THISISCAREPLANNINGCONTENT
Hypertension Comorbidity (Pediatric Inpatient)
Clinical Description
- Care of the hospitalized child with a known history of hypertension.
Key Information
- Hypertension in children is determined by age, height and sex.
- Elevated blood pressure in children may be due to renal conditions, endocrine conditions or congenital heart disease. A growing number of children; however, are diagnosed with hypertension due to obesity, lack of exercise and unhealthy diets.
- Children with hypertension rarely have signs or symptoms, even if blood pressure is dangerously high. For this reason, parents or children may interpret medication or risk factor modification unnecessary.
- Use appropriate size cuff for accurate blood pressure reading. Bladder width should be approximately 40% of arm circumference. Bladder length should be 80-100% of the arm circumference.
- If elevated blood pressure reading with oscillometric device, the reading should be repeated with auscultation. If using oscillometric devices, assure they are approved for use in the pediatric population.
Clinical Goals
By transition of careA. The patient will achieve the following goals:
Blood Pressure in Desired Range
- Education: Comorbidity: Self-Management
Correlate Health Status
Correlate health status to:
- history, comorbidity, congenital anomaly
- age, developmental level
- sex, gender identity
- baseline assessment data
- physiologic status
- response to medication and interventions
- psychosocial status, social determinants of health
- barriers to accessing care and services
- child and family/caregiver:
- health literacy
- cultural and spiritual preferences
- safety risks
- family interaction
- plan for transition of care
Hypertension Comorbidity
Signs/Symptoms/Presentation
- known history of hypertension
- maintenance medication use
Problem Intervention
Maintain Blood Pressure Management
- Evaluate adherence to home antihypertensive regimen (e.g., exercise and activity, diet modification, medication).
- Provide scheduled antihypertensive medication; consider administration time and effects.
- Monitor response to antihypertensive medication therapy (e.g., blood pressure, electrolyte levels, medication effects).
Associated Documentation
- Medication Review/Management
Education
CPG-Specific Education Topics
Comorbidity: Self-Management
adherence to disease management plan
when to seek medical attention
General Education Topics
General Education
admission, transition of care
orientation to care setting, routine
advance care planning
diagnostic tests/procedures
diet modification
opioid medication management
oral health
medication management
pain assessment process
safe medication disposal
tobacco use, smoke exposure
treatment plan
Safety Education
call light use
equipment/home supplies
fall prevention
harm prevention
infection prevention
MDRO (multidrug-resistant organism) care
personal health information
resources for support
References
- Baker-Smith, C.; Flinn, S. K.; Glynn, J. T.; Kaelber, D. C.; Blowey, D.; Carroll, A. E.; Daniels, S. R.; de Ferranti, S. D.; Dionne, J. M.; Falkner, B.; Gidding, S. S.; Goodwin, C.; Leu, M. G.; Powers, M. E.; Rea, C.; Samuels, J.; Simasek, M.; Thaker, V. V.; Urbina, E.; subcommittee on Screening and Management of High BP in Children. Diagnosis, Evaluation, and Management of High Blood Pressure in Children and Adolescents. Pediatrics. 2018;142(3) doi:10.1542/peds.2018-2096 Source[Clinical Practice Guidelines]
- Bernardi, L.; France, M.; Xavier, A.; Novello, D. Interdisciplinarity as a strategy for the prevention of systemic arterial hypertension in children: a systematic review. Science & Collective Health. 2017;22(12) doi:10.1590/1413-812320172212.09052016 Source[Systematic Review]
- Bricarello, L. P.; Poltronieri, F.; Fernandes, R.; Retondario, A; de Moraes Trindade, E. B. S.; de Vasconcelos, F. D. A. G. Effects of the dietary approach to stop hypertension (DASH) diet on blood pressure, overweight and obesity in adolescents: a systematic review. Clinical Nutrition ESPEN. 2018;28, 1-11. Source[Systematic Review]
