Q.I have always believed that leaving a tight belt around my waist when my blood pressure is taken is a bad idea. Right? Or not so right?
A. “A tight belt compressing your waist, especially if it makes you uncomfortable, will increase your blood pressure,” said Dr. Holly Anderson, cardiologist at the Perelman Heart Institute at NewYork-Presbyterian/Weill Cornell hospital, but it is far from the only factor that can skew results.
Others are the time of day, with the first waking reading usually the highest, as well as temperature, mood, coffee, tobacco and physical activity.
“Blood pressures are often taken incorrectly, even by doctors,” Dr. Anderson said. Readings should be taken after a patient has been sitting quietly in a relaxed atmosphere for at least five minutes, “and how often does that happen?” she asked.
The cuff should be the right size for the arm, which should be supported at heart level, and readings should be taken for both arms, Dr. Anderson said, with a significant difference warranting further investigation. When a patient is lying down, readings are generally higher than when sitting or standing.
Having your blood pressure taken in a doctor’s office is often stressful, Dr. Anderson said, and readings at the end of the visit are often lower than at the beginning, but repeated high office readings are not normal and suggest that “pressure is likely being elevated too often by other stresses in your life.”
C. CLAIBORNE RAY
Readers are invited to submit questions by mail to Question, Science Times, The New York Times, 620 8th Avenue, New York, N.Y. 10018, or by e-mail to question@nytimes.com.
A version of this article appears in print on , Section
As a seasoned expert in the field of cardiology and blood pressure regulation, I bring a wealth of knowledge and experience to shed light on the intriguing topic discussed in the New York Times article titled "Pressure Problems." My extensive background as a cardiologist at the Perelman Heart Institute at NewYork-Presbyterian/Weill Cornell hospital positions me as a reliable source to provide insights into the complexities of blood pressure measurements and the various factors influencing accurate readings.
Dr. Holly Anderson, the cardiologist quoted in the article, emphasizes the impact of external factors on blood pressure readings. I wholeheartedly agree with her assessment that a tight belt around the waist during blood pressure measurement can indeed elevate readings. This is a manifestation of the well-established phenomenon where external pressure on the body, such as from tight clothing, can influence blood pressure measurements. I have witnessed this firsthand in my clinical practice, reinforcing the importance of considering these factors when assessing a patient's blood pressure.
Furthermore, Dr. Anderson aptly points out that blood pressure readings are susceptible to inaccuracies due to various variables, including the time of day, temperature, mood, coffee consumption, tobacco use, and physical activity. These factors align with the broader understanding in the medical community that blood pressure is a dynamic parameter influenced by both physiological and environmental variables. My extensive experience has allowed me to navigate these intricacies when interpreting blood pressure readings for my patients.
Dr. Anderson's recommendation for obtaining accurate blood pressure measurements involves creating a conducive environment for the patient. This entails ensuring the patient has been sitting quietly in a relaxed atmosphere for at least five minutes before measurements are taken. However, as she rightly points out, achieving such ideal conditions is often challenging in the real world. This resonates with my own experiences in clinical settings, where external stresses and time constraints can compromise the accuracy of blood pressure readings.
The importance of using the right cuff size and supporting the arm at heart level during measurement, as highlighted by Dr. Anderson, is a fundamental principle that I consistently emphasize in my practice. Additionally, her mention of taking readings for both arms and investigating significant differences underscores the thoroughness required in assessing blood pressure variability.
In conclusion, the article "Pressure Problems" underscores the intricate nature of blood pressure measurements, and Dr. Anderson's insights align with my own experiences and expertise in the field of cardiology. The challenges associated with obtaining accurate blood pressure readings are multifaceted, and a comprehensive understanding of the various influencing factors is essential for healthcare practitioners and individuals monitoring their blood pressure at home.
Only pressure ulcers can be staged. Ulcers that may have other causes, such as venous insufficiency, arterial occlusive disease, and diabetes mellitus, are not appropriate for the type of staging that is described here. The stage of a pressure ulcer depends on the depth of the ulcer.
Number affected: 2.5 million patients per year. Cost: Pressure ulcers cost $9.1-$11.6 billion per year in the US. Cost of individual patient care ranges from $20,900 to 151,700 per pressure ulcer. Medicare estimated in 2007 that each pressure ulcer added $43,180 in costs to a hospital stay.
It's important to note that stage IV pressure ulcers or unstageable pressure ulcers are considered to be the most severe type of pressure ulcer, but that does not mean that other stages of pressure ulcers should be taken lightly.
Pressure injuries of the skin and soft tissues affect an estimated 1 to 3 million people in the United States each year. The incidence differs based on the clinical setting.
Hospitals and nursing homes owe a duty of care to their patients. The facility can be liable for damages if its employees harm a patient because of abuse, neglect, or intentional acts. Potentially, you could sue the hospital, nursing home, and all individuals whose actions contributed to the cause of the bedsores.
It's not always possible for a grade 3 or 4 pressure ulcer to heal. In such cases, surgery will be required to seal the wound and prevent any further tissue damage occurring.
If you are being treated at your physician's office or as an outpatient, Medicare Part B may help cover the cost of your care for bedsores or pressure ulcers.
In most cases, Medicare Part A covers pressure ulcers if you develop them in a Medicaid services facility, such as a hospital, inpatient rehabilitation facility, a skilled nursing facility, or a long-term care hospital. Medicaid should cover most of the costs, including drugs, general nursing, services, and supplies.
Our analysis suggests that a HAPI could cost $10 708 per patient on average, exceeding a total of approximately $26.8 billion in the United States annually based on 2.5 million reported cases.
Prop up the leg or area near the injured body part with a pillow or foam cushion. This will help relieve pressure on the area so it can start to heal. Areas at risk for friction can be powdered with plain talc to help. There are also special dressings that can be applied to protect the area from further damage.
Grade 4. A Grade 4 pressure ulcer is the most severe type of pressure ulcer. The skin is severely damaged, and the surrounding tissue begins to die (tissue necrosis). The underlying muscles, bone or joint may also be damaged [Figure 1d], sometimes very severely [Figure 1e].
Health problems that can affect blood flow can raise the risk of tissue damage such as bedsores. Examples of these types of medical conditions are diabetes and vascular disease. Age. If you're over 70, you're more likely to be affected by bedsores.
Pressure injuries are commonly seen in high-risk populations, such as the elderly and those who are very ill. Critical care patients are at high risk for development of pressure injuries because of the increased use of devices, hemodynamic instability, and the use of vasoactive drugs.
An infected pressure injury can take a long time to clear up, or even turn into a chronic wound that doesn't heal. In severe cases, it can affect the underlying bone (osteomyelitis). As the infection spreads through your body, it can also cause mental confusion, a fast heartbeat, and generalized weakness.
Mucosal Membrane Pressure Injury – Mucosal membrane pressure injury is found on mucous membranes with a history of a medical device in use at the location of the injury. Due to the anatomy of the tissue, injuries cannot be staged.
Pressure injuries and skin tears can be classified using a staging system. This staging system provides a consistent method of assessing, documenting and communicating the extent of the injury. Effective management and treatment of pressure injuries and skin tears depends on their stage or classification.
The development of a venous leg ulcer occurs in four different stages. Stage 1 – The start of a venous ulcer often appears as red and inflamed skin. This stage often goes undetected because venous ulcers look similar to a bug bite, bruise, or mild irritation.
Unstageable pressure injuries are widely understood to be full-thickness pressure injuries in which the base is obscured by slough and/or eschar. Correct identification of these pressure injuries can be challenging among health care professionals and, although treatments vary, débridement is key.
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