1400 A 24-year-old male is admitted with confusion, lethargy, and dyspnea after participating in a marathon. The client was seen drinking large amounts of plain water. Crackles notes to all lung fields with a productive cough. 1+ deep tendon reflexes, 2+ regular pulses, active bowel sounds, diaphoretic.

Vitals: 99.0°F. 37.0°C, 97 bpm, 151/85 mm Hg, RR 30 breaths/min, O2 sat 85% on room air.

1415:

• Admit to intensive care unit (ICU)
• Seizure precautions
• 12-lead electrocardiogram (ECG)
• Daily weight
• 3% saline at 100 mL/hr
• Serum sodium levels every 2 hours
• Furosemide 40 mg intravenous (IV) push × 1 dose
• Insert an indwelling urinary catheter
• Nitroglycerin 600 mcg IV bolus, then continuous IV infusion at 100 mcg/min (titrate per protocol)
• Non-invasive positive pressure ventilation (BiPAP) with FiO₂ titrated to maintain SpO₂ > 92%