Question

Mrs. Prather is a 54 year old female who arrived at the emergency department, complaining of nausea and dizziness that came on suddenly while working out at the sym this morning. Identifying Information: S4yr old female History of Present Illness; 54 yr old female presented to the ED c/o of severe nausea & dizziness while running on a treadmill this morning. She states she had eaten breakfast this morning before working out. She states "I have never been this nauseous in my life and I felt like I was going to faint." Past Medical History: Hypertension Diabetes Past Surgical History: Surgical resection-c-section with first child Current Medications: • Lisinopril-hypertension • Insulin-NPH • Insulin-Regular Allergies: No allergies Family History: Mother-alive-arthritis Father-deceased-CAD, hypertension, myocardial infarction, heart failure Social History: Occupation: High school teacher Tobacco Use: never Illicit Drug Use: never Alcohol Use: occasional use Review of Systems: (what patient tells you) Skin: no changes in hair, no changes with nails Mental Health: no current feelings of sadness, no sleep disturbances, no suicidal ideations Neurological: + light-headedness,+ dizziness, no paresthesia to feet & hands, no balance problems Head and neck: no headache, no neck pain, no stiffness Eyes: no vision changes, no eye discharge, no redness, no edema Ears: no change in hearing, no tinnitus, no discharge Nose: no change in sense of smell, no nasal discharge or congestion Throat and mouth: + toothache, no pain, no trouble swallowing Lymphatic: no swelling, no tenderness Cardiovascular: no chest pain, no leg swelling, no palpitations, no sob, no orthopnea

Answer 1

1. Based on assessment, i think patient may have hypoglycemia from her symptoms of dizziness and nausea. Also patient has diabetes and on anti diabetic agents.

2. Hypoglycaemia is a condition in which there is decrease in plasma glucose level to such an extent that patient shows certain symptoms like nausea , dizziness, vomiting and diaphoresis etc. in present case patient has already impaired glucose metabolism because of diabetes and patient is also taking insulin. Due to these risk factors , patient may have developed hypoglycemia as there may be insulim oversdose.

3. Patient should have blood sugar level, glycosylated hemoglobin level be checked to confirm.

4. In hypoglycemia, level of blood sugar should be less than normal range that 70-110 mg/dl

5. patient may be experiencing hypovolemic shock as she is feeling sleepy and her pulse is weak and thready with low blood pressure.

6. Because of risk factor like inadequate water or food intake and intake of inadequate dose of antihypertensive, patient may have developed hypotension because of which there is decreased perfusion to brain causing sleepiness and inadequate blood pumping causing weak and thready pulse.

7. Intravenous hydration should be started immediately