51.Pаtient: Mаrgаret Chen, 78-year-оld female Admissiоn Diagnоsis: Hyponatremia (serum sodium 122 mEq/L; normal: 135-145 mEq/L) History: Mrs. Chen was brought to the emergency department by her daughter, who reports her mother has been "acting confused" for the past 2 days. The patient lives alone and has been taking hydrochlorothiazide (HCTZ) for hypertension for 5 years. Her daughter states that during a recent heat wave, her mother increased her water intake significantly because she "didn't want to get dehydrated." Current Presentation: Confused and disoriented to time and place Complains of headache and nausea Appears lethargic but arousable Muscle weakness noted in extremities Reports recent vomiting (2 episodes yesterday) Vital Signs: BP: 108/68 mmHg HR: 88 bpm RR: 18 breaths/min Temp: 98.2°F (36.8°C) Laboratory Results: Serum sodium: 122 mEq/L (Low) (normal range 135-145 mEq). Serum osmolality: 260 mOsm/kg (Low) (normal range 280-294 mOsm/kg) Urine specific gravity: 1.002 (Dilute) (normal 1.005-1.030) The nurse is caring for Mrs. Chen, who has a serum sodium of 122 mEq/L. Which assessment findings are consistent with hyponatremia? (Select all that apply)
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