Blood pressure

[SchoolNursey]

Question, does anyone have protocols for what is considered high/low BP in the elementary and middle school child? I recently have had numerous students taken off ADHD meds by PCP due to elevated BP, but when parents tell me the BP reading, it surprises me. Example, middle school boy with BP of 122/78.

Just looking for guidelines for better understanding.

[SchoolNursey]

Just wanted to update this thread. My middle school student was cleared by cardiology to resume ADHD meds. According to the mom, cardiologist was confused as to why stimulant meds had been held for that blood pressure. So, I am assuming the cardiologist was not impressed. LoL

[MrNurse(x2), ADN]

cardiologist was confused as to why stimulant meds had been held for that blood pressure. So, I am assuming the cardiologist was not impressed. LoL

I alway wonder in these instances, does the specialist educate the internist so it doesn't happen again?

[Duranie]

On 3/8/2018 at 5:39 AM, MrNurse(x2) said:

I alway wonder in these instances, does the specialist educate the internist so it doesn't happen again?

Well, presumably a consult summary letter/report should be sent back to the PCP detailing the problems found or, conversely, ruled out... and the specialist’s recommendations going forward.... that is, if the parent listed the PCP on the intake forms, or if there was a referral to the specialist.

Now, whether the PCP reads the letter, and chooses to integrate the findings into their own knowledge and practice.... well, I’ve seen it go both ways— the PCP blows it off with a ‘whatever, that specialist has their opinion, but I don’t agree’ .... or they say ‘hmm, really... learned something new.... I’m gonna make the effort to read/educate myself more on [that topic]’ — it really just depends on the provider’s personality and mindset.

[AutumnDraidean]

That sounds so irritating!

What popped into my head was if the NP involved had just done CE on cardiac risk, obesity and type2 diabetes and was implementing stuff they learned without looking at the whole child. Maybe they are also one of those providers that swallowed a lot of hookum about ADHD.

I was also going to say that it would probably have to be the parents of the child to raise the issues with the actual physician supervising the NP. Even that gets fraught at some practices. I've gotten mad at my own peds practice NUMEROUS times for both lack of specialist referral AND inappropriate referral. I haven't switched because I don't think the grass will be greener anywhere else.

I'm glad the kiddo got cleared to go back on meds.