Hypertension in Children and Adolescents, Research Paper Example

Introduction

This research embraces an investigation of hypertension within specific age ranges younger adult 20 – 39 years old; middle aged 40 – 59; older adult 60 -85 and old- old adult 85 years of age and over. A number of features regarding this disease will be interpreted scientifically. They include developmental tasks; characteristics of hypertension; multiple problems of daily living and key psychosocial issues facing individuals affected the condition.

Hypertension is defined as a chronic illness that can affect persons of any age group. It is also known as high blood pressure. The condition is diagnosed when there is a consistent reading above 140/90. The national Institute of clinical excellence recommends three consecutive readings at monthly intervals of systolic pressure over 140 and diastolic above 90. According to current epidemiological data 34% of the world’s population is affected by hypertension. There have been marked increases among children and adolescents within the past 20 years (Luma, Spiotta & Spiotta, 2006).

Developmental tasks

Hypertension presents a number of developmental task challenges among the various  age groups namely younger adult 20 – 39 years old; middle aged 40 – 59; older adult 60 -85 and old- old adult 85 years of age. For example, normal younger adults are expected to be very active physically. Women are often at the prime of their child bearing age. While men do not bear children they complement the reproductive process. Hence, to make this valuable input they must be physically fit and relatively healthy. Sexual intercourse is a significant aspect of procreation in which younger adults are very active participants.

While hypertension can be symptomless medications used to control the irregularity could have serious impacts on the nervous system. Some medications affect sexual desires and thus limit fulfilment of this developmental tasks. There are also drugs which cause dizziness and until the body begins adjusting to the medication it can affect daily body functioning such as climbing stairs and driving. Ultimately, performance of simple tasks at younger adult’s job could be compromised from medication side effects (Slater, 2003).

Specifically, according to Erickson (1902 -1994) the younger adult psychosocial development is immersed in  a phenomenon of love intimacy versus isolation. In relation to hypertensive disorders in younger adults and its influence on the quality of life, the effects of high blood pressure levels on the body must be understood. These impacts may not progress towards a crisis level until later in life. However, while the younger adult may be more active, hypertension due to its effects on the heart and blood vessels can limit the extent to which a person could engage in strenuous activities compatible with their age group. In realizing this discrepancy the younger adult can become isolated in his world (Slater, 2003).

During the middle age developmental  stage (40 -60) many changes occur in the body. The individual is expected to be more caring producing generativity or stagnation. Bodily functions also experience drastic adjustments. For example, in women the child bearing period is over and the infertile stages take precedence. It is the time when menopause is realized and women tend to feel less attractive as their desire for passionate intimacy diminishes. With hypertension compromising the developmental process, stagnation could emerge. Again the medication management of this disorder plays an important role in whether a person could express the caring and generativity attributes expected during these stages (Slater, 2003).

It cannot be over emphasized that during this stage medications may have to change since many hypertensive patients besides showing adverse reactions to these drugs the body could become resistant whereby medications may have to change. Again the body takes time to adjust to every medication change, which can initiate stagnation instead of a more fulfilling life. With age also comes the risk of complications emerging from the disease. Hypertension could damage the heart, kidneys, eyes or the  patient can have a stroke (Slater, 2003).

The older adult between ages 60-85 seem to have the most developmental challenges. Aging gracefully is a desire of older adults, especially, if they do not have very serious health issues such as cancer, Alzheimer disease or kidney failure. Erickson (1902 -1994) perceives this stage as being full of wisdom, packed with ego and integrity garnered during the most productive years of life or they can sink into despair. Despair is highly likely due to loss of loved ones, especially, a life partner. Childlessness during these years can produce immense loneliness if the older adult has to live alone. Heart failure is common among this age group if suffering from hypertension. This condition greatly affects quality of life and functioning of the older adult.

Besides, if the chronic illness causes the older adult to sink into despair, quality of life is severely affected. The goal is to maintain independence as long as possible in older adults and the old older ones too. If affected by stroke their independence regarding walking is compromised. He/she may need to use a wheel chair or walker. Most patients who have been accustomed to their independence late in life, a stroke or heart failure could place them in a despair just awaiting death.

Characteristics of Chronic illness (Hypertension)

The characteristics of chronic illness could vary among cultures age groups and ethnic dispositions. As it relates to hypertension there are distinct characteristics if treatment approaches are to be effective.

Long-term

Chronic illness is long term in nature. Once diagnosed with hypertension it does not go away. Patients must be on medication or alternatives throughout their life time. In the long term if managed carefully complications such as stroke and heart disease could be reduced to minim risk. Since this is a long term condition termed chronic, the goal is managing levels so that they can remain within the normal range of 140/90. Importantly, health care workers ought to understand that since this is a chronic condition variations occur among patients. Patients should keep the same provider over a period to ensure that the condition is managed from an individual perspective rather than a collective process.

