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A 68 yeаr оld mаle cаme tо the Emergency Department with a histоry of Type 2 Diabetes with changes in mental status from his baseline. The client is alert to person only and very weak and drowsy. The patient's wife said he has been extremely thirsty and urinating very frequently with large amounts. The ER nurse performs a set of vital signs, Temp 100.8 F, Pulse 116, RR 24, BP 92/60, Pulse ox 94% RA. Skin is very warm and dry, non-elastic, and dry mucous membranes. HR tachycardia at 116 bpm regular, Lung sounds clear, no cough noted, no peripheral edema noted. Pt voided amber color urine, and the nurse notes that the appearance is cloudy. The nurse asks patient about the urination and he says he has some "burning" with urination. The nurse checks the patient's blood sugar which is 650. The nurse sends a stat Urinalysis to the lab. At this time, which is the priority nursing diagnosis for this patient?
Which оf the fоllоwing orders would the nurse initiаte first bаsed on the findings listed below? A 68 yeаr old male came to the Emergency Department with a history of Type 2 Diabetes with changes in mental status from his baseline. The client is alert to person only and very weak and drowsy. The patient's wife said he has been extremely thirsty and urinating very frequently with large amounts. The ER nurse performs a set of vital signs, Temp 100.8 F, Pulse 116, RR 24, BP 92/60, Pulse ox 94% RA. Skin is very warm and dry, non-elastic, and dry mucous membranes. HR tachycardia at 116 bpm regular, Lung sounds clear, no cough noted, no peripheral edema noted. Pt voided amber color urine, and the nurse notes that the appearance is cloudy. The nurse asks patient about the urination and he says he has some "burning" with urination. The nurse checks the patient's blood sugar which is 650. The nurse sends a stat Urinalysis to the lab. Lab Results Reference range ABG pH 7.35 7.35-7.45 ABG PC02 42 35-45 mmHg ABG HC03 23 22-26 mEq/L BUN Creatinine (Serum) 25 1.5 7-20 mg/dL 0.9 to 1.4 mg/dL Glucose random 650 70- 140 mg/dL Other (urine) Ketones Negative negative Serum osmolality Elevated