Hypertension

Question 1

Pathophysiology of Hypertension

Answer 1

1. The balance between cardiac output and vascular resistance determine BP
2. An increase in either of these variable, in the absence of a compensatory decrease in the other, increases BP

Question 2

Risk Factors

Answer 2

1. Family History
2. Obesity
3. Hyperlipidemia
4. Renal Disease
5. Systemic Lupus Erythematosus
6. CHD
7. Prematurity
8. Genetic Disorders
9. Diabetes
10. Increased Intracranial Pressure

Question 3

Signs and Symptoms

Answer 3

1. Growth Retardation
2. Obesity
3. Headache
4. Subtle behavioral or school performance changes
5. Fatigue
6. Blurred Vision
7. Nosebleed
8. Bell Palsy

Question 4

Nursing Assessment: Health History

Answer 4

1. Determine the presence of risk factors

Question 5

Nursing Assessment: Physical Assessment

Answer 5

1. Determine the child’s weight and height/length
2. Measure BP in all four extremities (to rule out coarctation of the aorta)
3. Inspect the skin for:
   > Acne, hirsutism or striae
   > Cafe-au-lait spots
   > Malar rash
   > Pallor, diaphoresis or flushing
4. Observe extremities for edema or joint swelling
5. Inspect chest for apical heave or wide-spaced nipples
6. Listen to heart sounds and note tachycardia or murmur
7. Palpate the abdomen for a mass or enlarged kidney

Question 6

Nursing Assessment: Laboratory and Diagnostics

Answer 6

• Use to evaluate the underlying cause of secondary hypertension*

1. Urinalysis, BUN and Creatinine
2. Renal ultrasound or angiography
3. Echocardiogram
4. Lipid profile

Question 7

Nursing Management

Answer 7

1. Salt restriction for obese child
2. Encourage family and child to control portion sizes
3. Decrease the intake of sugary beverages and snacks
4. Eat more fresh fruits, vegetables and a healthy breakfast
5. Consult with a nutritionist
6. Increase physical activity (have child find a sport they enjoy)
7. Teach family about BP medication
   > how to administer
   > caution about side effects
8. Teach parents how to measure child’s BP
9. Follow-up appointments

Question 8

Primary Hypertension

Answer 8

Found primarily in non-hispanic African Americans and children who are obese or overweight

Question 9

Secondary Hypertension

Answer 9

Occurs with an underlying medical problem such as renal or cardiac

Question 10

Prehypertension (elevated) Stage

Answer 10

1. Children 1-13
   > BP persistently between the 90-95 percentile or 130/80
2. Children >13
   > BP 120-129/<80

Question 11

Stage 1 Hypertension

Answer 11

1. Children 1-13
   > Greater than to equal to the 95th percentile
2. Children >13
   > 130/80 to 139/89

Question 12

Stage 2 Hypertension

Answer 12

1. Children 1-13
   > Greater than or equal to the 95th percentile + 12 mm Hg or >140/90
2. Children >13
   > Greater than or equal to 140/90

Question 13

Complications

Answer 13

1. Heart failure
2. Myocardial infarction
3. Kidney failure
4. Blindness
5. Transient ischemic attack (stroke)