Monitor your hypertensive patient with renal disease for fluid overload. Assess his fluid status by taking his daily weights, checking his fluid intake and output and breath sounds, and checking him for peripheral edema. Maintain fluid restrictions, as ordered, and assess his serum electrolyte levels for hyperkalemia, hyperphosphatemia, hypocalcemia, and hyponatremia. Administer a calcium-based phosphate binder, as necessary. And restrict has potassium intake, as ordered.

Mon'tor your patient's hemoglobin level and hematocrit for anemia. If the physician prescribes erythropoietin for anemia, administer it I. V or subcutaneousiy, as ordered. Because the drug may worsen your patient's hypertension, monitor his blood pressure closely.

If the physician prescribes an antihypertensive drug, administer it, as ordered. Monitor the drug's effectiveness by measuring your patient's blood pressure frequently. For a hospitalized patient, expect to measure it every 4 hours for the first 24 hours. For an outpatient, plan to measure it two or three times a day for the first day or two.

Cautiously administer drugs excreted by the kidneys. Such drugs include digitalis glycosides, aminoglycosides, penicillin, tetracyclines, and narcotics. If the physician has prescribed any of these drugs, he may have to modify your patient's dosage. Do not administer meperidine to your hypertensive patient with renal disease because its metabolite is cleared by the kidneys and can cause seizures as it accumulates.

Some More Facts

If the physician has prescribed dietary restrictions, help your patient design a diet plan for maintaining the restrictions or refer him to a dietitian, as needed. If the physician has prescribed a fluid restriction, tell your patient to comply with the restriction by calculating his intake and output.

Teach him the name of each prescribed drug and its dosage and therapeutic and adverse effects. If the physician has prescribed a calcium-based phosphate binder, tell your patient not to take iron because aluminum and calcium bind the iron. Tell him to avoid over-the-counter drugs, such as laxatives and antacids, that contain magnesium.

Instruct your patient on self-care measures, such as taking his daily weights and measuring his blood pressure. Teach him to identify edema and electrolyte imbalances, such as hyperkalemia. Tell him to report either of these to his physician.

If your patient will have a home care nurse, tell him that she'll perform physical assessments, including measuring his daily weights and urine output, checking his breath sounds, and checking for edema. She'll also assess him for signs and symptoms of electrolyte imbalances and evaluate his compliance with the drug regimen and dietary restrictions.

Tell the patient that she'll provide assistance as he adapts to his illness and its accompanying restrictions. She may suggest support groups and counseling, if needed. She'll provide emotional support and encourage him and his family to participate actively in the treatment program.