Called Patient Admit Assignment Help: How to Answer This Question

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What This Question Is About

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How to Approach This Question

Focus on explaining concepts clearly and supporting them with examples.

Key Explanation

This topic involves called patient admit. A strong answer should include explanation, application, and examples.

Original Question

You are called on a patient in the ED to admit a 55-year-old male who presented to the ER today with AMS and severe hyponatremia (Na+ 120). The ER physician tells you the patient has a history of small cell lung cancer (recently diagnosed), hypertension, and hypothyroidism. Based on this limited information, list at least 2 differential diagnoses that could cause AMS and hyponatremia (list at least 2 diagnoses for each system): Neuro: CV: Pulmonary: GI: GU: Metabolic: Psychiatric: You arrive to the ED, and you find the patient appearing older than their stated age, pale, and lethargic. He is arousable to touch but confused. He is unable to answer questions coherently. His wife is at bedside, and you ask her to update you on the duration of the current illness and any factors that she is aware of that may have precipitated this event. She explains to you that he has been progressively more confused and lethargic over the past 5 days. She also notes a significant decrease in urine output over the past two days, despite him drinking fluids regularly. His appetite has been poor, and he’s been feeling fatigued. She reports no recent vomiting, diarrhea, or fever but mentions his diagnosis of small cell lung cancer. You ask the wife if he takes any medications or illicit substances, and she reports that he is on levothyroxine for hypothyroidism and lisinopril for hypertension. She denies any history of substance abuse, illicit drugs, or alcohol. Given the presenting symptoms and hyponatremia, you note the following vital signs: HR 92, BP 110/72, RR 18, SpO2 96% on room air. What are at least 3 pertinent positives from the information now that begin to clue you into a possible diagnosis? 1. 2. 3. What are at least 3 significant negatives from the information provided that can begin to exclude some causes for AMS and hyponatremia? 1. 2. 3. Given the information provided, write out what your “one-liner” for this patient would be thus far that you would tell your physician: Given the history obtained, what at least 5 lab tests would you want to order? 1. 2. 3. 4. 5. Your labs return: Serum sodium: 120 Serum osmolality: 260 mOsm/kg (low) Urine osmolality: 410 mOsm/kg (high) Urine sodium: 55 mEq/L (high) TSH: 2.1, free T4: 1.1 BUN: 12, creatinine: 0.8 Glucose: 98 What does this show? Be specific indicating the tonicity, electrolyte abnormality, and disease process. Is this concerning? Why? What is your “one-liner” statement to your collaborative physician now? Your physical exam: Temp: 36.8°C, HR: 92, BP: 110/72, SpO2: 96% on RA Constitutional: Appears older than stated age, lethargic HEENT: PEERL, moist mucous membranes CV: RRR, no murmurs, rubs, or gallops, no edema Resp: CTA bilaterally GI: Nontender, nondistended, normal bowel sounds GU: Normal external exam Skin: Intact, no rashes or lesions Neuro: AMS, no focal deficits, reflexes intact, responds to pain What are 3 pertinent positives and 3 negatives in the ROS and physical exam? Positives: 1. 2. 3. Pertinent negatives: 1. 2. 3. What is your #1 working diagnosis and assessment after reviewing all this information? As the provider, what are the 4 important things to order now to treat this? 1. 2. 3. 4. Your new diagnostic tests return: Serum sodium: 126 (improved) Serum osmolality: 270 mOsm/kg (slightly low) Urine osmolality: 420 mOsm/kg (unchanged) BUN: 10, creatinine: 0.8 Is this an improvement? Would you correct the sodium level rapidly? Why or why not?

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