Question

3. It is important to make sure that medical data is obtained in a proper manner. For example, many doctors thought body builders usually had high blood pressure. Then, a doctor tried a different cuff and got different results. Examine Table 5.3. a. Why do you think the readings are no different Systolic Reading on Bodybuilders TABLE 5-3 with Bicep Circumference Larger Than 33 cm Reading taken Reading taken with medium cuff with large cuff 132 mm Hg 118 mm Hg 145 mm Hg 122 mm Hg 130 mm Hg 115 mm Hg 152 mm Hg 132 mm Hg 148 mm Hg 123 mm Hg b. Which cuff do you think gave the more accurate reading! 4. A patient was having her blood pressure taken by a nursing student. The nursing student became distracted and left the pressurized cuff on for much too long. What symptoms would the patient have? 5. Occasionally, the sphygmomanometer needs to be inflated to 200 mm Hg. When do you think that has to happen? 5. The posterior tibia can be palpated to find a pulse. A man is brought into the emergency room after a car accident. The nurse can palpate a femoral pulse but not one in the posterior tibia. Describe a possible injury.

Answer 1

3a. Blood pressure is the pressure exerted by the circulatory system on the blood vessels. We get two readings in blood pressure: the systolic BP and the diastolic BP> the systolic BP is the pressure exerted on the blood vessels during systole(cardiac contraction), whereas diastolic BP is the pressure exerted on the blood vessels during diastole (Cardiac rest).

In the table given above, we can find that both the readings are very different. The table represents the systolic readings on bodybuilders with bicep circumference larger than 33cm.

In the first column are the systolic readings taken by using a medium cuff, whereas the readings on the opposite column are taken by using a large cuff. The readings in the first column are higher as compared to the second column.

Whenever the blood pressure is being measured it is very important to use the correct sized cuff, or else the result might not be the correct. For this, it is important to ensure that the air bladder inside the cuff should cover 80% of the arm but not more than 100%. If the cuff size used is less than 80% of the arm, then it might not be able to close the blood vessels completely and the bladder will inflate too much and we may get high blood pressure. On the other hand, if the cuff size used is more than 100% of the arm then the air bladder inside the cuff overlaps each other as it is large and the bladder may inflate on itself and the blood vessel may close too easily and we may get a low BP.

In this given table we found that the arm circumference is larger than 33cm, in such a case a large cuff size should be used so that the air bladder covers more than 80% of the arm. We can find than when large-sized cuffs were used the blood pressures were within normal limits whereas when medium-sized cuffs were used the blood pressures were high because the air bladder in the cuff cannot cover the entire arm properly, therefore, the blood vessels do not close completely and the bladder inflates too much; thereby giving us a higher blood pressure levels.

3b. The more accurate readings of systolic blood pressure were received when large-sized cuffs were used. Because for a person with biceps more than 33cm in circumference a large-sized cuff must be used, so that the air bladder present inside the cuff is able to cover more than 80% of the arm.

4. A nursing student was measuring the blood pressure of the patient and got distracted and left the cuff inflated for too long. When the cuff is inflated it applies pressure on our blood vessels and closes them. If the cuff is left inflated the blood supply to the extremity (the hand that is being used) will be reduced or stopped. This can be very dangerous if left unattended. The patient may have the following symptoms because of the lack of blood supply:

• Tingling
• Numbness
• Burning of wrist
• Sore extremity
• Feeling stiff
• Feeling hot or cold
• The extremity may become pale in color
• Swelling

5. During the process of taking blood pressure, the cuff should be inflated 30-40 mmHg above the patient’s normal BP.

For example: if a patient's normal BP is 110/70mmHg then we can inflate the cuff up to 140-150mmHg.

If the patients BP is not known then the cuff can be dilated to 160-180 mmHg. Sometimes for patients who are hypertensive we may auscultate their pulse sounds even in 160mmHg. In such cases we may have to inflate the cuff to 200mmHg.

6. A man has been brought to the emergency room after car accident. The nurse is able to palpate the femoral pulse but not the posterior tibial pulse.

The femoral artery is the continuation of the external iliac artery. The femoral pulse is located in the inner thigh between the symphysis pubis and the anterior superior iliac spine. The femoral artery gives many branches to supply blood the lower extremities. The femoral artery travels through the anterior thigh and reaches the popliteal fossa and becomes popliteal artery. It gives rise to two branches anterior and posterior popliteal artery. The popliteal pulse is located at the back of the knee.

In the given patient the nurse is able to palpate the femoral pulse but not the popliteal pulse because the blood supply through the popliteal artery is interrupted because of the injury. The located of injury is above the popliteal artery. It means that the patient might have some serious injuries in the thigh of the knee, because of which the pulse cannot be palpated at the popliteal artery. This means that the blood supply to the distal extremity is compromised and the patient may require an urgent treatment.