2000: 66-year male arrives at the emergency department (ED) following a recommendation by his primary healthcare provider (PHCP). The client called his PHCP in the morning, reporting a headache, feeling unwell, fatigue, and thirst. He could not check his blood glucose because he reports being out of testing supplies for two weeks. He also reports being unable to take his prescribed antihypertensive and antidiabetic medications for one week because he lost his job. On exam, the client reports feeling fatigued and thirsty. He is alert and completely oriented. His physical exam was within normal limits except for a thready pulse with a rate of 119/minute.
The client has a medical history of type II diabetes mellitus, congestive heart failure (CHF), hypertension, and hyperlipidemia. He is prescribed atorvastatin, metformin, and lisinopril.
- Oral Temperature 98o F (36.7o C)
- Pulse 119/minute
- Respirations 19/minute
- Blood pressure 98/52 mm Hg
- Oxygen saturation 96% on room air
- Obtain intravenous (IV) access
- Five units of regular insulin via intravenous push (IVP)
- Infuse two liters of 0.9% saline over one hour
- Obtain capillary blood glucose (CBG) every two hours
- Potassium chloride 20 mEq by mouth x 1 dose
- Implement seizure precautions
The nurse reviews laboratory work ordered by the primary healthcare provider (PHCP)
The nurse obtains physician orders for this client with hyperosmolar hyperglycemic state (HHS)
➢ The nurse is preparing to implement the physician's orders. Which order should the nurse clarify with the physician?
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