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Hypertensive

Nephrosclerosis

Iglesias. Padilla.Group Presenters Casareno. . Rechelda Louise S. Rael Christian C. Reysanne P. Ladielee C. Cayabyab.

Overview Hypertensive Nephrosclerosis is a medical condition referring to damage to the kidney due to chronic high blood pressure. The rate of ESRD attributed to hypertension has grown 8. hypertensive nephrosclerosis (HN) accounted for 28% of patients reaching end-stage renal disease (ESRD). in the year 2009. Hypertensive nephrosclerosis is reportedly the second most common cause of ESRD.  According to the 2011 US Renal Data System (USRDS) data.7% since the year 2000. .

and progressive renal insufficiency. left ventricular hypertrophy. minimal proteinuria. .The term hypertensive nephrosclerosis has traditionally been used to describe a clinical syndrome characterized by long-term essential hypertension. hypertensive retinopathy. Most cases are diagnosed based solely on clinical findings.

Case of Patient “X” .

Patient Profile  Age: 34  Gender: Female  Home Address: Binmaley. both males)  Occupation – Housewife (former Office Clerk in Makati City for 7 years) . of Children: 2 (9 years old and 7 years old. Pangasinan  Civil Status: Single  No.

but no known allergies to any drugs/medications.  The patient constantly experienced easy fatigability and blurring of vision.  The patient declared allergies of chicken and poultry products.  The patient has no previous surgical operations.Medical Profile and History  The patient has no known familial history of hypertension. . diabetes and any renal diseases.  She then sought medical attention in an infirmary unit and discovered that she has elevated blood pressure with systolic pressure around 200 mmHg.

The patient went to Region 1 Medical Center in Dagupan City. She was referred to a Kidney Disease Specialist. she went to a medical practitioner to have her BP checked and found out that she is still having an elevation of BP. . The practitioner advised that she has to consult a specialist. she still experienced blurring of vision with dizziness.Her physician gave her an emergency antihypertensive drug to control her elevated BP and advised to stay for observation but she refused and decided to go home. The next day.

2015.They checked her kidney profile and detected that she had an elevated creatinine with a result of 3000 µmol/L. . they surgically placed an AV fistula in her right upper arm. she is now having her treatment in the MJVR Dialysis Center. and after 3 weeks. The specialist advised her that she has to undergo an Emergency Hemodialysis on October 1. They inserted an intrajugular catheter. 2011. 2 times a week since July 27. Presently.

Pathophysiology HYPERTENSIVE NEPHROSCLEROSIS LIFESTYLE (MODIFIABLE) Genetics (Non-Modifiable) Chronic Hypertension Thickening(Stenosis) of Glomerular Vein and Arteries é BP (Compensatory Mechanism) of Pre-Glomerular Veins and Arteries ê Glomerular Filtration Uremic Symptoms .

Drug Study .

5 -7. 2015 .1   URR   79%       Hemoglobin   97   120 – 150   Hematocrit   30   37 .350 *Taken on August 10.6   2.1   Post BUN   5.Laboratory Results TEST RESULT NORMAL VALUE   Pre BUN   27.5 -7.47   Platelet   221   150 .9   2.

! .! nephron!hyperthrophized! leading!to!decrease!ability!of!the! kidney!to!concentrate!urine!and! impaired!excretion!of!fluid.! expansion! ! ! >!Encouraged! >To!promote!lung! deep!breathing! expansion.!the! client!manifested!lessened' difficulty'of'breathing!as! manifested!by!decreased' in'RR'from'27'to'20!with! the!absence'of'nasal' flaring!and!presence'of' calm'breathing.! INTERVENTION' RATIONALE' ! ! Independent:' ! >!Elevated!the! >To!promote!lung! head!of!chair.! ! ! ! Dependent:' Dependent:! >!Gave! >!Gave!supplemental! supplemental! oxygen!as!ordered!! oxygen!as!ordered!! ! ! EVALUATION' ! >After!30!minutes!of! nursing!intervention.!With! fluid!volume!excess!hydrostatic! pressure!is!higher!than!the!usual! pushing!of!excess!fluids!into!the! interstitial!spaces.!fluid!volume!overloads!the! lymph!system!and!stays!in!the! interstitial!spaces!leading!the! patient!to!have!pulmonary! congestion!and!HPN!at!the!same! time!due!to!decreased!GFR.!the! client!will!experience! lessen!difficulty!of! breathing!as! manifested!by! decrease!in!RR!from! 27!to!20!with!the! absence!of!nasal! flaring!and!presence! of!calm!breathing.! SCIENTIFIC'EXPLANATION' PLANNING' ! Renal!disorder!impairs! glomerular!filtration!that! resulted!to!fluid!overload.! exercised.!Since!fluids!are! not!reabsorbed!at!the!venous! end.! ! ! Short'Term:' >AFTER!30!minutes! of!nursing! intervention.5! PR:!80! RR:'27' BP:!150/ 100! ! NURSING' DIAGNOSIS' ! Fluid!Volume! Excess!R/ T! decreased! Glomerular! filtration!Rate! and!sodium! retention.Nursing Care Plan ASSESSMENT' ' Subjective:' “Nahihirapan!akong! huminga”!as!claimed!by! the!client.! ! >GOAL'MET.! ! Objective:' >Nasal!flaring! >Rapid!shallow! breathing! >Use!of!accessory! muscle! >!Rales!upon! auscultation! ! V/S:' Temp:!36.

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