Case of patient with ESRD

A 47-year-old female patient was admitted due to reported chest pain and shortness of breath.
Upon assessment, she is lethargic, feels very weak, and replies to repeated questions slowly. BP
– 240/130 mm Hg, HR – 94 bpm. She is 68 inches tall and weighs 163 lbs. There is jugular venous
distention (10 cm) during neck examination; notable heart auscultation for S3 and S4; there are
crackles in the mid-lung fields. Abdominal assessment does not show organomegaly or renal
bruit. There is pitting edema (grade +2) in both lower extremities.
The patient had a history of DM, uncontrolled hypertension (for 20 years) and was diagnosed of
ESRD secondary to hypertension. She has no history of tobacco, alcohol or substance/drug use.
She is compliant with her medication. She adheres to a low sodium diet. She performs no
exercise.
She has cardiomegaly and pulmonary edema, as revealed in Chest X-ray. Electrocardiogram
suggests left ventricular hypertrophy. Echocardiogram shows ejection fraction of 45%..
Beta blocker and nitroglycerine drip was initiated.
Tasks
1. Compare acute and chronic renal failure e.g. in terms of cause, reversibility and urinary
output at onset.
2. Discuss pertinent patient information to determine cause(s)/factor(s) related to
development of ESRD.
3. Present through a concept map the pathophysiology of ESRD and its
manifestations/complications presented in the case.
a. Present the mechanisms responsible for hypertension.
b. Discuss factors contributing to the patient’s lethargy.
4. Discuss pharmacologic and non-pharmacologic considerations in managing hypertension
in patients who have ESRD.
5. Identify your priorities by developing nursing diagnoses with pathophysiologic basis, goals
of care/management, and the interventions.