Excess Fluid Problem: Medical Case Study of Mr P

• Decreased SOB, decreased crackles in the bases of the lungs, and possibly decreased O2

M.G., a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last

Implement measures to improve cardiac output: perform actions to reduce cardiac workload: place client in a semi- to high Fowler's position, instruct client to avoid activities that create a Valsalva response, implement measures to promote emotional and physical rest, implement measures to improve respiratory status, discourage smoking, provide small meals rather than large ones,

* Physical exercise was recommended as well. Previous research has proven that physical exercise and good diet can efficiently control the patient blood pressure.

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

The patient is 72 year old female who smokes. She complains of extreme fluid retention in lower two limbs and lower abdomen. Breathing is difficult and she is only able to sleep while sitting erect in a reclining chair.

Mr. Paul is a big fan of soccer. Although he consider himself active, he would really appreciate some more free time to do his favorite activities. He admits to a diet high in fat, he doesn't consume a lot of fast food, but do frequent Jamaican restaurant a lot. Right now, he wants to eat healthier and plans to cook healthier meals at home. Mr. Paul weight is in the normal range for his height. During his last check up visit few months ago, he reported that his blood pressure was relatively high, around 140/90, but after intensive regular at the gym, and a lighter diet, his blood pressure quickly returns to the normal range. His goal now is to keep up with the exercises. He has no known allergies, does not smoke or use illicit drugs, and drinks around 3 alcoholic drinks every other

The R.S. laboratory results show the patient is suffering from respiratory acidosis with a metabolic compensation. The PH is decreased from the normal 7.4, his PaCO2 is elevated from the normal range of 34-45 mm Hg, and his O2 is elevated from the normal range of 24-30 mm Hg. his elevated PaO2 indicates that he has a metabolic compensation. The body does not like to be in acidosis therefore it will start to correct the problem through compensating by promoting the kidneys to produce more metabolic acid to help restore the balance.

F.T. is a 70-year-old African American man who comes to the emergency department complaining of increased shortness of breath. He states that he started using his albuterol inhaler every 4 hours a few days ago, but does not seem to be helping. He has been having trouble sleeping and basic activities due to his shortness of breath.

The most serious health problem that the client has is impaired gas exchange. According to Sue Galanes (2007), impaired gas exchange is result from the balance between ventilation and perfusion is offset by a certain condition which affects the efficiency of the gas exchange. On account of client has congestive heart failure that can contribute to dyspnea, which means the efficiency of gas exchange is decreased. One of the significant defining characteristics of impaired gas exchange is dyspnea (Sabtu, 03 Agustus 2013). In addition, it was hard for the patient to talk in long sentence due to difficulty in breathing. Hence, impaired gas exchange is one of the health problems that the client suffered from. In regards of O2 is the basic element that all of cells and organs need, it can be considered as a fuel of human body. Therefore, impaired gas exchange is the most severe health problem the patient has currently.

The third question asks if patients pay attention to sodium and fluid intake. Patients who are noncompliant with the dietary recommendation can be closely related to worsening heart failure symptoms or hospitalization. The excess of sodium intake may contribute to fluid retention (Heo, Lennie, Moser & Okoli, 2009). The video recommends the daily dose and encourages patients to read labels. One suggestion is simple the use of a quick and easy acronym: S.A.L.T., which stands for Stay away from processed food, Avoid adding salt to foods, Look at sodium levels and Try to eat a balanced diet (Mahtani,

Dehydration should be corrected beginning with a 0.9% sodium chloride solution which will also help with deficits in body sodium. Maintenance needs calculated at 60mL/kg/day, as well as replacement fluids for ongoing losses and replenishment of fluids already lost should be figured up and started. As dehydration is corrected potassium levels will decrease rapidly so supplementation of potassium chloride, added to fluids is necessary, not to exceed 0.5mEq/kg/Hr, rechecking levels every 6-8 hours and adjusting supplement level accordingly. Phosphorous levels may also plummet after fluid therapy is started. Adding potassium phosphorous to fluids as a CRI of 0.01-0.03 mmol/kg/Hr. Recheck levels every 6-8 hours and adjust as needed. Hypomagnesium shouldn't become an issue if using 0.9% sodium chloride

First the doctor would focus on lowering George's blood pressure as this is a stress on the kidneys.

Consider a fluid restriction to prevent possible fluid overloading due to his decreased renal function (Vera, 2011).

Mr. Armstrong has a history of renal insufficiency and uncontrolled hypertension, along with symptoms of fatigue, pedal edema, and occasional shortness of breath. He does not have a history of trauma or obstruction to his kidneys, but his creatinine and BUN levels are currently at 3.5 mg/dl and 40 mg/dl. Normal creatinine concentration values are 0.7 to 1.2 mg/dl and normal BUN values are 10 to 20 mg/dl; this reveals that Mr. Armstrong’s kidneys are not removing wastes properly (McCance, Huether, Brashers, & Rote, 2014).  Mr. Armstrong’s history of renal insufficiency and uncontrolled hypertension is commonly found in patients diagnosed with intrarenal (intrinsic) acute renal failure. Intrarenal acute renal failure can be categorized as