NU140CL Unit 5 Care Plan Example

Fifteen Hundred Milliliters and a Thirsty Man: A Clinical Care Plan for Fluid Overload in a Composite 80-Year-Old With Heart Failure Who Resents His Fluid Restriction, Built From an Incomplete Chart and Revised After He Spoke Up

[Student Name]

Purdue University Global

NU140CL: Nursing Fundamentals Clinical

Unit 5 Care Plan

[Instructor Name]

[Date]

The patient is composite; values are bracketed where illustrative, and medical orders are the provider's.

The Assignment and What Was Missing

Patient D, a composite 80-year-old retired machinist, came in two days ago when his heart failure worsened. His orders include a [1,500] mL daily fluid restriction, a 2-gram sodium diet, an IV diuretic twice daily, daily weights and strict intake and output. When I prepared, the chart had no home dry weight, and the admission weight had been taken in a chair scale with his shoes on. I asked his nurse, who called his cardiology clinic; his usual weight there was [81] kg.

Assessment Cues

Subjective: "I'm so thirsty I can't think. You people are torturing me with this water rule." Short of breath when lying flat; sleeps on three pillows. Swollen ankles.

Objective: weight this morning [84.1] kg, about [3] kg above his clinic weight; crackles at both lung bases; pitting edema [2+] to mid-shin; oxygen saturation [92] percent on room air; respirations [22]; intake yesterday [1,850] mL against the [1,500] mL limit; urine output [2,400] mL after diuretic. Dry lips and tongue.

Nursing Diagnoses

Primary: Excess fluid volume related to reduced pumping ability of the heart and sodium and water retention, as evidenced by weight gain, crackles, edema and breathlessness lying flat.

Related: Discomfort related to thirst during fluid restriction, as evidenced by his report of intense thirst and dry mouth (Herdman et al., 2024).

His anger about the water rule was not noncompliance to be corrected; it was a symptom, thirst, that the plan had not yet addressed.

Outcomes

Within 48 hours: weight decreases by at least [1] kg; crackles reduced; able to sleep on two pillows; intake within [1,500] mL. Within 24 hours: reports thirst at a level he can tolerate, using his own words.

Interventions and Rationales

1. Weigh at the same time each morning, after voiding, on the same standing scale, without shoes. Rationale: consistent technique makes daily change meaningful; the admission weight was not comparable.

2. Record every intake, including ice chips at half their volume, and all output. Rationale: accurate totals show whether diuresis is working.

3. Give the diuretic as ordered and monitor potassium and blood pressure. Rationale: diuretics remove fluid but can lower potassium and pressure.

4. Keep him sitting well up, with oxygen on hand as ordered. Rationale: sitting up reduces breathlessness from fluid in the lungs.

5. Spread the fluid allowance across the day with him, writing a schedule he chose. Rationale: involving him in planning increases his control and adherence.

6. Offer thirst relief that adds little fluid: frequent mouth care, sugar-free gum or hard candy, cold water in small cups, lip balm. Rationale: thirst is a common, distressing symptom in heart failure, and simple measures can ease it (Waldréus et al., 2013).

7. Explain why the limit exists, in his terms, and ask what matters most to him. Rationale: understanding the reason supports cooperation better than rules alone (Potter et al., 2023).

What Changed After He Spoke Up

When I asked what bothered him most, he said it was the morning, after diuretics, with breakfast coffee counted against him. With his nurse's agreement we moved most of his allowance to morning and early afternoon, kept a small cup of coffee at breakfast inside the limit, and added mouth care before meals. He laughed for the first time when I brought the gum. His nurse and I added the schedule to the plan of care so the night shift would follow it too, since a change that lives only in one student's notes disappears at shift change.

Teaching Before Discharge

Because the restriction will continue at home, teaching begins before discharge rather than on the last morning. He practices weighing himself first thing each day, after voiding and before eating, on the same scale, and to write the number on a calendar. He should phone the clinic for a gain of roughly [1] kg overnight or [2] kg across seven days, or if he needs more pillows to breathe at night. His wife, who does the cooking, is included in a short talk about salt in canned soup and bread, two foods he mentioned eating every day. He chooses a marked water bottle as his way of tracking fluid at home, since counting cups felt like "doing homework."

Evaluation

After 48 hours his weight was [82.6] kg, crackles were heard only at the right base, and he slept on two pillows. His intake stayed at or below [1,500] mL both days. He rated his thirst "bad but not crazy" and said the schedule helped. The plan continues, with teaching about daily weights at home added before discharge.

References

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

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

Waldréus, N., Hahn, R. G., & Jaarsma, T. (2013). Thirst in heart failure: A systematic literature review. European Journal of Heart Failure, 15(2), 141-149. https://doi.org/10.1093/eurjhf/hfs174