A 72-yeаr-оld femаle with а histоry оf chronic kidney disease stage 4 and heart failure is admitted for worsening lower-extremity edema and shortness of breath. On assessment, the nurse notes 4+ pitting edema to both ankles and crackles in the lung bases. The patient reports fatigue but denies chest pain. Morning laboratory results reveal: Hemoglobin: 12.1 g/dL (normal 4–18 g/dL). Serum albumin: 2.1 g/dL (normal 3.5–5.0 g/dL), BUN: 48 mg/dL (normal 10–20 mg/dL (3.6–7.1 mmol/L). Creatinine: 3.2 mg/dL (normal 0.6–1.3 mg/dL (53–106 mmol/L) Vital signs: BP 146/88, HR 92, RR 22, SpO₂ 93% on room air