Case Study: Electrolyte Imbalance and Fluid Overload from Acute Renal Failure
Insufficiency
Alfredo Hernandez is a 38-year-old male who lives in southern Texas. He and his family migrated
to the US from Guatemala a few years ago and live together in a small house. His primary
language is Spanish, but he has acquired the ability to understand and speak some English in
this three years here. Like his mother, father, sisters, and cousins, he has Type II diabetes. His
diabetes is poorly controlled, and now he is insulin dependent. He has hypertension, decreased
vision, and his feet are often “cold and numb”. His family brings him to the community hospital
today because he is having a hard time breathing.
1. What should be the nurse’s first action after placing Alfredo in a hospital gown?
1. Obtain a glucose monitor reading.
2. Assess the blood pressure.
3. Take an oxygen saturation reading.
4. Place Alfredo on an EKG monitor.
Nursing Flow Sheet Provider Lab & MAR Collaborative Care
Diagnostic
Name: Alfredo Hernandez Age: 38
Health Care Provider: L Perez, PA Allergies: NKDA
Code Status: Full Code
Triage Assessment
Dec 3 1600 Temp 92.7, HR 110, BP 122/75, RR 24, Oxygen Saturation 91% room air, blood
glucose monitor reading is 240 g/dl. Alert and orientated x 3; lungs with bilateral
fine crackles ½ way up the lung fields, moist cough, respirations labored; bowel
sounds active; denies pain; States “Me cuesta mucho repirar.” He has 3+ pitting
edema and 1+ dorsalis pedis pulses, bilaterally.
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https://www.coursehero.com/file/83119722/Case-Study-Case-Study-Electrolyte-Imbalance-and-Fluid-Overload-from-Acute-Renal-Failure-Insufficienc/
, 2. Reflect on Alfredo’s assessment findings and identify the TOP 3 Priority assessment
concerns that indicate fluid volume excess.
1. Moist cough
2. Fine bilateral crackles ½ up the lung fields
3. 3+ pitting edema
3. What should be the nurse’s first priority action?
1. Obtain an order for insulin.
2. Raise the head of the bed.
3. Place oxygen at 2L/nasal cannula.
4. Obtain a translator.
Nursing Flow Sheet Provider Lab & MAR Collaborative Care
Diagnostic
Name: Alfredo Hernandez Age: 38
Health Care Provider: L Perez, PA Allergies: NKDA
Code Status: Full Code
Health Care Provider Prescriptions
Dec 3 1700 1. Chest X-ray
2. O2 Titrated to keep saturation > 94%
3. Furosemide 40 mg IV times 1 now
4. Peripheral IV
5. Complete Blood Count, Comprehensive Metabolic Panel
4. Number the prescriptions in order of the priority in which the nurse should complete them.
1. Request a chest x-ray and lab draw.-----4
2. Place O2 at 2L/nasal cannula.----1
3. Deliver furosemide 40 mg IV dose.----3
4. Place IV line.----2
5. The nurse reassesses the oxygen saturation reading after 15 minutes, and it is 94%. What
should he nurse do next?
1. Nothing, this is acceptable.
2. Notify the HCP.
3. Increase the O2 to 3L/nasal cannula.
4. Place Alfredo on a simple mask.
This study source was downloaded by 100000820177218 from CourseHero.com on 09-05-2023 00:34:03 GMT -05:00
https://www.coursehero.com/file/83119722/Case-Study-Case-Study-Electrolyte-Imbalance-and-Fluid-Overload-from-Acute-Renal-Failure-Insufficienc/
Insufficiency
Alfredo Hernandez is a 38-year-old male who lives in southern Texas. He and his family migrated
to the US from Guatemala a few years ago and live together in a small house. His primary
language is Spanish, but he has acquired the ability to understand and speak some English in
this three years here. Like his mother, father, sisters, and cousins, he has Type II diabetes. His
diabetes is poorly controlled, and now he is insulin dependent. He has hypertension, decreased
vision, and his feet are often “cold and numb”. His family brings him to the community hospital
today because he is having a hard time breathing.
1. What should be the nurse’s first action after placing Alfredo in a hospital gown?
1. Obtain a glucose monitor reading.
2. Assess the blood pressure.
3. Take an oxygen saturation reading.
4. Place Alfredo on an EKG monitor.
Nursing Flow Sheet Provider Lab & MAR Collaborative Care
Diagnostic
Name: Alfredo Hernandez Age: 38
Health Care Provider: L Perez, PA Allergies: NKDA
Code Status: Full Code
Triage Assessment
Dec 3 1600 Temp 92.7, HR 110, BP 122/75, RR 24, Oxygen Saturation 91% room air, blood
glucose monitor reading is 240 g/dl. Alert and orientated x 3; lungs with bilateral
fine crackles ½ way up the lung fields, moist cough, respirations labored; bowel
sounds active; denies pain; States “Me cuesta mucho repirar.” He has 3+ pitting
edema and 1+ dorsalis pedis pulses, bilaterally.
This study source was downloaded by 100000820177218 from CourseHero.com on 09-05-2023 00:34:03 GMT -05:00
https://www.coursehero.com/file/83119722/Case-Study-Case-Study-Electrolyte-Imbalance-and-Fluid-Overload-from-Acute-Renal-Failure-Insufficienc/
, 2. Reflect on Alfredo’s assessment findings and identify the TOP 3 Priority assessment
concerns that indicate fluid volume excess.
1. Moist cough
2. Fine bilateral crackles ½ up the lung fields
3. 3+ pitting edema
3. What should be the nurse’s first priority action?
1. Obtain an order for insulin.
2. Raise the head of the bed.
3. Place oxygen at 2L/nasal cannula.
4. Obtain a translator.
Nursing Flow Sheet Provider Lab & MAR Collaborative Care
Diagnostic
Name: Alfredo Hernandez Age: 38
Health Care Provider: L Perez, PA Allergies: NKDA
Code Status: Full Code
Health Care Provider Prescriptions
Dec 3 1700 1. Chest X-ray
2. O2 Titrated to keep saturation > 94%
3. Furosemide 40 mg IV times 1 now
4. Peripheral IV
5. Complete Blood Count, Comprehensive Metabolic Panel
4. Number the prescriptions in order of the priority in which the nurse should complete them.
1. Request a chest x-ray and lab draw.-----4
2. Place O2 at 2L/nasal cannula.----1
3. Deliver furosemide 40 mg IV dose.----3
4. Place IV line.----2
5. The nurse reassesses the oxygen saturation reading after 15 minutes, and it is 94%. What
should he nurse do next?
1. Nothing, this is acceptable.
2. Notify the HCP.
3. Increase the O2 to 3L/nasal cannula.
4. Place Alfredo on a simple mask.
This study source was downloaded by 100000820177218 from CourseHero.com on 09-05-2023 00:34:03 GMT -05:00
https://www.coursehero.com/file/83119722/Case-Study-Case-Study-Electrolyte-Imbalance-and-Fluid-Overload-from-Acute-Renal-Failure-Insufficienc/
