A 91-year-old female complains of generalized weakness. She tells you that she is depressed because her husband died last month and she keeps forgetting to take her diabetes medication. Her skin is warm and dry. Her vital signs are P 98, R 16, BP 112/78, and SpO2 is 97% on room air. You should:

• A. Administer oxygen.
• B. Administer oral glucose.
• C. Transport her for an involuntary psychiatric evaluation.
• D. Assess her blood glucose level.

Answer: (A)

The key idea here is to determine glucose status before treating, because weakness in an elderly patient with diabetes could reflect hypoglycemia or hyperglycemia and requires different actions.

Her SpO2 is good and her vital signs are stable, so giving oxygen isn’t addressing the most likely issue. Warm, dry skin can point toward dehydration or hyperglycemia rather than hypoglycemia, which often presents with sweating and anxiousness. The safest, most informative next step is to obtain a quick capillary glucose level with a handheld glucometer. This single measurement will guide you: if the reading is low, you treat promptly with oral glucose if she can swallow (or use glucagon/IV dextrose per protocol if she cannot); if the reading is high or normal, you pursue other causes of weakness and arrange appropriate care.

In this scenario, administering oxygen would not fix the underlying problem given adequate oxygen saturation. Transport for psychiatric evaluation isn’t indicated without evidence of imminent danger or clear psychiatric crisis. The glucometer reading is the decisive step that lets you choose the correct treatment path based on her actual glucose status.