mrs. kouassi is a 44-year-old african from the ivory coast. although she was diagnosed with hypertension about eleven years ago, it was left untreated. a year ago, she was seen in the emergency department for fatigue, poor appetite, nausea, and vomiting. she complained of shortness of breath, muscle weakness, and swelling of her lower legs. her blood pressure reached 220/210. she was hospitalized, diagnosed with end-stage renal disease (esrd), and started on hemodialysis. she currently goes to a dialysis center four times a week. she