1100: 83-year-old female was brought in by her family for 'not acting right.' Over the past two days, the family reports that she has not eaten as much, become forgetful, and experienced urinary incontinence described as 'foul-smelling.' She is currently managed with insulin for her type II diabetes mellitus, and the family reports high blood glucose levels despite her not eating. The family reports that her blood glucose level was 155 mg/dL(8.6 mmol/L) [70-110 mg/dL (4-6 mmol/L)], which was obtained before her arrival. The family reports that her baseline is alert and fully oriented. The family states the symptoms started abruptly. The client is alert and only oriented to person and place. She has a degree of speech latency and perseveration. She repeats phrases such as 'It is burning, it burns!'. The client's skin appears dry, flaky, and warm—sunken eye appearance. Skin tenting was noted in both extremities. She has a full range of motion in her arms and legs on the right side and no range of motion on her left side. She has a medical history of atrial fibrillation, diabetes mellitus type II, and a cerebrovascular accident three years ago that left her with left-sided hemiplegia.

Oral Temperature 99^o F (37^o C)

Pulse 86/minute; Irregular

Respirations 16/minute

Blood pressure 113/68 mm Hg

Oxygen saturation 96% on room air

• Obtain capillary blood glucose (CBG)
• Obtain urine specimen via straight (intermittent) urinary catheter
• Admit to medical-surgical unit
• Urine culture and sensitivity
• Complete blood count
• Complete metabolic panel
• Head computed tomography (CT) scan
• Insert peripheral vascular access
• 0.9% saline at 150 mL/hr

• Discharge client home
• Doxycycline 100 mg PO daily