The nurse is caring for a patient with pneumonia. Which lab abnormality is most concerning?

B. The inability to clear the airway is a critical issue. This patient has a weak, congested-sounding cough and moist crackles, indicating that secretions are present and not being effectively cleared. This can lead to airway obstruction, decreased oxygenation, and further respiratory complications. Clearing the airway is a top priority to ensure the patient can breathe properly and prevent further deterioration.
A. Difficulty breathing (dyspnea) is a serious concern as it can indicate respiratory distress or failure. However, it is often a symptom rather than a primary issue, and its underlying causes (such as an inability to clear the airway or inadequate oxygen levels) must be addressed first.
C. Confusion can result from high fever, infection, or hypoxia. While it is important to address the fever and its underlying cause, confusion itself is usually a secondary issue. Addressing the primary respiratory issues will often improve the patient's mental status as well.
D. Hypoxia can result from severe pneumonia, and resolving it involves ensuring the patient has a clear airway and adequate ventilation. Measuring and correcting oxygen levels (e.g., with supplemental oxygen) is crucial, but the underlying cause (such as airway obstruction) must also be managed.

A. Acetone breath, characterized by a fruity or acetone-like odor on the patient's breath, is a classic sign of DKA. In addition, Kussmaul respirations, which are deep and labored breathing patterns, can occur as the body attempts to compensate for metabolic acidosis in DKA.
C. Nausea and vomiting are common symptoms of DKA and can occur due to metabolic acidosis, electrolyte imbalances, and gastrointestinal disturbances associated with the condition.
F. Tachycardia and hypotension are signs of hemodynamic instability, which can occur in severe cases of DKA due to dehydration, electrolyte imbalances, and the systemic effects of metabolic acidosis.
G. Turning off an insulin pump can lead to insulin deficiency, which is a precipitating factor for DKA, particularly in patients with type 1 diabetes who rely on continuous insulin therapy. This finding is consistent with the development of DKA.
B. Blurred vision and headache can be symptoms of DKA, although they are not specific to this condition. Elevated blood glucose levels and dehydration associated with DKA can lead to osmotic diuresis and subsequent fluid shifts, which may manifest as headache and visual disturbances.

D. A history of type 1 diabetes mellitus (DM) predisposes the patient to DKA but the history of appendix removal at age 7 is not directly relevant to the current presentation of DKA.
E. Alcohol ingestion can contribute to the development of DKA by inhibiting gluconeogenesis and promoting ketoacidosis, particularly if the patient is not consuming adequate carbohydrates and insulin. However, it is not a direct sign of DKA.