Passage / Scenario

Vital Signs
Day 1:
Temperature 38.6 ┬░C (101.4 ┬░F)
Heart rate 96/min
Respiratory rate 26/min
Blood pressure 158/88 mm Hg
SaO2 91% on room air
Day 2:
Temperature 38.4 ┬░C (101.2 ┬░F)
Heart rate 88/min
Respiratory rate 24/min
Blood pressure 152/82 mm Hg
Sa0: 92% on 05 at 4 L/min
Day 3:
Temperature 37.8 ┬░C (100.1 ┬░F)
Heart rate 82/min
Respiratory rate 22/min
Blood pressure 130/78 mm Hg
Provider Prescriptions

Day 1:
Purified protein derivative 0.1 mL intradermal to right forearm
Day 1 through Day 3:
Isoniazid 300 mg PO daily
Rifampin 600 mg PO daily
Acetaminophen 500 mg 1-2 tablets PO every 4 to 6 hr PRN fever, pain

Medical History

No previous surgeries
No known allergies
No previous hospitalizations
No chronic illnesses
Traveled out of the country 2 months ago

Diagnostic Results

Day 1:
ALT 36 SI/L (4 to 36 SI/L)
AST 35 units/L (0 to 35 units/L)
Alkaline phosphatase 158 units/L (30 to 120 units/L)
Chest x-ray pending results
Day 3:
Mantoux Test: 12 mm induration (negative reaction less than 5 mm
ALT: 38 SI/L (4 to 36 SI/L)
AST: 36 units/L (0 to 35 units/L)
Alkaline phosphatase: 129 units/L (30 to 120 units/L)

Nurses' Notes

0900:
Client admitted from emergency department with hemoptysis, dull chest pain, increasing fatigue, anorexia, nausea, chest tightness, and 3.2 kg (7 Ib) weight loss in 2 weeks. Heart rate regular, lung sounds with crackles in bilateral upper lobes. No edema. Airborne precautions initiated upon admission.
Day 2:
1100:
Client reports shortness of breath, nausea, and fatigue. Crackles auscultated bilaterally throughout lung fields. Productive cough, with thick, blood-streaked sputum. Bowel sounds active, no edema.
Day 3:
0900
Client reports some improvement in dyspnea. Client coughing up thick, yellow blood-streaked sputum. Crackles auscultated in bilateral upper lobes of lungs. Sclera noted to be yellow. Clients weight is 0.7 kg (1.66) less than at admission. Preborrazed to increase intake of ora firmas Client reports urine appears recoish-orange in color.