Question

The nurse is obtaining the vitals of a 76-year-old African

American male patient. The nurse notes that the BP of the right arm
is 187/98 and of the left arm is 201/76. What would cause the
difference in the right arm vs. the left. Is this Blood pressure
anticipated or unanticipated for the patient?

Answer 1

the minute difference in systolic pressure in both arms is anticipated. However, the huge pressure difference in diastolic pressure in both arms is unanticipated.

Step-by-step explanation:

If the difference in BP reading between both arms is more than 15 mm Hg and the difference is consistent, it indicates some issue. The pumping of blood from the heart to left arm has more pressure as compared to the right arm and it is normal if the difference in systolic pressure in both arms is less than 10 mm Hg. The diastolic pressure shall remain same in both arms because the blood is not pumped directly into the diastole. The diastolic BP tells about the arterial pressure and it should be low so that the heart does not have increase its pumping speed in order to compensate the diastolic pressure.

The African-American patient does not any unanticipated increase in systolic pressure in both arms as the left arm systolic pressure is usually higher. However, the difference in diastolic pressure in both arms has a difference of more than 20 mm Hg which is alarming. This might be a sign of some blocked artery or peripheral artery disease, diabetes, kidney disease or some heart defect.

Answer 2

In general, epidemiologically speaking, it is known that in African Americans the tendency is towards suffering hypertensive disease. So encountering pressures above 140/90 mmHg is not an uncommon thing, though not what should be. And blood pressures above that level are considered uncommonly high and need to be treated because this will affect the brain, and most particularly the kidneys. Hypertension is also very common in senior African Americans.

Given this introduction, the answers to the questions would be:

1. The cause for the great difference between the blood pressure of the right arm (187/98) and that of the left arm (201/76) is an advancement of the cardiovascular disease affecting the patient. It means that the arm where the higher number in the systolic pressure happened, is probably presenting with an obstruction of some kind, making the issue of higher blood pressure, even worse.

2. Although as said before, hypertension is an epidemiologic reality in African Americans, and especially in seniors, so it is expected that the patient will have an elevated BP, over the expected norm. However, the two pressures obtained on different arms indicates that there is something going on, as the elevation over the baseline for hypertensive patients has been overcome in systolic pressure by much more than 10 mmHg. This patient will need immediate intervention.