- Burrello, J.; Erhardt, E. M.; Saint-Hilary, G.; Veglio, F.; Rabbia, F.; Mulatero, P.; Monticone, S.; D'Ascenzo, F. Pharmacological Treatment of Arterial Hypertension in Children and Adolescents a Network Meta-analysis. Hypertension. 2018;72, 306-313. doi:10.1161/HYPERTENSIONAHA.118.10862 Source[Meta-analysis]
- Chaturvedi, S.; Lipszyc, D. H.; Licht, C.; Craig, J. C.; Parekh, R. Pharmacological interventions for hypertension in children. Evidence-Based Child Health. 2014;9(3), 498-580. doi:10.1002/ebch.1974 [Metasynthesis,Meta-analysis,Systematic Review]
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- Farhangi, M. A.; Nikniaz, L.; Khodarahmi, M. Sugar-sweetened beverages increases the risk of hypertension among children and adolescence: a systematic review and dose-response meta-analysis. Journal of Translational Medicine. 2020;18 doi:10.1186/s12967-020-02511-9 Source[Meta-analysis]
- Flynn, J. T.; Kaelber, D. C.; Baker-Smith, C. M.; Blowey, D.; Carroll, A. E.; Daniels, S. R.; Gidding, S. S. Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics. 2017;140(3), e20171904. [Quality Measures,Clinical Practice Guidelines]
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- Harris, K. C.; Benoit, G.; Dionne, J.; Feber, J.; Cloutier, L.; Zarnke, K. B.; Padwal, R. S.; Rabi, D. M.; Fournier, A. Hypertension Canada's 2016 Canadian hypertension education program guidelines for blood pressure measurement, diagnosis, and assessment of risk of pediatric hypertension. Canadian Journal of Cardiology. 2016;32(5), 589-597. doi:http://dx.doi.org/10.1016/j.cjca.2016.02.075 [Quality Measures,Clinical Practice Guidelines]
- Hockenberry, M. J.; Wilson, D.; Rodgers, C. C. (2019). Wong's nursing care of infants and children. St. Louis: Mosby, Elsevier. [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Leyvraz, M.; Chatelan, A.; da Costa, B. R.; Taffe´, P.; Paradis, G.; Bovet, P.; Bochud, M.; Chiolero, A. Sodium intake and blood pressure in children and adolescents; a systematic review and meta-analysis of experimental and observatinal studies. International Journal of Epidemiology. 2018;June 27, 1796-1810. doi:10.1093/ije/dyy121 Source[Meta-analysis,Systematic Review]
- Lopilato, A. C.; Muratagic, M.; Patel, S. Pediatric hypertension: A pharmacological review. AACN: Advanced Critical Care. 2017;26(2), 81-90. doi:10.1097/NCI.0000000000000084 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
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- Nerenberg, K. A.; Zarnke, K. B.; Leung, A. A.; Dasgupta, K.; Butalia, S.; McBrien, K.; Lamarre-Cliche, M. Hypertension Canada's 2018 guidelines for diagnosis, risk assessment, prevention, and treatment of hypertension in adults and children. Canadian Journal of Cardiology. 2018;34(5), 506-525. [Quality Measures,Clinical Practice Guidelines]
- Paczkowska, A.; Kopciuch, D.; Nowakowska, E.; Hoffmann, K.; Bryl, W. Compliance among adolescents with arterial hypertension. Advances in Clinical and Experimental Medicine. 2016;25(3), 441-448. doi:10.17219/acem/33838 [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
- Patel, N.; Walker, N. Clinical assessment of hypertension in children. Clinical Hypertension. 2016;22(15) doi:10.1186/s40885-016-0050-0 Source[Expert/Committee Opinion]
- Rabi, D. M.; McBrien, K. A.; Sapir-Pichhadze, R.; Makhla, M.; Ahmed, S. B.; Dumanski, S. M.; et al.. Hypertension Canada's 2020 comprehensive guidelines for the prevention, diagnosis, risk assessment, and treatment of hypertension in adults and children. Canadian Journal of Cardiology. 2020;36, 596-624. doi:10.1016/j.cjca.2020.02.086 [Clinical Practice Guidelines]
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- Siddiqi, N.; Shataqt, I. F. Antihypertensive agents: a long way to safe drug prescribing in children. Pediatric Nephrology. 2020;35, 2049-2065. doi:10.1007/s00467-019-04314-7 Source[Review Articles]
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Disclaimer
Clinical Practice Guidelines represent a consistent/standardized approach to the care of patients with specific diagnoses. Care should always be individualized by adding patient specific information to the Plan of Care.
