Hypertensive

Nephrosclerosis

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

Overview
Hypertensive Nephrosclerosis is a medical
condition referring to damage to the
kidney due to chronic high blood pressure.
According to the 2011
US Renal Data System (USRDS) data, in the
year 2009, hypertensive nephrosclerosis
(HN) accounted for 28% of patients
reaching end-stage renal disease (ESRD).
The rate of ESRD attributed to
hypertension has grown 8.7% since the
year 2000. Hypertensive nephrosclerosis is
reportedly the second most common cause
of ESRD.

The term hypertensive nephrosclerosis

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

Case of
Patient X

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

Medical Profile and History

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

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, she still experienced
blurring of vision with dizziness, 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.
The patient went to Region 1 Medical
Center in Dagupan City. She was
referred to a Kidney Disease Specialist.

They checked her kidney profile and

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

Pathophysiology
HYPERTENSIVE NEPHROSCLEROSIS
LIFESTYLE (MODIFIABLE)

Genetics (Non-Modifiable)

Chronic Hypertension

Thickening(Stenosis) of Glomerular Vein and Arteries

BP (Compensatory Mechanism) of Pre-Glomerular

Veins and Arteries

Glomerular Filtration

Uremic Symptoms

Drug Study

Laboratory Results
TEST

RESULT

NORMAL VALUE

Pre BUN

27.6

2.5 -7.1

Post BUN

5.9

2.5 -7.1

URR

79%

Hemoglobin

97

120 150

Hematocrit

30

37 - 47

Platelet

221

150 - 350

*Taken on August 10, 2015

Nursing Care Plan

ASSESSMENT'

'
Subjective:'
Nahihirapan!akong!
huminga!as!claimed!by!
the!client.!
!
Objective:'
>Nasal!flaring!
>Rapid!shallow!
breathing!
>Use!of!accessory!
muscle!
>!Rales!upon!
auscultation!
!
V/S:'
Temp:!36.5!
PR:!80!
RR:'27'
BP:!150/ 100!
!

NURSING'
DIAGNOSIS'
!
Fluid!Volume!
Excess!R/ T!
decreased!
Glomerular!
filtration!Rate!
and!sodium!
retention.!

SCIENTIFIC'EXPLANATION'

PLANNING'

!
Renal!disorder!impairs!
glomerular!filtration!that!
resulted!to!fluid!overload.!With!
fluid!volume!excess!hydrostatic!
pressure!is!higher!than!the!usual!
pushing!of!excess!fluids!into!the!
interstitial!spaces.!Since!fluids!are!
not!reabsorbed!at!the!venous!
end,!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,!
nephron!hyperthrophized!
leading!to!decrease!ability!of!the!
kidney!to!concentrate!urine!and!
impaired!excretion!of!fluid.!
!

!
Short'Term:'
>AFTER!30!minutes!
of!nursing!
intervention,!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.!

INTERVENTION'

RATIONALE'

!
!
Independent:'
!
>!Elevated!the!
>To!promote!lung!
head!of!chair.!
expansion!
!
!
>!Encouraged!
>To!promote!lung!
deep!breathing! expansion.!
exercised.!
!
!
!
Dependent:'
Dependent:!
>!Gave!
>!Gave!supplemental!
supplemental!
oxygen!as!ordered!!
oxygen!as!ordered!! !
!

EVALUATION'
!
>After!30!minutes!of!
nursing!intervention,!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.!
!
>GOAL'MET.!

THANK
YOU!!!!!