What were your top three differential diagnoses for this patient?
Myocardial Infarction
Stroke
Septic Shock leading to hypoglycemia
What pertinent positives and negatives did you use to narrow your differentials?
Alcohol Dependence with Withdrawal
Positive: Tremors, diaphoresis, hx of alcohol abuse, headache, tachycardia, tachypnea, and nausea, CIWA score of 14.
Negative: No visual hallucinations, no seizure activity, afebrile, delirium.
Stroke
Positive: HTN, tachycardia, diaphoresis, nausea, tachypnea, headache.
Negative: Facial droop, slurred speech, lost of sensation on one or both sides of the body.
Septic Shock leading to hypoglycemia
Positive: Tachycardia, tachypnea, diaphoresis, shaking, nausea.
Negative: Fever, delirium, confusion.
What diagnostic tests (if any) would you order to include or exclude your diagnosis? Explain your rationale.
Test Ordered Timestamp Rationale
Continuous Monitoring 0042 Patient presented with diaphoresis and tachypnea which would prompt monitoring.
IV Access 0126 Patient is presenting with symptoms that could suggest he will need immediate interventions such as IV fluids and possible cardiac or respiratory medications.
CBC, CMP 0129 This will help us ensure a baseline for the patient and determine if there is electrolyte imbalances. This will also show if there is signs of elevated WBC which will rule in Septic shock. It will also tell us glucose levels which could rule in hypoglycemia.
Alcohol Dependence with Withdrawal
I would also order a alcohol level to confirm intoxication as well as drug testing to ensure patient had not used any other forms of drugs. The alcohol level would rule in the intoxication and this diagnosis.
Stroke
I would order a head CT and head MRI with contrast, perform a full neurological assessment as well as coagulation blood studies. These would all help rule in the diagnosis of stroke. I would also do a thorough past medical history to assess the patient for possibility of clots. (Symptoms | NHLBI, NIH, 2023).
Septic Shock with Hypoglycemia
I would order glucose monitoring as well A1C to check the patient diabetic status. I would also perform a thorough history to determine if the patient is a diabetic. I would also order a CBC and lactic acid to determine if the patient WBC which would rule out the patient having a infection and negative lactic acid would also rule out this diagnosis. (Professional, 2022).
Need response for the post with why this differential is appropriate with the labs
What is the most life threatening complication of ETOH withdrawl and what are three interventions you as the NP would consider starting for this pt?
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