Please reply to the following discussion with one reference. Participate in the discussion by asking a question, providing a statement of clarification, providing a point of view with a rationale, challenging an aspect of the discussion, or indicating a relationship between two or more lines of reasoning in the discussion. Cite resources in your responses to other classmates.
MB Discussion:
How would you evaluate and manage a pediatric patient who has BP and BMI greater than what is expected for their age group? Which additional conditions would you want to screen for and why?
In evaluating and managing a pediatric with hypertension and elevated body max index (BMI), I would begin with weekly weigh-ins and blood pressure. In addition, I would have the guardian monitor the child’s food intake with a dietary log. Furthermore, I would request the guardian to log the child’s activity level and their activities. Research shows that children involved in sports programs and regularly participate in physical activity have lower BMI’s. Furthermore, increased physical activity in children helps facilitate better nutrition and psychological support (Bülbül, 2020). Next, I would obtain a sleep hygiene history and habits. Finally, the child’s screen time would need to be assessed and monitored. This evaluation would allow the provider to assess which lifestyle modification would need to be enforced. If the assessment shows that the lifestyle does not impact the child’s blood pressure or weight, a further evaluation may need to be conducted. This evaluation would consist of diabetic screening and hypothyroidism. Diabetes increases 3% every year in children, and the prevalence of hypothyroidism in children is 2% (Fatourechi et al., 2017). Once the cause of high BMI and hypertension is identified, a treatment and action plan can be formulated.
What physical exam findings and diagnostic results would be concerning to you in this patient and why? What would be three differentials in this case?
The patient should have blood work done to rule out diabetes or a thyroid condition. The blood test would include a lipid panel, fasting glucose, and hemoglobin A1C. If the bloodwork reveals an A1C greater than 6.5%, it would suggest that the patient has diabetes mellitus (Bülbül, 2020). In addition, the patient has a family history of diabetes and hyperlipidemia. This increases the patient’s chance of having these conditions by two to six times (Burn et al., 2019). In addition, the patient’s exam revealed acanthosis nigricans and hypertension, which can indicate insulin resistance. Therefore, it would be recommended to rule out diabetes. The first diagnosis I would select would be hypertension due to elevated blood pressure. The second diagnosis I selected would be obesity due to an elevated BMI. The final diagnosis would be attention deficit hyperactivity disorder (ADHD) due to his learning disability.
What are your final assessments (diagnoses) for this patient? What is your treatment recommendation and education for the patient and family? Why?
In this case, the focus is aimed at this patient’s obesity, ADHD, and hypertension. During his six-month follow-up, the patient was diagnosed with ADHD using the assessments completed by his teachers and guardians. The provider then prescribed him an extended-release dextroamphetamine/amphetamine (Adderall XR) 5mg PO daily. The most effective plan for this patient is to continue this medication and other possible therapies necessary. These therapies can help address sleep disorders, sensory impairment, learning disabilities, mood disorders, and conduct disorders (Burns et al., 2019). His mother did verbalize the patient was not compliant with his medication. The patient and parent will need to be educated on the importance of medication compliance for effectiveness. The patient and his guardians will have to go through lifestyle modifications in proper diet and physical activity. These modifications will help him obtain a more appropriate BMI. A low sodium and sugar diet will be recommended with increased fresh fruits, vegetables, and water (Burn et al., 2019).
References
Bülbül S. (2020). Exercise in the treatment of childhood obesity. Turk pediatric arsivi, 55(1), 2 10. https://doi.org/10.14744/TurkPediatriArs.2019.60430
Burns, C., Dunn, A., Brady, M., Starr, N., Blosser, C. (2019). Burns’ pediatric primary care (7th ed.). Saunders. ISBN: 9780323581967
Fatourechi, A., Ardakani, H. M., Sayarifard, F., & Sheikh, M. (2017). Hypothyroidism among pediatric patients with type 1 diabetes mellitus, from patients’ characteristics to disease severity. Clinical pediatric endocrinology: case reports and clinical investigations: official journal of the Japanese Society for Pediatric Endocrinology, 26(2), 73–80. https://doi.org/10.1297/cpe.26.73
