A 52-year-old patient is admitted to the hospital with symptoms of confusion, headache, and muscle cramps. Laboratory tests reveal the following findings: serum sodium 120 mEq/L, serum osmolality 260 mOsm/kg, urine osmolality 500 mOsm/kg, and urine sodium 40 mEq/L. What is the most likely diagnosis based on these laboratory findings?

Choice A Reason:

Implementing strict hand hygiene protocols is the most critical intervention to prevent infection in patients with acute lymphoblastic leukemia (ALL). Patients with ALL are highly susceptible to infections due to their compromised immune systems, which result from both the disease and the chemotherapy treatment. Hand hygiene is a fundamental practice in infection control, significantly reducing the transmission of pathogens. Ensuring that all healthcare providers, patients, and visitors adhere to strict hand hygiene protocols can greatly minimize the risk of infections.

Choice B Reason:

Administering prophylactic antibiotics regularly can help prevent infections, but it is not the most critical intervention. Overuse of antibiotics can lead to antibiotic resistance and other complications. While antibiotics are important in managing infections, they should be used judiciously and in conjunction with other infection control measures, such as hand hygiene.

Choice C Reason:

Encouraging the patient to eat a high-protein diet is beneficial for overall health and recovery, but it does not directly prevent infections. A high-protein diet can help maintain muscle mass and support the immune system, but it is not a primary infection control measure.

Choice D Reason:

Limiting the patient’s fluid intake is not relevant to preventing infections in patients with ALL. Adequate hydration is important for overall health and helps in the management of side effects from chemotherapy. Fluid restriction is not a standard intervention for infection prevention in this context.

Choice A: Optic Neuritis

Optic neuritis is an inflammation of the optic nerve that can cause pain and vision loss. The pain typically worsens with eye movement, and vision loss usually occurs in one eye. Symptoms include temporary vision loss, visual field loss, loss of color vision, and flashing lights. However, optic neuritis does not typically cause nausea or seeing halos around lights, and the pupil reaction to light is usually preserved.

Choice B: Macular Degeneration

Macular degeneration primarily affects central vision and is more common in older adults. It can cause blurred or reduced central vision, difficulty recognizing faces, and visual distortions such as straight lines appearing bent. However, it does not cause sudden onset eye pain, nausea, or seeing halos around lights. The pupil reaction to light remains normal in macular degeneration.

Choice C: Narrow Angle Glaucoma

Narrow angle glaucoma, also known as acute angle-closure glaucoma, is a medical emergency characterized by a sudden increase in intraocular pressure. Symptoms include severe eye pain, nausea, vomiting, seeing halos around lights, and a mid-dilated, non-reactive pupil. This condition occurs when the drainage angle between the iris and cornea becomes blocked, leading to a rapid rise in eye pressure. Immediate treatment is necessary to prevent permanent vision loss.

Choice D: Cataract

Cataracts cause clouding of the lens, leading to symptoms such as blurred vision, difficulty seeing at night, sensitivity to light, and seeing halos around lights. However, cataracts develop gradually and do not cause sudden onset eye pain or nausea. The pupil reaction to light is also typically normal in cataract patients.