The cause for essential hypertension is still unknown. In cases of secondary hypertension the underlying disorder is often chronic too. Therefore, in the long term it is imperative that regular visits to one provider for both disorders is arranged. Long term chronic illness require planning on accomplishing the daily necessities of life. Consequently, patients should be educated into managing life’s serious issues including finances and someone must be responsible for making decisions if he/she becomes incapable of doing so. Hence, education pertaining to advanced directives is necessary.

 Uncertain

Chronic illnesses do make life uncertain. Hypertension has been predicted the silent killer, especially, among persons who are undiagnosed. For individuals who have been diagnosed and on medication, weight loss programs or alternative medicine regimes, there is still a great element of uncertainty. Medications do not always keep the blood pressure to the desired level. No one knows when the blood pressure will become elevated requiring hospitalization for more effective management. As such, the routine of work and other scheduled activities are cancelled without prior preparation.

 Require great efforts at palliation (not palliative care – symptom management)

In some chronic diseases intense pain management is required. However, so far hypertension once treated and managed carefully does not produce pain to the extent of patients receiving pain medications routinely. Some patients complain of seasonal headaches or pain over the eyes.  Become multiple diseases

Hypertension has the potential to develop into multiple diseases. These are known as complications of hypertension. They include hypertensive encephalopathy, chest pain/angina; dementia, loss of memory; myocardial infarction, coronary artery disease, left ventricular failure; kidney disease, hemolytic anemia congestive heart failure and failing vision. Since chronic diseases are systemic the accompanying disorders first manifest as irregularities within the cardio vascular system in the case of hypertension. Researchers have advanced that the relationship of hypertension with the long term course indicates that overtime patients will develop a number of other associating medical conditions in the same way hypertension is linked to diabetes mellitus (Strauss, 1984).

 Intrusive

The intrusive nature of chronic illness is manifested as impositions upon healthcare expenditure and massive life style changes. For example, some health insurance companies do not insure clients with pre -conditions. Therefore, those patients may have to pay out of pocket for care as well as medications. Also, the premiums may be more than, for a person who does not have a chronic disease. Intrusively, a person with hypertension must have a budget for medication as well as regular doctor’s visits.

 Require wide variety of ancillary services

 Essential hypertension without complications do not from the onset require immense ancillary services. Chronic illness does carry with it some measure of disability requiring assistance in preparation of meals, dressing, mobility and house cleaning. Depending on the serenity of the condition, it may become necessary to engage a fulltime helper

 Expensive  

 Chronic illness is an expensive condition to manage in the long term. This is mainly due to associating complications. While there are numerous complications affecting hypertension disease, they do not occur in the early stages. However, in controlling hypertension after some medications have become obsolete new drugs are very expensive. Again some insurance plans do not cover the newer drugs so patients may have to pay out of pocket or use substitutes

Multiple problems of daily living

Prevention and management of medical crises

This is crucial for any chronic illness. Depending on the specific condition interventions vary. For example, in hypertension crises can occur. In preventing crises frequent screening for indications of possible emerging complications is mandatory. Cholesterol evaluation in hypertension is significant since high cholesterol levels do predispose to heart disease. Many patiens refuse high cholesterol medications either due to belief systems or mere side effects intolerance. However, those clients must be educated regarding foods to avoid that will take cholesterol levels up. Also, blood glucose levels are significant even though hypertension does not cause diabetes, it is important to consider blood glucose level screening in hypertensive patients. Cardiac enzymes evaluation in patients with hypertensive disease cannot be over emphasized. Coronary heart disease is a serious complication of hypertension. To prevent its emergence then frequent screening is mandatory (Strauss, 1984).

Hypertension management is often through education first and attempts to modify life styles. Life style modifications encompass encouraging exercise if the individual is pursuing a sedentary life style. Next are dietary interventions.  If the client is obese weight control could greatly reduce hypertension crises controlling the blood pressure through natural means.  Many patients do not respond to these measures, especially, if hypertension is a secondary condition. .Consequently, there are a group of medications doctors use to manage the condition medically. High blood pressure must be managed applying strategies used to contain complications of any chronic disorder (Strauss, 1984).

 Control of symptoms

Controlling symptoms of hypertension is important even though they may be insidious. The main symptom in high blood pressure is increase in systolic and diastolic levels above the normal. There are distinct danger zones requiring immediate intervention. They include a blood pressure of 200 or more systolic and 100 or more diastolic. This could be considered a medical emergency. Therefore health care providers ought to educate clients concerning reading when the take blood pressure tests at home. Some medications are prescribed only as crisis interventions and this must be carefully communicated to the patient by his/her health care provider. Patients must be taught how to address a crisis in chronic illness when no health care provider is present (Strauss, 1984).

