This nursing case study is about fluid overload on patient having  Congestive heart disease and decreased renal function. There are 2 documents. The first one is about the topic and the requirements

Scenario 2: Mr Clive Jenkins Progress Notes Yesterday 1830 New patient admitted to department via GP referral for clinical investigation after not taking cardiac medications for 3 days. Awaiting cardiology review. Obs as charted. Commenced on IV fluids and now Nil by mouth due to anticipated Trans -oesophageal Echo (TOE). Signed: R Jones. Registered Nurse. Yesterday 23 00 Thank you for your referral to Mr Jenkins. Unfortunately, it appears he has not taken his cardiac medication for the last few day s. This has been recharted with the addition of Furosemide for the next 48 hours until the oedema subsides and increase in Ramipril. ECG shows sinus tachycardia with no new evident ischaemic changes. Therefore, will not proceed with trans-oesophageal ech o at this time - can recommence diet/oral fluids. Will review tomorrow afternoon. Signed: Dr. T Smith. Cardiologist Today 0600 Patient awake most of night as uncomfortable and confused. Easy to orientate and compliant with instructions. Fluid balance chart commenced, trending positive balance. All other assessments as charted. For transfer to ward once bed is available . Passing good amounts of urine at this stage. Diuretic Signed: W Fielding. Registered Nurse Scenario 2: Mr Clive Jenkins GP LETTER Dr Jones 49 Bligh S treet New town 6525 6594 Date: Yesterday RE: Mr Clive Jenkins. DOB 5/3/1940 To whom it may concern, Mr Jenkins has been a patient at my rooms for several years. His main past history includes Myocardial infarction in 2016, Congestive Cardiac Failure and most recently a diagnosis for early stage Dementia. He lives alone. He has been regularly taking Ramipril 2.5mg, Spiro nolactone 25mg which seems to manage his symptoms well, but he ha s displayed a tendency to not renew his scripts in a timely fashion once the previous scripts are exhausted. This has led to previous admissions in the past and I suspect it is the same issue this time evidenced by his current cardiac picture and his weig ht gain. From what I can gather during my appointment with him today, he has not taken his cardiac medication for three days. I have prescribed Amoxycillin to treat his evident cellulitis .

Whilst I have been in communication with Mr Jenkin’s cardiologis t, I understand Mr Jenkins has not attended his recent appointments. If you required any further information, please do not hesitate to contact my rooms. Kind regards, Signed Dr Jones