Hypertension & Chronic Kidney DiseaseRosemarie MooreStudent ID: 4084464NURS 1495Niagara College CanadaDate: July 8th, 2019 Introduction Mr. K.M. is a 72-year-old male admitted to the Welland General Hospital on March 29, 2019. He was admitted with high blood pressure; he is overweight and smokes 1 pack a day. He is retired as well as a widow, who is been living at home by himself for the past 15 years. He has 2 daughters whom they take turns to stop by and visit him during the week. Mr. M’s education level is grade 12. Diagnosis Mr. M. medical diagnosis is Hypertension and stage 4 Chronic Kidney Disease. Hypertension is sustained elevation of systemic arterial blood pressure. Hypertension may be classified as primary or secondary hypertension. (Lewis, S. M., Goldsworthy, S., Barry, M., Tyerman, J., & Lok, J. (2019). Medical-surgical nursing in Canada: Assessment and management of clinical problems. Toronto: Elsevier Mosby). For the purposed of this paper, we will focus on secondary hypertension. The clinical findings that suggest secondary hypertension include hypokalemia; abdominal bruit; variable pressures with history of tachycardia, sweating, and tremor or a family history of renal disease (Lewis et al., 2019). Hypertension is one of the leading causes of kidney disease. Kidney disfunction is the direct result of ischemia caused by the narrowed lumen of the intrarenal blood vessels. The gradual narrowing of the arteries and arterioles leads to atrophy of the tubules, destruction of the glomeruli, and eventually death of nephrons (Lewis et al., 2019). Chronic Kidney Disease (CKD) involves the progressive, irreversible loss of kidney function (Lewis et al., 2019). Chronic kidney failure can affect many systems in the body, such as hypertension, which usually sets in and is worsened by sodium retention and increased extracellular fluid volume( Hubert, R. J., & VanMeter, K. (2018). Gould’s pathophysiology for the health professions. St. Louis, MO: Elsevier.) In some individuals, increased renin production contributes to the problem. Hypertension accelerates atherosclerotic vascular disease, produces intrarenal arterial spasm, and eventually leads to left ventricular hypertrophy and heart failure (Lewis et al., 2019).Clinical Manifestations Hypertension is a silent disease; it is frequently asymptomatic until it becomes severe and a target-organ disease has occurred. A patient with severe hypertension may experience a variety of symptoms secondary to effects on blood vessels in the various organs and tissues or to the increased workload of the heart. These symptoms may include fatigue, reduced activity tolerance, dizziness, palpitations, angina, and dyspnea. (Lewis et al., 2019). The most common cardiovascular abnormality is hypertension in patients with Chronic Kidney Disease (CKD) and is worsened by sodium retention and increased extracellular fluid volume. (Lewis et al., 2019). The signs and symptoms that develop over time with patients of CKD and may include nausea, vomiting, loss of appetite, fatigue and weakness, sleep problems, muscle twitches and cramps, swelling of feet and ankles and persistent itching (Mayo clinic: Chronic kidney disease. ).Medical Interventions Patients with hypertension will be monitor for their blood pressure and may be prescribed medications to control their blood pressure (refer to Appendix A on page 6 for a list of common medications). Physicians will also review patient’s lifestyle and will encourage patients to make lifestyle changes such as dietary changes, including reduction of sodium, limitation of alcohol intake, increase physical activity, avoid smoking, stress management, and weight reduction. (Lewis et al., 2019). As well as hypertension patients, patients with CKD, physicians may obtain a family history and request blood tests, urine test, imaging test, and even obtain a sample of the kidney (Mayo clinic: Chronic kidney disease. ), to understand the severity of the kidney function. Patients will also be prescribed medications and laboratory work (refer to Appendix B on page 7 for example of laboratory testing). As well as dietary changes such as reduction of protein, sodium and fluid restriction, potassium restriction, phosphate restriction. CKD patients will be ordered to receive dialysis, this can include either peritoneal dialysis (PD), which is removing waste products and excess fluid from the blood using a natural semipermeable membrane, the peritoneum. Dialysis fluid is infused into the peritoneal cavity, and excess fluid and waste products pass across the membrane into the fluid, which is then drained and discarded. Patients may receive hemodialysis (HD) at a clinic or hospital and patient’s blood waste and excess fluid is removed from the body into a machine to pump the blood through an artificial semipermeable membrane (Lewis et al., 2019).Patient’s and Family Coping Mechanism Patient’s diagnosed with hypertension