Question

A nurse is caring for an adolescent in the emergency department (ED).

Exhibit 1
Nurses' Notes
0700:Adolescent admitted to ED. Adolescent's parents are concerned about left leg injury that appears to be getting worse. Parents report adolescent has had fever, decreased appetite, and decreased energy within the past 2 days. Adolescent reports leg injury occurred while playing soccer.0715:Adolescent is alert and oriented to person, place, time, and situation. Adolescent reports left lower leg pain as 4 on a scale of 0 to 10.Heart rate regular. Capillary refill less than 3 seconds. Respirations even, unlabored. Lungs clear anterior/posterior. Abdomen soft, nondistended. Bowel sounds hyperactive in all 4 quadrants. Pedal pulses +2 bilaterally. Medial lateral aspect of left lower leg: 3 x 3 cm2 area of redness with small pustules present. Tenderness and warmth noted to the area.

Exhibit 2
Vital Signs
0700:Temperature 38.7° C (101.7° F)Pulse 100/minRespiratory rate 18/minBlood pressure 110/60 mm Hg

Exhibit 3
Laboratory Results
0730:Sodium 132 mEq/L (136 to 145 mEq/L) Potassium 5.0 mEq/L (3.4 to 4.7 mEq/L) BUN 16 mg/dL (5 to 18 mg/dL) WBC count 13,000/mm3 (5,000 to 10,000/mm3) Hgb 9.5 g/dL (10 to 15.5 g/dL) Hct 30% (32% to 44%) Casual blood glucose 250 mg/dL (less than 200 mg/dL)

Exhibit 4
History and Physical
Type 1 diabetes mellitus

The nurse is reviewing the adolescent's electronic medical record (EMR). Which of the following findings requires immediate follow-up by the nurse?

A. Skin assessment
B. Temperature
C. Pulse
D, Blood pressure
E. WBC count
F. Abdominal assessment
G. Pain
H. Casual blood glucose
I. Potassium

Answer 1

The finding that requires immediate follow-up in the scenario presented is the adolescent's high casual blood glucose level of 250 mg/dL, which is a concern for a patient with Type 1 diabetes. Other findings such as high white blood cell count and the physical signs of infection also warrant attention.

Step-by-step explanation:

The adolescent's medical record in the emergency department shows several findings that require attention, but the finding that requires immediate follow-up by the nurse is the casual blood glucose level of 250 mg/dL. This value is significantly elevated, indicating poor glucose control, which can be particularly dangerous for an individual with Type 1 diabetes mellitus. As high blood glucose can lead to diabetic ketoacidosis, a potentially life-threatening condition, it's essential to address this abnormality promptly. Additionally, fever, redness, and pustules around the injury site also point to the possibility of infection, which can exacerbate diabetes-related complications.