NU140 Unit 8 Case Study Analysis Example

Nine Hundred Milliliters In, Five Hundred Out: A Case Study Analysis Working the Intake and Output Arithmetic for a Composite 74-Year-Old Man on Thickened Liquids After a Stroke, Then Ranking His Three Problems

[Student Name]

Purdue University Global

NU140: Nursing Fundamentals

Unit 8 Case Study Analysis

[Instructor Name]

[Date]

The patient is composite; volumes, weights and values are bracketed where illustrative, and fluid targets follow common teaching estimates that a provider would individualize.

The Case

[Mr. O.], a composite 74-year-old retired mail carrier, had a left-sided stroke five days ago. A swallowing evaluation found a delayed swallow, and he was placed on a soft diet with mildly thick liquids. He dislikes the thickened drinks and often leaves them. He weighs [70] kg, down from [72] on admission. Today his mouth is dry, his urine is dark, his heart rate is [98] and his blood pressure is [112/68], lower than his usual [138/80]. His serum sodium is [147] mmol/L and his blood urea nitrogen has risen. He coughs occasionally during meals. His last bowel movement was four days ago.

Working the Intake and Output

Over the last 24 hours his recorded intake was: thickened water and juice [480] mL, thickened coffee [180] mL, soup [240] mL, totaling [900] mL by mouth, with no IV fluids. His recorded output was urine [520] mL. Insensible losses through the skin and breath are not measured but are commonly estimated at roughly [500] to [800] mL a day in an adult.

Balance: [900] mL in minus [520] mL measured out leaves about [380] mL, which is less than his estimated insensible losses. His true balance is therefore negative, probably by several hundred milliliters a day, which fits his two-kilogram weight loss over five days.

Estimated need: a common teaching estimate for maintenance fluid in an older adult is about [25] to [30] mL per kilogram per day. At [70] kg that is roughly [1,750] to [2,100] mL a day. He is taking in less than half of that.

Urine output: [520] mL over 24 hours is about [22] mL an hour, or [0.3] mL per kilogram per hour, short of the minimum most texts teach, which at his weight works out to [35] mL an hour.

Every number points the same way: he is drinking less than half of what he needs, and his kidneys are conserving what little he takes in.

Interpreting the Signs

Dry mouth, dark concentrated urine, a faster heart rate, a lower blood pressure than usual, a rising sodium and weight loss together indicate a fluid volume deficit. Older adults with swallowing problems are at particular risk, because thickened drinks are less appealing, thirst is blunted with age, and they may limit drinking to avoid coughing; studies of older adults with oropharyngeal dysphagia have found dehydration to be common (Leibovitz et al., 2007). His four days without a bowel movement are partly explained by low fluid, low fiber in a soft diet and reduced mobility after the stroke.

Ranking the Three Problems

1. Risk for aspiration. He has a delayed swallow and coughs during meals. Aspiration can cause pneumonia, a leading complication after stroke, and can become life-threatening quickly. It ranks first because it threatens his airway and breathing.

2. Deficient fluid volume. The arithmetic and signs show an established deficit. It ranks second: it is already present and worsening, and it can lead to kidney injury and confusion, but it develops over days rather than minutes and can be corrected.

3. Constipation. Four days without a bowel movement causes discomfort and can worsen appetite, but it is the least immediately dangerous, and correcting his fluid intake will help it.

The ranking follows the common order of airway and breathing first, then circulation and fluid, then other needs (Potter et al., 2023). The problems are linked: his fear of coughing reduces his drinking, which worsens both his fluid deficit and his constipation.

Planned Actions

For aspiration risk: upright positioning for meals and thirty minutes after, small sips, the swallowing techniques the therapist recommended, and oral care before meals. For fluid volume: offering thickened fluids every hour while awake, trying flavors and temperatures he prefers, asking the speech therapist about a free water protocol if appropriate, recording every intake, and weighing him daily; if intake cannot rise, the provider is contacted about IV or other fluids. For constipation: increasing fluid as above, a fiber-containing soft diet if allowed, assisted walking, and a bowel regimen as prescribed.

Mr. O.'s own preferences are part of the plan: he says he would drink more if the thickened drinks were cold and if he could have his usual afternoon coffee, so both are added to his tray schedule, and his daughter is asked to bring the flavor of juice he likes.

Evaluation Plan

Over the next 48 hours, success would look like [1,500] mL or more taken each day, urine output above [35] mL an hour, a pale urine color, stable weight, no coughing during meals and a bowel movement. Using standard diagnoses keeps the plan clear for the whole team (Herdman et al., 2024).

References

Herdman, T. H., Kamitsuru, S., & Takáo Lopes, C. (Eds.). (2024). NANDA International nursing diagnoses: Definitions and classification, 2024-2026 (13th ed.). Thieme.

Leibovitz, A., Baumoehl, Y., Lubart, E., Yaina, A., Platinovitz, N., & Segal, R. (2007). Dehydration among long-term care elderly patients with oropharyngeal dysphagia. Gerontology, 53(4), 179-183. https://doi.org/10.1159/000099144

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.