A 45-year-old client presents to the outpatient clinic reporting worsening numbness and tingling of both hands with a 2-day history of dysuria and polyuria.

A 45-year-old client presents to the outpatient clinic reporting worsening numbness and tingling of both hands with a 2-day history of dysuria and polyuria. The client has worked the last 16 years as a secretary and has a history of asthma, obesity, hypothyroidism, and hypertension. The client also reports chronic fatigue and feels stressed and overworked. The client is alert and oriented, and neurologic exam is negative. Vital signs are temperature 98.6oF (37oC), heart rate of 78 beats per minute, respiratory rate of 18 breaths per minute, blood pressure of 144/86, and pulse oximetry reading of 96%.