ATI Med Surg 2 Respiratory exam | Nurselytic

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History and Physical
The client has a history of type 1 diabetes mellitus for 16 years, which is managed with insulin at bedtime and before each meal. The client measures capillary blood glucose twice daily. He had a motor-vehicle crash 3 years prior.
Nurses Notes
The client is lethargic and rouses with physical stimulation. His Glasgow Coma Scale score has decreased from 14 to 12. Auscultation of the lungs reveals rales in the right lower lobe. The right upper lobe is diminished but clear. Kussmaul respirations are noted. An 18-gauge IV in the right forearm is edematous and cool to touch. Capillary refill is 3 seconds. He has dry mucous membranes and decreased skin turgor.
Vital Signs
• Supine blood pressure: 100/70 mm Hg
• Sitting blood pressure: 85/50 mm Hg
• Heart rate: 120/min
• Respiratory rate: 24/min
• Temperature: 37.9°C (100.2°F)
• Oxygen saturation: 95% on room air
Medical History
The client was admitted to the unit from the emergency department. The client's partner reports lethargy, vomiting, diarrhea, and fever lasting for 2 days.
Diagnostic Results
• Casual blood glucose: 580 mg/dL (normal: <200 mg/dL)
• Sodium: 152 mEq/L (normal: 136-145 mEq/L)
• Potassium: 5.3 mEq/L (normal: 3.5-5.0 mEq/L)
• BUN: 32 mg/dL (normal: 10-20 mEq/L)
• Creatinine: 1.8 mg/dL (normal: 0.5-1.3 mg/dL)
• Serum pH: 7.2 (normal: 7.35-7.45)
• HCO3-: 13 mEq/L (normal: 21-28 mEq/L)
• Urine reagent strip testing: pH 4.4 (normal: 4.6-8.0), Specific gravity: 1.036 (normal: 1.005-1.030), Ketones: positive (negative), Glucose: present (none)
• Glycosylated hemoglobin: 9.69% (normal: <7.9% indicates good diabetic control)
ECG Findings
ECG indicates tachycardia with a prolonged PR interval, widened QRS, and peaked T waves.

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