Barbara Ewing is an 86-year-old female with a recent history…
Barbara Ewing is an 86-year-old female with a recent history of poor appetite, difficulty swallowing, and weight loss. Her medical history includes hypertension and coronary artery disease managed by medications and a stroke several years ago leaving her with left sided weakness and inability to walk. She is very shaky and has notable tremors of her upper extremities when she moves her arms. Atrophy of the left arm and leg are noted. Ms. Ewing typically sits in a wheelchair most of the day, however lately she has felt too weak and has been staying in bed most of the time. Skin breakdown has developed on her coccyx and elbows with notable erythema, edema, warmth, tenderness, and yellow drainage. Ms. Ewing has not been able to rate her coccygeal pain using a pain scale, however she moans, cries, and pushes you away when her coccyx is touched. Otherwise, Ms. Ewing has intact, dry skin and mucous membranes, pitting edema of both legs and feet, and scant urine output. Vital signs are: 38.7, 112, 26, 96/44. The following laboratory values were assessed: Serum Electrolytes Na 155 mEq/L Cl 106 mEq/L K 2.9 mEq/L BUN 18 mg/dl Creat. 1.1 mg/dl CO2 19 mmol/L Ca 7.9 mg/dl Mag 1.7 mEq/L Phos 4.7 mg/dl Glucose 185 mg/dl Albumin 2.9 g/dl Lactic Acid 6.0 mEq/L Ms. Ewing’s neurologic status may be directly influenced by which of the following?
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