I'm Dizzy, Tired and Can't Remember What I Ate for Lunch

A 74-year-old white male presents to the ED with confusion, fatigue, dizziness, headache and distal right arm paresthesia. Experienced nurses, model your clinical judgement skills for students and newbies by posting some priority actions. Nurses General Nursing Case Study

Updated: Feb 23, 2023

This article was reviewed and fact-checked by our Editorial Team.

I'm Dizzy, Tired and Can't Remember What I Ate for Lunch

Chief Complaint

Headache, dizziness, right distal arm paresthesia 3-4 days, confusion, recent history of mental impairment along with bradyphrenia (mild cognitive impairment or slowed thinking and processing of information).

History of Present Illness

A few months before the ED visit, I spoke with him on the phone and he said, "I'm just so tired all the time. I can't even walk across the driveway to the barn without feeling exhausted.” He finally admitted that he had stopped taking medications for hypertension and hyperlipidemia during the COVID-19 pandemic. "I just quit. I didn't feel like taking them.”

A few days ago, he told his wife he was feeling dizzy and that something was "not quite right", but he refused to go to the ED. This evening, he asked to come to the ED after experiencing increased dizziness, headache, and numbness in his hand. His wife tells the ED nurse, "He's been having a hard time remembering things.”

General Appearance

Well-developed, well-nourished, resting comfortably, breathing comfortably on room air.

Past Medical History

Hypertension, hyperlipidemia, pre-diabetes, glaucoma with ocular implants, excess EtOH consumption (greater than 2 drinks/day for men)

Family History

Father died from colon cancer at the age of 80. Mother died of cervical cancer at age 63. No siblings. One biological daughter, age 53 with no health concerns. His step-son works in the hospital and stops by during the visit.

Social History

The patient has been married to his third wife for twenty-five years. He lives on a farm and has taught at a local college for many years. This last year he has been teaching from home. His hobbies include playing the banjo and gardening. They raise llamas, so he works in the barn and fields when he isn't teaching.

Patient drinks 2-3 alcoholic beverages daily and occasionally smokes marijuana (it is legal in his state).

Medications

lisinopril-HCTZ 20-12.5 mg daily, metoprolol 25 mg BID, COSOPT, XALATAN ophthalmic, atorvastatin 80 mg. Patient states he started taking all of his medications again about two months ago.

Allergies

NKA

Vital Signs

BP 208/97 sitting, RA
Pulse rate 63
HR 56
RR 19
T 98.8^oF
SpO2 98%
HT 5' 11"
WT 210 lbs
BMI 29.9

Dizziness, headache, confusion, fatigue – these are symptoms of SO MANY PROBLEMS – what else do you notice? What else would you like to know?

I've been working on preparing my students for the Next-Gen NCLEX, so I'm thinking a lot about clinical judgment and prioritization.

What's the first thing you need to do?

Is there anything emergent going on?

As the Nurse, what are your priority actions?

Since you can't post your guesses here, I'm hoping you Nurses out there will model your critical thinking by showing the students and newbies your thought process (thanks in advance!)

DISCLAIMER: These case studies are presented for learning purposes only and with full understanding that it is outside the scope of practice for a nurse to make a medical diagnosis. When participating, assume that a licensed healthcare provider is making the actual diagnosis, ordering all the tests and interpreting the results. You are looking at the case retrospectively to learn from the data presented – the idea is to increase your knowledge so you can sharpen your assessment and teaching skills.

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About SafetyNurse1968, ADN, BSN, MSN, PhD

Patient Safety Columnist / Educator

Dr. Kristi Miller, aka Safety Nurse is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is obsessed with patient safety. Please read her blog, Safety Rules! on allnurses.com.

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