A 32-year-old woman was referred to a teaching hospital with a blood pressure of 220/120 mm Hg. Her hypertension appeared during a pregnancy, 6 years previously, and over the years has been treated with a variety of antihypertensive drugs. Blood pressure was equal in all 4 extremities, and bilateral abdominal bruits were noted on physical examination. Fundoscopy showed A/V nicking, extensive hemorrhages and exudates. Her serum & urine laboratory values were within normal limits except her serum K+ 3.3 mEq/L (4). A renal arteriogram revealed bilateral fibromuscular dysplasia, with evidence of high-grade obstruction on the left side. •How is the afferent arteriolar pressure in the affected kidney? •How is the GFR in the affected kidney? •How is the excretion of Na+ and water in the left kidney? How about in the right one? •How is Renin secretion by the left kidney? How about by the right one? •How do you explain the plasma [K+] of the patient •Which is the mechanism causing the patient’s hypertension?

Answers

Answer 1

The afferent arteriolar pressure in the affected kidney is elevated. The GFR in the affected kidney is decreased. The excretion of Na+ and water is impaired in the left kidney, while it remains normal in the right kidney. Renin secretion is increased by the left kidney and normal in the right kidney. The patient's low plasma [K+] is due to excessive potassium excretion. The patient's hypertension is caused by bilateral renal artery stenosis.

In this case, the patient presents with hypertension, which was initially developed during pregnancy and has been managed with antihypertensive drugs. Physical examination findings, such as equal blood pressure in all extremities and bilateral abdominal bruits, suggest bilateral renal artery involvement. The renal arteriogram confirms the presence of fibromuscular dysplasia with high-grade obstruction on the left side. The elevated afferent arteriolar pressure in the affected kidney results from the stenosis of the renal artery, leading to increased resistance to blood flow. This increased resistance causes a decrease in the glomerular filtration rate (GFR) in the affected kidney. The impaired Na+ and water excretion in the left kidney can be attributed to the stenosis, while the right kidney functions normally. Renin secretion is increased by the left kidney as a compensatory response to decreased perfusion, whereas the right kidney's renin secretion remains unaffected. The patient's low plasma [K+] is a result of excessive potassium excretion due to increased aldosterone secretion stimulated by renin-angiotensin system activation. The underlying cause of the patient's hypertension is bilateral renal artery stenosis, which leads to increased vascular resistance and activation of the renin-angiotensin system.

Renal artery stenosis is a condition characterized by the narrowing of one or both renal arteries, leading to reduced blood flow to the kidneys. This can result in hypertension due to various mechanisms, including increased renin secretion, sodium and water retention, and activation of the sympathetic nervous system. Fibromuscular dysplasia is a common cause of renal artery stenosis in young women. Treatment options for renal artery stenosis-induced hypertension may include medication to control blood pressure, angioplasty with stenting to restore blood flow, or, in severe cases, surgical intervention. It is crucial to manage hypertension promptly to prevent complications such as kidney damage, heart disease, and stroke.

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Related Questions

Rubric Criteria:
Analysis of the role of leadership and advocacy in the provision of health care.
Questions:
Leadership is a component of Rob’s role as a registered nurse within the clinic.
Define leadership within the nursing context.
Give two examples of how Rob might enact this in his daily practice (400 words)
Rob is also required to act as an advocate in his role as a registered nurse.
Define advocacy within the nursing context.
Give two examples of how Rob might enact this in his daily practice (400 words)

Answers

Leadership within the nursing context can be defined as the ability to influence, guide, and motivate others towards achieving common goals in the delivery of quality patient care.

It involves taking responsibility, making decisions, and effectively communicating with the healthcare team to ensure optimal outcomes. In Rob's role as a registered nurse within the clinic, leadership is an essential component of his responsibilities. Two examples of how Rob might enact leadership in his daily practice are as follows: Setting a positive example: As a leader, Rob can demonstrate leadership by setting a positive example through his own actions and behaviors. He can exhibit professionalism, compassion, and integrity in his interactions with patients, colleagues, and other members of the healthcare team.

Promoting teamwork and collaboration: Leadership involves fostering a collaborative and cohesive team environment. Rob can actively engage with other healthcare professionals, such as doctors, nurses, and support staff, to promote effective teamwork and interdisciplinary collaboration. By encouraging open communication, active listening, and respecting the input of others, Rob can facilitate a culture of mutual respect and shared decision-making, ultimately leading to improved patient outcomes.

Advocacy within the nursing context refers to the act of supporting and advocating for the rights, needs, and well-being of patients. Nurses often serve as the voice of their patients, ensuring their concerns are heard and their best interests are protected. In his role as a registered nurse, Rob is required to act as an advocate for his patients. Two examples of how Rob might enact advocacy in his daily practice are as follows:

Patient education and empowerment: Rob can advocate for his patients by providing them with the necessary information, resources, and support to make informed decisions about their healthcare. He can educate patients about their conditions, treatment options, and potential risks and benefits, empowering them to actively participate in their care. By ensuring that patients have access to accurate information, Rob enables them to make autonomous choices and actively engage in shared decision-making.

Ensuring patient rights and dignity: Advocacy also involves safeguarding the rights and dignity of patients. Rob can advocate for his patients by respecting their privacy, confidentiality, and cultural values. He can ensure that patients are treated with empathy, compassion, and respect by advocating for their needs and preferences within the healthcare setting. This may include addressing any concerns or conflicts that arise, promoting patient-centered care, and advocating for equitable access to healthcare services.

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