Hypertension in Adolescents
I. Case Presentation
A 16 year old African American male arrives at his pediatrician’s office for a preparticipation physical evaluation. His history includes asthma as a toddler, tonsillectomy in 2010. His mother, grandmother, and uncle all have hypertension. His grandmother has diabetes as well. He has an older brother and younger sister, both are healthy. His father is a paraplegic due to a MVA, otherwise his father has no health issues.
The patient vital signs are normal except for his blood pressure which is 146/89. The medical assistant informs the patient that his blood pressure is high and questions about his day and diet. The patient did have a full day of school before rushing to the office.
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The most common ones are obesity and a family history of hypertension. Assessment involves a detailed history and physical examination, laboratory tests, and possibly specialized studies. Nonpharmacologic management of hypertension include weight reduction, exercise, and dietary modifications. Recommendations for pharmacologic treatment are based on several factors. They include symptomatic hypertension, evidence of end organ damage, stage 2 hypertension, stage 1 hypertension not affected by lifestyle modifications, and hypertension with diabetes mellitus (JNC 7 report).
Questions:
3. How many readings need to be considered high or abnormal before a patient is diagnosed with HTN?
4. Name some referrals that a PCP would order for an adolescent diagnosed with HTN?
III. Additional case presentation
One week later the 16 year old arrives back to the office with the results. Every day the results were abnormal. The pediatrician decides to refer the patient to a pediatric nephrologist.
The initial visit with the pediatric nephrologist included lab work (CBC, CMP, Lipid Panel, U/A) and a comprehensive history. Although all the lab work came back normal, the nephrologist decided to order an echocardiogram and renal ultrasound, as well as an ambulatory blood pressure monitor for 24 hours.
After all test results normal, the patient was diagnosed with essential hypertension. The physician decides to start the patient on Lisinopril 10mg daily
I interviewed my primary care physician Dr. Michelle Class, who is a pediatrician in the private practice of Lori McAuliffe, M.D., P.A. Dr. Class has worked in the field of pediatrics since completing Medical school at The University of Florida and a 3-year residency to become a board certified pediatrician. She offers primary care to children from birth till the age of twenty-one, and provides routine physicals to chart growth and development, well-visits, and professional consultation, diagnosis and treatment for chronic and temporary illness or other health issues. All efforts work toward preventing disease and injury amongst children, the primary goal of all pediatricians in the field of health care. The practice at which she works also allows doctors to utilize epidemiological resources and inform patients about current health trends regarding illness, current school, county regulations updates on health and vaccination deadlines, and basic understanding of childcare, hygiene, and nutrition practices for children and parents. I chose to interview Dr. Class because she is an excellent doctor, who I have been privileged to have over the years. She has personally given me her very best whenever my health was poor, as well as been a wonderful person who truly cares for her patients physical and mental wellbeing. Her passion and dedication to the craft of pediatric medicine are evident in the quality of care and service she
Modern medical advancements have significantly decreased the prevalence and severity of infectious disease as well as the treatment of acute, traumatic conditions. Pharmacological research has also gained insight into the management of chronic disease. Still, there is an epidemic of chronic, treatable diseases like stroke, heart disease, and kidney disease. Hypertension proves to be the underlying factor associated with these diseases. Hypertension is often referred to as the silent killer because of its indication in deadly disease, and the importance of monitoring ones blood pressure is vital. Lifestyle, diet, and genetic predisposition are all factors of high blood pressure. Chronic high blood pressure above safe levels, known as hypertension, puts elevated physical stress on the renal and cardiovascular systems. By controlling this factor in patients, healthcare providers can decrease cardiovascular events, improve health outcomes, and decrease overall mortality. Patient education is often overlooked in its role in the control and prevention of high blood pressure. This paper analyzes the causes and physiology behind high blood pressure as they relate to the current nursing interventions. The role of nurses is discussed in relation to patient education regarding high blood pressure, and educational approaches are analyzed.
The albumin serum level is a little low. Low albumin levels are a warning and an indication that further investigation may be warranted. They may reflect a
As I did the physical exam I explained to the patient that I would listen to the arteries with a stethoscope for an abnormal sound which will let me know if there is poor circulation due to plaque? I also explained to the patient that by checking the pulse in the ankle and legs it would also indicate if
A) "Your blood pressure is very high. You need to see your healthcare provider today."
All the symptoms that were described were based on the kidney functions, so more and further
K.H. is a 67-year-old African-American man with primary hypertension and diabetes mellitus. He is currently taking an angiotensin-converting enzyme (ACE) inhibitor and following a salt-restricted weight loss diet. He is about 30 pounds over his ideal weight. At his clinic visit his blood pressure is noted to be 135/96. His heart rate is 70 beats/min. He has no complaints. His wife brought a blood pressure cuff and stethoscope with her in the hope of learning to take her husband’s blood pressure at home.
and the information from this case to explain each of the following aspects of blood pressure and discuss
The concern on whether anti-hypertensive’s should be withheld in patients who are hypertensive has been debatable in the recent past. Generally, the treatment of hypertension among hospitalized patients is basically an opportunity to enhance the recognition and treatment of blood pressure (Axon, Nietert & Egan, 2011, p.246). This is mainly because hypertension is a basic risk factor for heart diseases, stroke, and death whose impact is widespread to nearly 70 million adults in America. There have been numerous educational initiatives and publication of treatment processes to address this condition in the past few decades. Despite these measures, nearly 39 million Americans are at risk of hypertension because they have not reached their desired or optimal blood pressure.
Patient 2: The patient had an infection in her lungs with an unknown cause. I was on alert for drops in oxygen levels below the patient’s normal range, increases in blood pressure above the patient’s normal range, and the patient’s activity tolerance without the BiPAP machine. I was also looking for signs of a DVT.
Renal History: The patient learned that he had kidney disease a few years ago. He had a biopsy in October 2012 that showed IgA nephropathy per TGH records. He started dialysis in 2013. Initially, he started peritoneal dialysis for seven months. He had a lot of side effects
After all the medications were given Mr. B’s vitals were as follows: Blood Pressure (BP) of
suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it
Hypertension is widely considered to be one of the most important risk factors of cardiovascular diseases (angina, arrhythmia, etc.). It is the second leading disease that causes mortality in the world. Hypertension is the condition when there is an increase in the force of blood on the walls of vessels. It can also be defined as an arterial blood pressure that is raised above 140/90 mm Hg (systolic/ diastolic BP). Hypertension can be classified into Secondary hypertension and Essential hypertension. When specific cause is evident but heredity, and various physiological parameters play a role in increasing blood pressure is known as Essential Hypertension. Secondary Hypertension is one where the cause is known. According to WHO guidelines between 2006 and 2015, deaths due to cardiovascular diseases are expected to increase by 17% while the deaths from infectious diseases, nutritional deficiencies, maternal and prenatal conditions are projected to decline by 3%. The main causes of hypertension includes the age ,hereditary, gender, extra weight, alcohol consumption, stress life, lazy life etc.
With the information found with what a patient’s blood pressure is, it helps health care