Case:

A 33-year-old woman presented with severe hypertension and acute renal failure. Initial evaluation
demonstrated hyperreninemia with hyperaldosteronism and a possible renal artery stenosis at the
contrast-enhanced CT scan. Although this data suggested the presence of a secondary form of
hypertension, further exams excluded our first diagnosis of renal artery stenosis. Consequently, the
patient did not undergo renal angiography (and the contrast media infusion associated with it), but she
continued to be medically treated to achieve a tight blood pressure control. Our conservative approach
was successful to induce renal function recovery over 2 years of follow-up.

The next day, the nurse on guard in the morning stepped up while carrying a physical examination
device. The nurse wants to examine patients diagnosed with hypertension and to make sure, the nurse
must check the patient's vital signs.

Nurse : Good Morning Mrs, I’m nurse xxxx. What can i do for you?

Patient : Good Morning nurse, i’m not feeling well today.

Nurse : Mrs, can you tell about the problems of your condition?

Patient : There is something wrong with me, i have a problem with headache and chest pain.

Nurse : Did you sleep well last night, Mrs ?

Patient : Not really cause i still got a problem with my headache.

Nurse : Okay Mrs. this morning i will checking vital sign to check your pulse, temperature and
measuring your blood pressure.

Patient : Surely nurse, I’m ready, Please check it.

Nurse : Firstly, I will check the temperature and pulse of you, Mrs. (put a thermometer in the axilla
patient while checking the pulse).

Patient : How about the result, nurse?

Nurse : The result is your temperature 360° C and your pulse 110x/minute.

Nurse : And I will checking your blood pressure, Mrs. (Measuring the blood pressure) your blood
pressure is 140/90 mmHg. You got a problem with your blood pressure cause is too high range and i will
report this to a doctor.

Patient : What is it the danger, nurse?

Nurse : Sure, if you permit the blood pressure high range and that risk a complication like a heart
failure, renal failure and stroke.

Patient : What is steps may recommend to lower my high blood pressure, nurse?

Nurse : You need a rest a little bit. Moreover, you have to avoid the high fat foods that are high in
saturated fat, cholesterol and also limit sodium, sweets, sugary drinks, and red meats. I suggest you to
eat more fruits, vegetables, low fat diary. You can lower your blood pressure and keep it down.

Patient : Okay Mrs, thank you for your information. I’ll change to my lifestyle.

Nurse : Your welcome and after that you should take your medicine, Doctor come to you soon and
you can consultation about your medication, Mrs.

Please, wait the moment.

Patient : Okay nurse, I’ll wait.

Nurse : I need to go now, Mrs. Enjoy your rest later, I Hope you will better soon.

Patient : Okay, thanks nurse.