may experience difficulty coping to their new diagnosis, they may not feel any symptoms of high blood pressure. New lifestyle changes, especially with their diet, it may become difficult as they may have to reduce and/or eliminate sodium from their diet. (Mayo Clinic: High blood pressure (hypertension), 2018). Patients with Chronic Kidney Disease may experience difficulty coping to their diagnosis since their lifestyle changes may be more severe. Patient’s receiving dialysis will receive treatment at least three times a week for at least 4 hours a day and this can affect to maintain employment as well as a regular lifestyle. CKD patients are encouraged to find support from friends or family, as well as support groups with other people who are going thru the same experiences and may be able to encourage or give support. (Mayo clinic: Chronic kidney disease. 2018)Nursing Diagnosis and Nursing Interventions Nursing diagnosis for a patient with hypertension: (1) Ineffective health maintenance r/t insufficient resources as evidence by patient living by himself at home. Nurses will provide health teaching as well as community resources for patients living alone at home to receive services such as “meals on wheels”, and/or programs that will support patients with hypertension. (2) Anxiety related to stressors, threat to currents status as evidence by lifestyle changes associated with hypertension. Nurses caring for patients with hypertension, will do health teaching on the importance of maintaining a healthy lifestyle, diet, exercise, maintaining an adequate blood pressure level as well as the sign and symptoms of the disease. (3) Risk for activity intolerance r/t imbalance between oxygen supply and demand as evidence by patient complaining of feeling dizzy. Nurses may provide health teaching on the importance to exercise as well as how to maintain adequate oxygen supply while exercising. The nursing diagnosis for a patient with CKD: (1) Excess fluid volume related to decreased urine output, dietary excesses and retention of sodium and water as evidence by patient unable to void. Nurses will assess patients input and output as well as weight during shift to identify any potential imbalance of fluid in the body. (2) Imbalanced nutrition more than body requirements related to as evidence by patient being overweight. (3) Activity intolerance related to fatigue as evidence by patient stating to feel tired all the time. Nurses will encourage patients to alternate exercise with rest during the day as well as days patients may be receiving dialysis. Appendix AMedication Effects Adverse ReactionsBisoprolol mild to moderate hypertension vertigo, headache, insomnia, fatigue, dizziness, mental changes, memory loss, hallucinations, depression, lethargy, drowsiness, strange dreams, catatonia, peripheral neuropathy.Hydrochlorothiazide Mild to moderate hypertension Dizziness, drowsiness, lethargy, weakness, hypotension, anorexia, cramping, vomitingCandesartan hypertension, alone or in combination dizziness, fatigue, headache, syncope, chest pain, peripheral edema, hypotension, palpitations, sinusitis, nausea.hydromorphone moderate to severe pain (alone and in combination with nonopioid analgesics) confusion, sedation, dizziness, dysphoria, euphoria, floating feeling, hallucinations, headache, unusual dreams.blurred vision, diplopia, miosisAppendix BDiagnostic & Laboratoy test Why is been order? Expected Results Patient’s Result Significance to PatientBUN/ creatine to check for renal damage Female: 44-97 mcmol/LMales: 53- 106 Mcmol/L 100 mcmol/L How much function of urine are the kidneys producingHemoglobin Rapid indirect measure of RBC count Female: 120-160 g/ LMales: 140-180 g/L 145 g/L How much oxygenated blood is traveling in the bodyWBC To evaluate patients with infections 3.2-12.0 x 10 (9)/ L 6.6 /L The lower the amount of WBC, the higher risk for infectionGlomerular filtration rate (GFR) To measure how well kidneys are filtering the blood 15-30 ml/min 25 ml/min How much kidney function is leftDialysis To clean patient’s blood from waste Pagana, K. D., Pagana, T. J., & Pike-MacDonald, S. A. (2019). Mosby’s Canadian manual of diagnostic and laboratory tests. Toronto, ON: Elsevier.ReferencesHubert, R. J., & VanMeter, K. (2018). Gould’s pathophysiology for the health professions. St. Louis, MO: Elsevier.Lewis, S. M., Goldsworthy, S., Barry, M., Tyerman, J., & Lok, J. (2019). Medical-surgical nursing in Canada: Assessment and management of clinical problems. Toronto: Elsevier Mosby.Mayo clinic: Chronic kidney disease. (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521Mayo Clinic: High blood pressure (hypertension). (2018). Retrieved from https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/diagnosis-treatment/drc-20373417Pagana, K. D., Pagana, T. J., & Pike-MacDonald, S. A. (2019). Mosby’s Canadian manual of diagnostic and laboratory tests. Toronto, ON: Elsevier.