The nurse cares for a 21 year-old male with a history of HIV…

The nurse cares for a 21 year-old male with a history of HIV admitted the the medical surgical unit with respiratory distress. Nurses’ Note     1100: A 25-year-old male who has been HIV positive for 3 years is admitted for a dry cough and fever of 101.0oF/ 38.3oC. The client has fatigue, shortness of breath, a respiratory rate of 28, and pulse oximeter of 90% on room air. Breathing is slightly labored and he has a tight feeling in the chest when taking a deep breath. He has been on antiretroviral medications since his diagnosis of HIV but recently stopped taking the medication when he was laid off from his job. His symptoms did not improve with over-the-counter medications after 3 days.  IV started in 0.9% normal saline infusing in the right arm at 75 ml/hr. Labs drawn. Laboratory Report     BUN 22 mg/dL 10-20 mg/dL Creatinine (Serum) 1.5 mg/dL 0.9 to 1.4 mg/dL Hematocrit 48 % Males: 42-52%;Females: 35-47% Hemoglobin 15g/dL Males: 13-18 g/dL; Females:12-16 g/dL WBC 15.2 mm3 4.5 – 10.5 x 103 cells/mm3 Platelets 300,000 mm3 140,000 to 450,000/ mm3 PT 10 seconds 9.5-12 seconds CD 4 178 mm3 500- 1,500 cells/mm3 Potassium(serum) 4.5 mEq/L 3.5 to 5 mEq/L Sodium (serum) 148 mEq/L 135 to 145 mEq/L       Which 2 lab findings are most concerning? Select the 2 most concerning lab findings.  
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A 32-year-old female client with a history of hyperthyroidis…

A 32-year-old female client with a history of hyperthyroidism is brought to the  emergency department by their spouse Nurses’ Notes   0900: Accompanied by spouse,  client reports being short of breath and having palpitations. Placed in ER treatment room directly from triage. Alert and oriented x 4 appears restless, anxious, and fatigued. Has flushed skin that is hot to touch. Bilateral eye protrusion noted, and states eyes feel “very dry.”  Lung sounds clear to auscultation, no reported cough but has intermittent and worsening dyspnea. Normal  S1 and S2 and 2-3+ bilateral pulse strength palpated. Hyperactive bowel sounds auscultated on all 4 quadrants. The client does not report any pain and also states that they have felt excessive hunger and thirst over the past week that is unrelieved by oral intake. Also reports  unexpectedly lost approximately 4.0 kg (approximately 8 lbs.) of body weight over the past week.   Vital Signs     Time 0900     Temp 103.2 F ( 39.6 C)     P 137     RR 28     B/P 152/98     Pulse oximeter 97% on RA     Pain 0   Laboratory Report     Lab Results Reference Range   White Blood Cells (WBC) 13 x 103 cells/mm3 4.5 – 10.5 x 103 cells/mm3   Potassium (serum) 5.0 mEq/L 3.5 to 5 mEq/L   Sodium (serum) 142 mEq/L 135 to 145 mEq/L   Thyroid stimulating hormone (TSH) 0.27 mU/L 0.45 to 4.5 mU/L   Serum triiodothyronine (T3) 400 ng/dL 80 to 200 ng/dL       Serum thyroxine (T4) The nurse recognizes the patient is experiencing : 270 nmol/L   57 to 148 nmol/L.    
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