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When it comes to a child some of physical assessments that we can be looking for that are common with this diagnosis include, the patient being overweight, maybe some edema in the extremities, pallor, flushing, the lower and upper extremity pulses can be palpated as well to see if they are bounding. Some of the workup that can done for this patient can inclue, CBC, ESR, CRP, renin, renal nuclear scans, BUN, creatinine as well as renal nuclear scans if the provider finds it necessary Viswanathan  M, 2020). If there is a suspicion of renal vascular disease patient needs to be referred to a renal specialist. However, if there is some cardiac involvement the patient would need to probably be referred to a cardiologist and would most likely need an electrocardiogram. To make sure there is no congenital heart defects that can lead to secondary hypertension. Some of the conditions can involve aortic valve stenosis, atrial septal defect, coarctation of the aorta, complete atrioventricular canal defect, pulmonary valve stenosis amongst others Viswanathan  M, 2020). Some of the management that can be included for this patient would differently forms. If the patient is overweight, there is a treatment for obesity that would include dietary changes as well as lifestyle changes. Children ages 2-3 should not have more than 1200 milligrams of sodium one day. As the child grows they should not have more than 1500 milligrams of salt a day. Patients parent will also need to be informed of limiting salt intake in the child’s diet as well. patient also needs to stay active at least an hour of active play time, this is also done of course by limiting screen time in their daily activities as this can induce longer sitting times. Parent needs to have certain things prepared before the visit like the following, any symptoms the child might have as well as any key personal information like any family history, of high cholesterol, hypertension, or stroke as well as diabetes. As well as any medications or herbal supplements the child is taking as well.  However, if the problem keeps being consistent then the patient needs to be referred to a nephrologist to see if there is an underlying problem with the kidneys (Bazzano LA, 2019). Patient will also be prescribed if consistent problem the child will usually begin with ACE inhibitor. ARB’s can also be given as they tend to not cause coughing in children (Bazzano LA, 2019). They are both equally as effective as the other and are only to be given once a day . Some of the differential diagnosis includes, coarctation of the aorta, renal artery stenosis or hyperaldosterism.

2.) How would your plan of care be different if the child were 10 years old?

For a 10-year-old the plan would not be different. I think the patient as well as the parents would be taught the same self-care techniques for the child that include altering the diet to be more fiber filled, with less fats as well as less fried fatty foods or salty foods. Patient should be more center focused on eating a well-balanced diet with greens, vegetables as well as fruits to keep BMI on the healthy range and avoid gaining unhealthy weight. Patient also will be advised to keep up with a sport such as soccer, basketball, hockey or anything that makes them sweat and keeps them active. If these are applied into the patients life and there is still problems patient will be sent over to specialist or be put on momentarily BP medications because the goal is to keep such young patients off medications so its more important to start out with the least inavise methods first then go off to medication if very necessary.

3.) What risk factor counseling and advice would you include?
Some of the risk factor counseling I would include would be to make sure the patient follows healthy eating and diet guidelines as this will make their life much easier. These simple goals will help the patient prevent coronary artery disease, hyperlipidemia, hypercholesteremia, diabetes, heart attack, stroke, etc. Important risk factors for primary hypertension in children and adolescents are higher body mass index and a family history of hypertension. Other risk factors include low birth weight, male sex, and African American or Hispanic/Latino race/ethnicity (Viswanathan  M, 2020).

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