Please respond to the professor’s discussion question below with one reference.
I sent the reply and my first discussion as an attachment.
The professor’s response to what I said:
We’re off to a good start, so thank you.
From this comment, the first thing I notice is that Elizabeth is going to do a lot of tests. The only one that wasn’t on the list was a test for the thyroid. Most doctors use a TSH test to check for thyroid problems, which drives me a little crazy:). Tell me what you think of as “thyroid screening” for this patient and why you think it might be helpful. Or, if you don’t think it’s necessary, tell me why.
To help everyone understand how high blood pressure and the thyroid are linked…
https://www.aafp.org/afp/2002/0901/p851a.html
Just based on this one comment, there is so much to talk about, so you can all take it from here. I’m excited to hear what you think about this case study.
Thanks again
How to evaluate and treat a child with higher blood pressure and body mass index than expected was the first thing I talked about.
Patients with a high BMI, especially children, should have their BMI measured by hand on a regular basis. The National Health and Nutrition Examination Survey found that kids with high blood pressure have big arms that need cuffs made for adults. Using a cuff makes it easier to measure blood pressure correctly. People with high blood pressure tend to have arms that are shaped like cones, and the upper arm can be big for their age, up to 20 cm (Brady, 2017). Body mass index is usually used to find out if a child up to age 20 is obese (BMI).
During the evaluation, there are many things that need to be taken into account. First, it’s important to know everything you can about the patient’s past. This includes their sleeping history, in which they should talk about snoring, apneic events, and falling asleep during the day. It is also important to look at their diet history, including how much fiber they eat, how many calories they eat every day, how often and when they eat, and how much sugar or sugary drinks they drink (Styne et al., 2017). The other thing to look at is how active they are, which may include how much and what kind of pain they have in their muscles and joints. The last thing is to find out about their mental and social history, such as if they have ever had anxiety or depression.
I would also like a thorough physical exam to find out their body mass index (BMI) and waist circumference. I would also look at their striae, hirsutism, acanthosis nigricans, and abdominal hepatomegaly on their skin. A lab test could also be used to get hemoglobin A1c, fasting lipids, fasting insulin and glucose, and aspartate and alanine transaminase. Anxiety and depression can also be checked for with a toxicology screen, which is another important part of the evaluation process. Polysomnography is also an important part of figuring out if someone has obstructive sleep apnea.
Concerning findings from a physical exam and diagnostic tests.
One of the most important things to look at is the patient’s body mass index (BMI), which will help to classify the risks the patient is likely to face. Children up to age 20 who have a BMI of 95% or more are considered obese. If the patient’s BMI is at least 85% and less than 120% is considered severely obese, the patient has class II obesity (Mayoclinic.org, 2020). If the patient is older than 20, the BMI cutoff for being overweight or obese should be between 25 and 30 kg/m2. Patients with high blood pressure have a higher BMI, which can lead to class III obesity (BMI of 40 kg/m2) Most of the time, a child’s BMI affects their BP. This is because studies have shown that children with severe obesity or obesity have higher BP and are more likely to get hypertension than children the same age but with a lower BMI.
Final diagnosis and suggestions for treatment.
Focusing on a healthy weight and living a heart-healthy life is the most important thing the patient can do. If the patient is a child, the American Academy of Pediatrics (AAP) suggests a healthy way to lose weight for children aged six and up, especially if their BMI puts them in the obese category. It also tells children whose BMI puts them in the overweight category the best way to keep their weight stable (Riley et al., 2018). It is important for the patient to think about changing their diets and eating healthier foods like more fruits, vegetables, and low-fat dairy. Cut back on carbs, sugars that have been processed, and fats. This kind of dietary change can help both children and adults lower their blood pressure. Regular physical activities are another way to help. By working out every day, the patient can not only reach their fitness goals, but also keep their sugar levels in check.
References
T. M. Brady (2017). Children with obesity-related high blood pressure. Frontiers in Pediatrics, 5th. https://doi.org/10.3389/fped.2017.00197
Mayo Clinic (2020). Mayo Clinic: How to diagnose and treat obesity. Mayo Clinic is the Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/obesity/diagnosis-treatment/drc-20375749
Riley, M., Hernandez, A., & Kuznia, A. (2018). Children and teens with high blood pressure. AAFP stands for the American Academy of Family Physicians. https://www.aafp.org/afp/2018/1015/p486.html
Styne, D. M., Arslanian, S. A., Connor, E. L., Farooqi, I. S., Murad, M. H., Silverstein, J. H., and Yanovski, J. A. (2017). Assessment, treatment, and prevention of childhood obesity: A clinical practice guideline from the Endocrine Society. The Journal of Clinical Endocrinology and Metabolism, 102(3), 709–757. https://doi.org/10.1210/jc.2016-2573