Carrying out prescribed regimens

In health care there is always the issue of non-compliant patients/clients. Culture plays an important role regarding whether patients take prescribed medications or follow advice offered by health care professionals. African Americans have been known to be seriously affected by this disorder when compared to other ethnic groups. However, research shows where hypertension is not an Africa disease because blacks coming from the Caribbean and Africa do not have the same predisposition (Peters, Arorian, & Flack, 2006).

As such, while Hispanics are also affected noncompliance seems to be dominant among blacks. One researcher said that African Americans have a food culture, which hinder compliance. They engage in a sedentary life style and seldom take their medications due to the adverse effects. Many people in this ethnic group complain that they feel better when not taking the medication. However all chronic illness require compliance with a particular regime. It is the health care provider’s responsibility to devise strategies that would encourage compliance rather than force and threaten clients into carrying out prescribed regimes (Strauss, 1984)

 Prevention of/living with social isolation

In the quest to prevent people living in social isolation who are affected by chronic illness advocates recommend that relatives become participants in their care to garner an understanding of the chronic illness and how it affects their personality. They will be exposed to interpreting the changes occurring consequently. There have been arguments that especially in the American society elderly people are abused by children, siblings and friends when they encounter difficulties in their health. As such, many states have provided housing in safe residences called assisted living facilities where the older and old-old adults could live in congregate communities with peers.

Younger adults may still have their spouses alive and many caring friends. Engaging is social activities is essential to preventing social isolation. Once the chronic illness does not create enormous disabilities individuals can still be employed either in the same capacity as when they were younger or one that is less stressful. Minimizing stress is essential towards blood pressure control. Importantly, social isolation is a form of stress and every effort should be made by health care providers to engage the services of a social worker in eliminating the occurrence of social isolation when it appears to be imminent.

  Adjustment to changes in disease course

Hypertension control requires many adjustment to changes. First it is modifying life style to reflect more activity in daily routine. Walking is encouraged above driving when it is possible. Laughing more is a natural medicine for relieving stress. Hence, changes towards how one reacts to life’s challenges will have to be learnt. Spiritual counselling could be effective if the person has that resource available. Changes in diet cannot be overemphasized because some clients’ blood pressure is controlled by diet alone.

 Normalizing

Normalizing is a strategy whereby the focus is placed on facilitating normalcy in living standards despite evidence of chronic illness. For persons suffering from hypertension normalcy in daily activities is easily maintained except if there are underlying disease conditions. One of the greatest challenges faced by high blood pressure suffers is controlling their eating preferences. In United States of America where fast food takes precedence above green vegetables the tendency to go with the crowd is strong. These eating habits may have a cultural impact as it relates to normalcy.

Patients/clients will have to understand that occasional fast foods eating must be replaced for more wholesome foods including fresh green vegetable. Importantly, a new normal will have to be adapted for better cardiovascular health. Daily activities such as working and conducting household chores are seldom affected when patients comply with the prescribed regime.

 Funding

Funding for chronic diseases is often the responsibility of each client. Persons with health insurances their providers cover the cost either partially or entirely. People without health insurance measures are adapted by health agencies  to fund at an affordable costs.

Confronting psychological/marital/family problems

Hypertension unlike many other  chronic illnessesdoes not offer any severe psychological/marital or family problems. However, if they do surface the services of a social worker could be accessed

Key psychosocial issues facing individuals affected the condition

A key psychological issue facing individuals affected by high blood pressure include the fear instilled by providers of patients developing a stroke, heart/ kidney failure, going blind and a number of complications, which may never occur. A very unprofessional way of addressing hypertension if a client appears with an elevated blood pressure level is to tell him/her that they will get a stroke. This will not help the client, but fear and anxiety may even raise the blood pressure further and do cause a stroke. Some health care provider are guilty of this strategy. The individual already may have a stressed life that is creating elevated blood pressure levels and when being told these unpleasant news about their health it does not lower the blood pressure neither helps the client in any way to get better.

Conclusion

The foregoing research presentation outlined features of how chronic illness is managed in the twenty-first century. Developmental tasks; characteristics of hypertension; multiple problems of daily living and key psycho social issues facing individuals affected by the condition were  major themes addressed in this exploration.

References

Luma, G, Spiotta, R., & Spiotta (2006). Hypertension in children and adolescents. Am Fam Physician 73 (9): 1558–68.

Slater, L. (2003). Generativity versus stagnation: An elaboration of Erikson’s adult stage of human development, Journal of Adult Development 10 (1): 53–65

Strauss, A. (1984). Chronic Illness and the quality of life. Mosby

Peters, R. Arorian, K., & Flack, J. (2006). African American culture and hypertension prevention. West J Nurs Res, 28(7); 831 – 864