QLexNursing

Hyperglycemia

💎 The client has a casual glucose level of 300 mg/dL, which is well above the expected value of < 200 mg/dL, clearly indicating hyperglycemia.

💎 Clinical symptoms of thirst and frequent urination (polyuria), documented on Day 3, are classic signs of hyperglycemia and possible osmotic diuresis.

💎 Despite these symptoms, the urine specific gravity is 1.010, which is on the lower–normal side, suggesting dilute urine, supporting the idea of osmotic diuresis rather than dehydration-driven concentration.

💎 The client is receiving parenteral nutrition, which often contains high dextrose concentrations, and this is a well-known cause of elevated blood glucose, especially if insulin coverage is not adjusted.

💎 Altogether, the combination of high serum glucose, thirst, polyuria, and TPN administration strongly supports hyperglycemia as one of the key conditions reflected in the medical record.

Infection

💎 The client’s temperature increased from 37.2°C (99°F) on Day 1 to 39°C (102.2°F) on Day 3, which is a significant fever and a classic indicator of infection.

💎 The WBC count is 11,500/mm³, which is above the normal range (5,000–10,000/mm³), further supporting the presence of a systemic inflammatory or infectious process.

💎 The client is lethargic, a nonspecific but important sign that can accompany systemic infection and fever, especially in acutely ill or older clients.

💎 The presence of a PICC line and parenteral nutrition increases the risk for line-related or systemic infections, such as catheter-associated bloodstream infection.

💎 Together, the elevated temperature, increased WBC, and clinical picture point strongly toward infection as the second key condition in the chart.

Dehydration

💎 Although the client reports thirst and frequent urination, which could suggest fluid loss, the hematocrit (38%) and hemoglobin (13 g/dL) are within normal range and do not show hemoconcentration, which is typical in significant dehydration.

💎 The urine specific gravity is 1.010, which is not highly concentrated; in true dehydration, you would expect a higher specific gravity (e.g., ≥1.025) as the kidneys conserve water.

Pneumothorax

💎 The nurse notes “bilateral breath sounds clear and present throughout” on both Day 1 and Day 3, and the oxygen saturation remains 95–96% on room air, which does not support pneumothorax, where you might expect diminished or absent breath sounds and decreased SpO₂.

💎 The chest x-ray done on Day 1 confirmed the PICC line in the superior vena cava, and there is no mention of lung collapse, air in the pleural space, or respiratory distress, which would be expected with a pneumothorax.