Review the case study below and answer the 3 related questions following: George, Regina; 62YO Female MRN: 884532675 Date: 01/17/23, 1845 SITUATION: 62-year-old female presents to ED today wit

Review the case study below and answer the 3 related questions following:
George, Regina; 62YO Female
MRN: 884532675
Date: 01/17/23, 1845
SITUATION:
62-year-old female presents to ED today with increased fatigue and weakness, confusion (per husband), and hand tremors. Patient has complaits of humbness/tingling in hands/feet, dizziness, and decreased appetite.
BACKGROUND:
Patient was brought in by husband who noticed unusual confusion and hands twitching. Husband stated “maybe she has a bladder infection, so I brought her in.” She has a history of ETOH abuse with mild liver cirrhosis. Prior labs drawn on 11/15/22. She did state that her an her husband enjoy going to dinner and having “a few drinks.” Patient is also known to be noncompliant with medications.
Allergies: NSAIDS, penicillin, bee stings
Medical Hx: ETOH abuse, mild cirrhosis of liver, chronic pancreatitis, Vit. D deficiency, CKD, peripheral neuropathy, CHF, type 2 DM, HTN.
Home medications: 100mg gabapentin BID, multivitamin daily, 250mg metformin BID, 10u Lantus at HS, 25mg HCTZ daily, 10mg lisinopril daily, Vit. B12 injection monthly (last dose on 01/01/23)
Medications due today: 100mg gabapentin, 250mg metformin, 10u lantus
ASSESSMENT:
Neuro- patient is normally alert and oriented to person, place, and time; but husband noted some unusual confusion this morning along with bilateral hand/finger twitching, which continues to present in ED. Hand grasps are strong and equal. Able to follow directions. Patient has noticeable fatigue and gets short of breath while walking a few steps. Airway. patent, patient able to maintain breathing on her own. Lungs are clear bilaterally. No cough or congestion noted. Skin- pink, warm, dry. +1 Bilateraly lower extremity edema. GU- urine dark amber with some foul odor. + Trousseau’s and Chvostek’s signs. Current blood sugar is 239. +1 equal radial/pedal pulses. Vital signs in ED: apical pulse 128 and irregular, respirations 22, SPO2 90%RA, BP 92/56, afebrile oral temp 98F. Patient denies pain at this time. Negative Covid test.
Labs Range 11/15/22 Today
Na+ 135-145 138 138
K+ 3.5-5.0 4.7 3.6
Cl- 98-106 100 99
Ca+ 8.4-10.5 8.4 6.7 (L)
Mg 1.5-2.5 1.6 1.5
Vit.D >50nmol/L 40 (L) 32 (L)
Hct 36-48% 36 36
Hgb 11.6-15 11 (L) 11.2 (L)
RBC 3.8-5.1 3.9 3.7 (L)
Platelets 140-150 145 142
Albumin 3.4-5.4 3 (L) 2.8 (L)
BUN 6-24 5 (L) 5.1 (L)
Creatinine 0.59-1.04 0.6 0.62
Bilirubin 0.1-1.2 1.5 (H) 1.6 (H)
GGT 5-40 47 (H) 48 (H)

REPORT/RECOMMENDATIONS
1. What is the medical diagnosis/underlying cause for the bilateral hand twitching and +Trousseau’s and Chvostek’s signs?
2. What is the first issue you would deal with?
3. What education would you provide to this patient (and her husband)?