Question

A) Describe the purpose of the palpable systolic pressure (asculatory gap).

B) Describe what further assessment should be obtained if values for vital signs are abnormal.

Answer 1

An auscultatory gap is the period of diminshed sound during manual measurement of blood pressure. The significance of measuring auscultatory gap correctly is that it prevents blood pressure monitoring errors i,e an underestimation of systolic blood pressure and overestimation of diastolic blood pressure. It is therefore recommended to palpate and auscultate while taking manual blood pressure. The radial pulse palpation is generally practiced in order to measure correct auscultatory gap.

In this method, with the fingers palpating radial or brachial artery, inflate the cuff of the machine rapidly untill you can't feel the pulse anymore and then 22 mmHg higher. Release the cuff 2 -3 mmHg per second untill you start feeling the pulse again, this is the palpable systolic pressure. Therefore measuring the correct palpable systolic pressure will enable us to measure the correct reading of blood pressure.

ANSWER B) If the values of the vital signs are abnormal, then the following assessment needs to be done:

• Response of the patient to verbal commands and to pain.
• Pupils are reactive to light or not to check the neurological response of the patient.
• The perception of skin as its warm or cold and clammy to monitor is patient is precipitating signs of dehydration or shock.
• Measuring the Glass Cow coma scale to check the motor and verbal functioning in the patients.
• Assess for patients muscular strengths and weakness like ability to speak, walk and perform self care activities to rule out hemiparesis, stroke etc.
• Use of auscultatory and palpatory methods to evaluate pain, enlargement, presence of nodes and tumors, presence of fluid collection.
• General appearance of patient from head to foot, like cyanosis, pedal edema, presence of various reflexes.
• The measurement of intake and output of the patient is also important for diagnosing condition like acute renal failure, heart failure etc.
• Genaral health history about past and present medical illness, their lifestyles, habits etc. will help to find the causes and risk factor about a disease condition.