PLease follow grading rubric -attachedA 68-year old Caucasian male with PMH of HTN, DMII, and CAD who was brought in by EMS after his wife found him unresponsive. She states that he has been progressively agitated, confused and lethargic over the past four days and he has not been eating or drinking.He takes Metformin, Lisinopril, Atenolol, and ASA daily and is compliant.He lives with his wife and is a postal carrier. He does not drink, smoke, or engage in illicit drug use.ROS: Wife endorses that he has been sick for about a week and states he has had recent fever and chills, weight loss of about 10 pounds, non-productive cough, and urinary frequency. All other ROS noncontributory.Physical Exam: T38.2 BP 92/60 HR 115 RR 20 91%RAGEN: Somnolent, groaning. Does not answer to voice and is not following commands.HEENT: mucous membranes dryNECK: Supple, No lymphadenopathyCV: Tachycardia, regular, no m/r/g.LUNGS: Clear to auscultation bilaterallyABD: soft, nontender, nondistended, bowel sounds positive, no hepatosplenomegalyEXT: no edemaNEURO: PERRL, moves all extremities, DTRs 2+ and symmetric.SKIN: decreased turgor, no rash.Pertinent labs:WBC 12.6, HCT 46.9, PLT 294NA 144, K+ 4.6, CL 112, HCO3 22, BUN 44, CR 2.6, GLU 1346ABG: 7.39/40/80/20OSM: 334U/A: +glucose, trace protein, trace ketonesCXR: No acute cardiopulmonary disease.EKG: Normal sinus rhythm, no acute findings. No comparison available.Then answer the following questions:What are your top three differential diagnoses, prioritized by likelihood?What is your final Diagnosis and why?What is your management plan?What treatment parameters will you utilize regarding electrolytes.What strategies will you use to promote healthy Provider-Patient and Provider-Family relationships?
