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Client reports feeling lethargic, weak, a lack of appetite, and being constipated for several days. Client has also noted an increase in urination. Client has not experienced nausea or vomiting. Lungs are clear bilaterally. S1 and S2 heard on heart auscultation. No murmurs noted. No jugular vein distention or pedal edema observed. Abdomen flat, nontender, bowel sounds heard in all four quadrants. Pupils are equal, round, reactive to light, and accommodating. No nystagmus noted. Negative Chvostek and Trousseau signs. Hyporeflexia noted in Achilles tendons bilaterally. Client pushes back weakly with resistance on legs and arms. Client is alert and oriented to time, place, person, and events. Skin warm, dry, and returns to place slowly when pinched. Oral mucous membranes dry. Vital signs: temperature, 98.2°F (36.8°C); heart rate, 88 beats/min; respiratory rate, 18 breaths/min; blood pressure, 148/74 mm Hg. Pulse oximetry, 96% on room air.
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