilaterally on auscultation. S1 and S2 auscultated. Radial and pedal pulses palpable, alternating strength between normal and thready. Capillary refill greater than 3 seconds in lower extremities. Skin color pale, warm to touch in all extremities. Mucous membranes dry. Muscle strength graded as weak in the upper and lower extremities, equal bilaterally. Hyperreflexia appreciated in the upper extremities bilaterally. 

EKG: Sinus Tachycardia with peaked T waves and prolonged ST segment.

Complete Blood Count, Basic Metabolic Panel, Urinalysis, A12-lead Electrocardiogram, insert intravenous line, vital signs per protocol, cardiac monitoring per protocol.

Vital Signs: Temperature 37.4 ℃, HR 122, BP 90/56, RR 32, O2 saturation 95% on room air.

The client is a 52-year-old male that arrived at the Emergency Department

The client is a 52-year-old male that arrived at the Emergency Department accompanied by his wife 12 hours after he completed a vigorous exercise regimen in the midday heat followed by a dinner of hamburgers, French fries, and beers with his longtime friend who was in town visiting. The client states that he has been experiencing increasing shortness of breath, lethargy, dizziness, and muscle twitching. He also reports very dark yellow urine.

Client reports a medical history of hypertension, early onset type II diabetes, coronary artery disease, obesity, and recently quit smoking after 25 years. 

Medications: lisinopril 40 mg orally once per day, aspirin 81 mg orally once per day, and naproxen 250 mg four times per day as needed.

Focused client assessment completed. Client is lethargic but is oriented to person, place, time, and situation. Client’s work of breathing is labored, even, with accessory muscles in use. Lungs are clear bilaterally on auscultation. S1 and S2 auscultated. Radial and pedal pulses palpable, alternating strength between normal and thready. Capillary refill greater than 3 seconds in lower extremities. Skin color pale, warm to touch in all extremities. Mucous membranes dry. Muscle strength graded as weak in the upper and lower extremities, equal bilaterally. Hyperreflexia appreciated in the upper extremities bilaterally. 

EKG: Sinus Tachycardia with peaked T waves and prolonged ST segment.

Complete Blood Count, Basic Metabolic Panel, Urinalysis, A12-lead Electrocardiogram, insert intravenous line, vital signs per protocol, cardiac monitoring per protocol.

Vital Signs: Temperature 37.4 ℃, HR 122, BP 90/56, RR 32, O2 saturation 95% on room air.

The client is a 52-year-old male that arrived at the Emergency Department

The client is a 52-year-old male that arrived at the Emergency Department accompanied by his wife 12 hours after he completed a vigorous exercise regimen in the midday heat followed by a dinner of hamburgers, French fries, and beers with his longtime friend who was in town visiting. The client states that he has been experiencing increasing shortness of breath, lethargy, dizziness, and muscle twitching. He also reports very dark yellow urine.

Client reports a medical history of hypertension, early onset type II diabetes, coronary artery disease, obesity, and recently quit smoking after 25 years. 

Medications: lisinopril 40 mg orally once per day, aspirin 81 mg orally once per day, and naproxen 250 mg four times per day as needed.

Focused client assessment completed. Client is lethargic but is oriented to person, place, time, and situation. Client’s work of breathing is labored, even, with accessory muscles in use. Lungs are clear bilaterally on auscultation. S1 and S2 auscultated. Radial and pedal pulses palpable, alternating strength between normal and thready. Capillary refill greater than 3 seconds in lower extremities. Skin color pale, warm to touch in all extremities. Mucous membranes dry. Muscle strength graded as weak in the upper and lower extremities, equal bilaterally. Hyperreflexia appreciated in the upper extremities bilaterally. 

EKG: Sinus Tachycardia with peaked T waves and prolonged ST segment.

Complete Blood Count, Basic Metabolic Panel, Urinalysis, A12-lead Electrocardiogram, insert intravenous line, vital signs per protocol, cardiac monitoring per protocol.

Administer 10 mL of a 10% calcium gluconate solution intravenously over 2 to 3 minutes

Inject 10 units of Regular Insulin intravenously followed by 25 g of 50% dextrose intravenously now

Albuterol 20 mg nebulized solution now

Infuse D5W with 3 ampules of bicarbonate intravenously at 125 mL/hr

Vital Signs: Temperature 37.4 ℃, HR 122, BP 90/56, RR 32, O2 saturation 95% on room air.