Eyes:  Conjunctivae, EOM and lids are normal. PERL. Right and left eyes are without drainage or nystagmus. No scleral icterus.

Neck: Normal range of motion and phonation. Neck is supple. No JVD. No tracheal deviation present. No thyromegaly or thyroid nodules. No cervical lymphadenopathy noted bilaterally.

Cardiovascular: rapid rate, S1 and S2 without murmur or gallop. Brachial, radial, dorsalis pedis, and posterior tibial are 2+/4+ bilaterally.

Chest: Respirations are regular and even with mild dyspnea.

Lungs are coarse and with some rales posterior bases.

Abdomen:  Soft. Bowel sounds are active, nontender, no masses noted. No hepatosplenomegaly noted. No peritoneal signs.

Musculoskeletal: Full range of motion of the bilateral shoulders, wrists, elbows.

Neurologic: Somnolent. Cranial nerves II-XII are intact.

Skin: Warm and dry.

Psychiatric: Mood and affect are normal. Calm and cooperative. Behavior, judgment is intact.

LABORATORIES AND DIAGNOSTICS:

WBC 7.2, Neutrophil 63%

Creatinine 2.5 mg/dL, BUN 45 mg/dL, Na 144 mEq/L, Potassium 4.4 mEq/L, Total Bilirubin is 0.9 mg/dL, Platelets 100,000

BNP 242 pg/mL

Lactate 1.0 mg/dL

All other labs are unremarkable

Chest x-ray: Right lower lobe infiltrate

EKG: NSR, no ST or T wave changes

Questions:

1. Develop a list of differential diagnoses specific to hypoxia. What are the four most important differential diagnoses to consider?
2. Based on the available clinical data, what is the most likely diagnosis for the hypoxia? What other acute (new) diagnoses do you need to treat? List them all below. There are a total of 4 diagnoses.
3. What additional diagnostic tests should be ordered to further evaluate this patient?
4. Write an assessment and treatment plan for all four acute diagnoses you identified in question 2. Each diagnoses must have a complete treatment plan. All written orders must have complete instructions. For instance, a medication order must have the name, dose, frequency, and route. Lab orders must include the lab name and frequency. If an order should be done now, stat, urgent or routine that also should be indicated.
5. What is the most appropriate level of care for this patient?
6. What physician specialty or other interprofessional consults should be ordered?
7. What anticipatory guidance/patient education should you provide to the patient?