Pulse pressure, widened

Pulse pressure, widened: Excerpt from Nursing: Interpreting Signs and Symptoms

Pulse pressure is the difference between systolic and diastolic blood pressures. Normally, systolic pressure is about 40 mm Hg higher than diastolic pressure. Widened pulse pressure—a difference of more than 50 mm Hg—commonly occurs as a physiologic response to a fever, hot weather, exercise, anxiety, anemia, or pregnancy. However, it can also result from certain neurologic disorders—especially life-threatening increased intracranial pressure (ICP)—or from cardiovascular disorders that cause blood backflow into the heart with each contraction such as aortic insufficiency. Widened pulse pressure can easily be identified by monitoring arterial blood pressure and is commonly detected during routine sphygmomanometric recordings.

Action stat!

If the patient's level of consciousness (LOC) is decreased, and you suspect that his widened pulse pressure results from increased ICP, check his vital signs. Maintain a patent airway, and prepare to hyperventilate the patient with a handheld resuscitation bag to help reduce partial pressure of carbon dioxide levels and, thus, ICP. Perform a thorough neurologic examination to serve as a baseline for assessing subsequent changes. Use the Glasgow Coma Scale to evaluate the patient's LOC. (See Glasgow Coma Scale, page 363.) Also, check cranial nerve function—especially in cranial nerves III, IV, and VI—and assess pupillary reactions, reflexes, and muscle tone. Insertion of an ICP monitor may be necessary. If you don't suspect increased ICP, ask about associated symptoms, such as chest pain, shortness of breath, weakness, fatigue, or syncope. Check for edema, and auscultate for murmurs.

Medical causes

Aortic insufficiency.With acute aortic insufficiency, pulse pressure widens progressively as the valve deteriorates, and a bounding pulse and an atrial or a ventricular gallop develop. These signs may be accompanied by chest pain; palpitations; pallor; strong, abrupt carotid pulsations; pulsus bisferiens; and signs of heart failure, such as crackles, dyspnea, and jugular vein distention. Auscultation may reveal several murmurs, such as an early diastolic murmur (common) and an apical diastolic rumble (Austin Flint murmur).

Arteriosclerosis.With arteriosclerosis, reduced arterial compliance causes progressive widening of pulse pressure, which becomes permanent without treatment of the underlying disorder. This sign is preceded by moderate hypertension and accompanied by signs of vascular insufficiency, such as claudication and angina.

Febrile disorder.Fever can cause widened pulse pressure. Accompanying symptoms vary depending on the specific disorder causing the fever.

Increased ICP.Widening pulse pressure is an intermediate to late sign of increased ICP. Although decreased LOC is the earliest and most sensitive indicator of this life-threatening condition, the onset and progression of widening pulse pressure also parallel rising ICP. (A gap of 50 mm Hg can signal a rapid deterioration in the patient's condition.) Assessment reveals Cushing's triad: bradycardia, hypertension, and respiratory pattern changes. Other findings include headache, vomiting, and impaired or unequal motor movement. The patient may also exhibit vision disturbances, such as blurring or photophobia, and pupillary changes.

Nursing considerations

▪ If the patient displays increased ICP, continually evaluate his neurologic status.

▪ Be alert for restlessness, confusion, unresponsiveness, or decreased LOC.

▪ Watch for subtle changes in the patient's condition.

Patient teaching

▪ Explain diagnostic tests, such as blood studies, computed tomography scan, and magnetic resonance imaging.

▪ Explain the underlying disorder and treatment plan.

Book Source Details

• Book Title: Nursing: Interpreting Signs and Symptoms
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Nursing: Interpreting Signs and Symptoms Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-668-7

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