Category: Fundamentals The presence of a systolic blood pressure difference of 10 to 20 mm Hg between the arms is a normal finding. If greater, it may indicate atherosclerosis, coarctation of the aorta or other vascular processes preferentially affecting one extremity.
Category: Fundamentals A narrowed pulse pressure (≤20 mm Hg) may be a manifestation of hypovolemia, increased peripheral vascular resistance, or decreased stroke volume. A narrowed pulse pressure is classically noted in aortic stenosis and pericardial tamponade.
Category: Fundamentals The difference between systolic and diastolic pressure is termed pulse pressure. Increased pulse pressure (i.e., ≥60 mm Hg) is commonly observed with anemia, aortic regurgitation, increased intracranial pressure, and patent ductus arteriosus.
Category: Fundamentals Falsely high blood pressure may be caused by an overly narrow cuff, anxiety, pain, tobacco use, exertion, an unsupported arm, or slow inflation of the cuff. Irregular heart rates may also interfere with accurate determination of blood pressure.
Category: Fundamentals Erroneous blood pressure measurements may result from several factors. Falsely low blood pressure may be caused by using an overly wide cuff, by placing excessive pressure on the head of the stethoscope, or by rapid cuff deflation.
Category: Fundamentals Arterial blood pressure indicates the overall state of hemodynamic interaction between cardiac output and peripheral vascular resistance. Arterial blood pressure is the lateral pressure or force exerted by blood on the vessel wall.
Category: Fundamentals Blood flowing into the aorta with each cardiac cycle initiates a pressure wave. Blood flows through the vasculature at 0.5 m/sec, but pressure waves in the aorta move at 5 m/sec. Palpated pulses represent pressure waves, not blood flow.
Category: Fundamentals Breathing is controlled in the medullary respiratory center of the brainstem. The respiratory center is modulated by the pneumotaxic center, which limits the length of the inspiratory signal and influences the apneustic center in the pons.
Category: Psychiatric Nursing A non-life-threatening discontinuation syndrome of flu-like symptoms may occur after abrupt cessation of a selective serotonin reuptake inhibitor (SSRI). This syndrome can be minimized by gradually tapering the dose.
Category: Psychiatric Nursing Management of treatment-related sexual dysfunction includes reducing the SSRI dosage and adding or switching to an antidepressant not associated with sexual dysfunction, such as bupropion (Wellbutrin) or mirtazapine (Remeron).
Category: Psychiatric Nursing Most side effects from SSRIs are transient. Dose-related sexual effects, such as decreased libido or delayed ejaculation in men and anorgasmia in women, are common and typically do not resolve without intervention.
Category: Psychiatric Nursing MAO inhibitors prevent the breakdown of monoamines, so the patient taking an MAO inhibitor must avoid sympathomimetic substances and foods that contain tyramine, such as cheese, liver, yogurt, yeast, soy sauce, red wine and beer.
Category: Psychiatric Nursing The greatest danger with monoamine oxidase (MAO) inhibitors is hypertensive crisis, which can be caused by food or drug interaction and can result in cerebral hemorrhage and death.
Category: Psychiatric Nursing MAO inhibitors inhibit the breakdown of 5-HT and norepinephrine in the synaptic cleft. MAO inhibitors have anticholinergic side effects such as blurred vision, dry mouth and other mucosal surfaces, constipation, urinary hesitancy and tachycardia.
Category: Psychiatric Nursing Because all benzodiazepines have a longer duration of action than flumazenil, sedation commonly recurs and repeated doses of flumazenil may be needed. Adverse effects of flumazenil include confusion, agitation, dizziness and nausea.
