After reviewing the аssessment results аnd vitаl signs the nurse recоgnizes the patient is in an adrenal crisis. Which оf the fоllowing findings from the history and physical are consistent with this diagnosis?
Tаsk: Dоcument а cоmplete аnd thоrough physical examination from your patient encounter Be sure to document any and all specific exam findings that you observed or were provided during the encounter. Below you will find a copy of the patient information provided to you during the OSCE: Patient Name: Lundy Ganz Age: 40 y/o Gender: Female Chief Complaint: “I think I have a UTI” Vital Signs: (if applicable) Temperature: 37.1°C (98.8°F) Pulse rate: 75 Respiration rate: 16/min Blood pressure: 132/88 mmHg Oxygen saturation: 99% on room air Weight: 81.6 kg (180 lb) Height: 164.6 cm (64.8 in) HPI: Lundy is a 40 y/o female who presents with a complaint of increased urinary frequency and concern for UTI. This began 7 days ago. She reports that this is not a new problem for her, and she has had several UTIs in the past year. Pt notes that 3 weeks ago she had something similar when she started having burning when she urinated and increased urinary frequency, for which she was placed on an antibiotic by a telehealth provider who was not able to complete a urine dipstick due to the nature of the encounter. She cannot recall the name of the medication, but thinks it began with an "M". She took that medicine twice daily for 5 days with relief of her symptoms entirely. Pt denies fever, dysuria, urgency or hematuria at this time. Denies flank pain, urinary incontinence, or unusual vaginal discharge. She does report occasional vaginal "spotting", as recently as last week. Her menstrual periods are irregular but often come between 22 and 32 days apart. Her LMP was over 3 weeks ago. There is no associated abdominal pain, nausea or vomiting. Prior to today, Lundy treated her urinary symptoms by increasing her intake of water and cranberry juice but that did not help. In addition, she used over-the-counter "AZO UTI" tablets that she purchased at CVS, but that did not change her symptoms. Some of these things helped during the last UTI episode. She denies hx of kidney stones in the past. Past Medical History: Illnesses/Injuries: Chronic conditions: Elevated cholesterol (first detected 6 months ago), attempting fish oil and dietary modification as treatment currently. OB-GYN Hx: G0P0; atypical pap smear 3 years ago (ASCUS); HPV (7 years ago); gonorrhea cervicitis (treated 5 years ago) Hospitalizations: None Surgical History: None Immunizations/Health Maintenance: Up to date on all vaccines Medications (Prescription, Over the Counter, Supplements) Over-the-counter daily multivitamin Over-the-counter fish oil (unsure of dose) Allergies (e.g. environmental, food, medication and reaction) Sulfa drugs (reaction: anaphylaxis by pt report) Family Medical History: Father: alive, 82 years old, diabetes mellitus type 2 Mother: passed away at 81 years old (this occurred last year) Sister 1: 35 y/o alive, hyperlipidemia Sister 2: 30 y/o alive and well Children: none Social History: Tobacco/Vape: Yes, use vape (nicotine product) multiple times daily for the last 4 years. Alcohol: Has 1-2 glasses of wine per night, 4-5 days per week. Illicit drugs: Often uses THC products (i.e., candy) as a sleep aid Marital/Sexual: Single. Pt reports being sexually active with multiple partners over the last 6 months. She identifies as bisexual. Pt reports that her most recent partner used condoms. Living situation: Lives in La Mesa Job: Commercial real estate agent Hobbies: Making home improvement videos, volunteering for a local homeless shelter Diet: Is attempting to eat a low-fat diet currently for treatment of her elevated cholesterol Review of Systems: General No fever/chills. Pt does report 10 lb weight gain over last 6-8 months. No night sweats. Skin Denies hair loss, nail pitting, rashes, or discoloration. No report of jaundice Head No atypical or frequent headaches, neck pain or stiffness. No head trauma reported. Eyes Occasional problems with distance vision, mainly at night over the last year. No double vision or eye pain. Pt denies conjunctivitis, hearing loss, tinnitus, nasal discharge. No LAD reported. No headaches Ears No hearing loss, tinnitus, otorrhea, or otalgia (ear pain) Nose/Sinuses No nosebleeds or rhinorrhea Throat/Mouth/ Neck No neck pain, sore throat, hoarseness, swelling, neck stiffness, or lymph node swelling. Respiratory No cough, shortness of breath, orthopnea, dyspnea, or hematemesis. Cardiovascular/ PV No chest pain, palpitations, swelling or edema of the extremities. No extremity discoloration or cold extremities reported. Gastrointestinal See HPI. No abdominal pain. No diarrhea or constipation. No blood in stool seen. Genitourinary See HPI. Pt reports vaginal spotting over the last month at times without active vaginal bleeding, no pelvic pain. Musculoskeletal Denies joint swelling, redness, warmth or myalgias. Psychiatric No anxiety, depression, hallucinations, and homicidal or suicidal ideations Neurologic Denies confusion, syncope, paresthesias, numbness, or muscle weakness. No dizziness. Hematologic / Lymph Denies easy bruising or bleeding. Denies gum bleeding. Endocrine No reported heat or cold intolerance. Drinking more fluids than usual, but states in attempt to treat her UTI for which she is peeing more than usual. Intake/Triage Diagnostic Testing Performed: Urinalysis (collected and processed at patient intake): Be sure to note that patient results are in the left-hand column. PATIENT RESULT: REFERENCE RANGE: Color: clear yellow Appearance: clear Leukocyte esterase: 0 Nitrites (mg/dL): 0 Urobilinogen (mg/dL) 0.3 Protein (mg/dL): trace pH: 6.5 Blood (mg/dL): neg Specific gravity: 1.025 Ketones (mg/dL): neg Bilirubin (mg/dL): neg Glucose (mg/dL): 500 mg/dL RBC: none WBC: 1 Squamous epi cells: none Bacteria: none Mucus: none Color clear to yellow Appearance clear Negative Negative 0.2-1 Negative 5.0-9.0 Negative 1.005-1.030 Negative Negative Negative 0-5/HPF 0-3/HPF Negative Negative Negative Urine pregnancy (b-hCG) Result: Negative ***END OF STUDENT INFORMATION***