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Hypoglycemia
The patient presented with confusion, diaphoretic, pale, anxious a
Hypoglycemia
The patient presented with confusion, diaphoretic, pale, anxious and tachycardic all signs of hypoglycemia. The patient was not experiencing slurred speech, blurry vision, or unresponsive which can be seen in sever hypoglycemia.
Urosepsis
The patient presented with confusion, tachycardia, hypotension and pain or pressure in the lower abdomen. However, due to the patient’s confusion he wasn’t able to tell me if he was experiencing burning, urgency, or frequency.
Diverticulitis
The patient presented with tachycardia, hypotension, and a fever. However, he complained or right lower quadrant pain and left lower quadrant pain would be expected with diverticulitis. In patient of this ago confusion and anxiety can be present when there is an infection source.
What diagnostic tests (if any) would you order to include or exclude your diagnosis? Explain your rationale.
In this case I would order and abd and pelvis ct to evaluate for a gastrointestinal or urinary source of infection or inflammation. If this came back negative, I would consider scanning this patient head to assure no acute intracranial process was causing the confusion. I would order a CBC, BMP, ABG, and Blood cultures to evaluate for leukocytosis, sepsis and an elevated lactic acid. I also ordered urine studies on this patient given his age and confusion and right lower quadrant pain which came back positive for a UTI. I also performed a bedside glucose test to check for hypoglycemia since the patient was diaphoretic and confused.
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In the setting of urosepsis what are the first three steps to management and evaluation that the NP should take per the sepsis guidelines?
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