Peds – week 5 discussion 1st reply

NC discussion

How would you evaluate and manage a pediatric patient who has BP and BMI greater than what is expected for his/her age group? Which additional conditions would you want to screen for and why?

To manage and evaluate a pediatric patient having obesity or hypertension concerns, one needs to obtain a weekly BP and weight chart. Furthermore, it is also appropriate to obtain a log of everything that patient has been eating and the information about how active they are daily. It is also appropriate to obtain information about the daily screen time of that patient and their daily sleeping habits. It is essential to obtain such information because they allow the clinicians or nurse practitioners to evaluate and determine the patient’s lifestyle changes that need to be solved or addressed as required (Cuda & Censani, 2019). Moreover, the information also allows the relevant stakeholders, such as the nurse practitioners determine whether these habits play a role in BP and weight concern, thus warranting additional testing. Evaluating pediatric patients with hypertension in the primary care setting begins with routine screening. Routine blood pressure screening should begin annually at age three. BP percentiles are determined by sex, age, and height on a standard growth cure. Elevated blood pressure is greater than the 90th percentile. Stage 1 hypertension (HTN) is greater than the 95th to 99th percentile plus 12mmHg. Stage 2 HTN is greater than the 99th percentile plus 12 mmHg (Maaks, Starr, & Gaylord, 2019). Managing HTN in the primary care setting is done first by diagnosing it. HTN can only be diagnosed if HTN is documented on three separate occasions. Initial evaluation for children with stage 1 HTN includes a complete blood count (CBC), serum nitrogen, creatinine, electrolytes, lipid panel, glucose, and urinalysis. A renal ultrasound should be done if urinalysis or renal function tests are abnormal. Initial management for HTN includes nonpharmacological measures including diet, exercise, and weight management. Medication management should be considered when HTN is symptomatic, HTN is stage 2 without a modifiable factor, and persistent HTN despite nonpharmacological measures. (Bunik, 2020). Additional conditions that should be screened for children with HTN include obesity, renal disease, type 1 or 2 diabetes mellitus, or known heart condition. These children should have BP screened earlier and at every visit as well as medication management may be indicated (Maaks, Starr, & Gaylord, 2019).  

Evaluating pediatric patients with obesity in the primary care setting also begins with routine screening. Obesity is screened in pediatric primary care by obtaining a history of diet and activity and plotting measurements on a growth chart. For children under two, the growth chart is based on a weight and height ratio The standard for measuring obesity in children older