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Dec.17.2019

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.

Clinical Goals

By transition of care

A. The patient will achieve the following goals:
  • Blood Pressure in Desired Range

B. Patient, family or significant other will teach back or demonstrate education topics and points:
  • Education: 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

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

  • Becton, L. J.; Shatat, I. F.; Flynn, J. T. Hypertension and obesity: Epidemiology, mechanisms and clinical approach. Indian Journal of Pediatrics. 2012;79(8), 1056-1061. doi:10.1007/s12098-012-0777-x [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • 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]
  • Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents; National Heart, Lung, and Blood Institute. Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents: summary report. Pediatrics. 2011;128(Suppl 5), S213. doi:10.1542/peds.2009-2107C [Review Articles,Expert/Committee Opinion,Core Curriculum,Position Statements,Practice Bulletins]
  • 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]
  • 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]
  • 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]
  • Lurbe, E.; Agabiti-Rosei, E.; Cruickshank, J. K.; Dominiczak, A.; Erdine, S.; Hirth, A.; Invitti, C.; Litwin, M.; Mancia, G.; Pall, D.; Rascher, W.; Redon, J.; Schaefer, F.; Seeman, T.; Sinha, M.; Stabouli, S.; Webb, N. J.; Wühl, E.; Zanchetti, A. European society of hypertension guidelines for the management of high blood pressure in children and adolscents. Journal of Hypertension. 2016;34(10), 1887. doi:10.1097/HJH.0000000000001039 [Quality Measures,Clinical Practice Guidelines]
  • Marshall, I. J.; Wolfe, C. D.; McKevitt, C. Lay perspectives on hypertension and drug adherence: Systematic review of qualitative research. BMJ (Clinical Research Ed.). 2012;345, e3953. doi:10.1136/bmj.e3953 [Metasynthesis,Meta-analysis,Systematic Review]
  • 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]

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.