Rationale behind exam test question?

[Tdc8250]

We just had an exam in class and one of our questions was the following:

a patient with a wrist fracture has a short arm cast with impaired venous return distal to the cast, which of the following would be indicative of the patients condition?

A.) bounding pulse pressure

B.)

C.)

D.) pain unrelieved by opioids

and i cant remember the other two options but the answer was D...I chose A because if blood flow isn't returning to the heart wouldn't the pressure in the veins distal to the fracture become higher? I asked my teacher the rationale behind the question, and she said that if the patient is in pain that is unrelieved it is because of the lack of oxygen getting to the arm from impaired circulation. Which makes sense, but wouldn't a bounding pulse distal to the cast also be a sign? I'm just trying to better understand the rationale on why A wouldn't be an option!

[Okami_CCRN, BSN, RN]

This patient would be at risk for compartment syndrome and thus a pain that is unrelieved by interventions and decreased venous return are all signs of compartment syndrome (Think 5 P's).

Pulse pressure is defined as the difference between systolic and diastolic blood pressure (SBP-DBP = pulse pressure). pulse pressure isn't something that is felt, so bounding pulse pressure is a distraction answer.

[mrsboots87]

Think about where your pulse would be checked before you make that your answer. You will not likely have any palpable pulse points at the distal end of that cast as it will cover the radial pulse and over half of the hand. So the fact you can't even palpate the pulse on that hand knocks that answer out already.

But, if you could somehow check a pulse distal to the cast, it would be very weak. Since blood flow is reduced proximal to the area you are checking. It would never be bounding distal to the cast. Reduced blood flow=equals less pressure distal to the reduced flow.

As blood flow decreases to an area of the body, it becomes ischemic. With lack of blood and oxygenation, tissue begins to die. This is painful. A type of pain that most narcs is not going to resolve at normal doses. A broken wrist should NEVER have unresolvable pain. Fractures are painful but generally tolerable after the initial after a while. If your patients goes from tolerable pain managed by opioids to unrelieved pain, there is definitely a problem.

[mrsboots87]

This patient would be at risk for compartment syndrome and thus a pain that is unrelieved by interventions and decreased venous return are all signs of compartment syndrome (Think 5 P's).

Pulse pressure is defined as the difference between systolic and diastolic blood pressure (SBP-DBP = pulse pressure). pulse pressure isn't something that is felt, so bounding pulse pressure is a distraction answer.

As a nurse myself, I also got distracted. Haha. But I still wouldn't have picked that answer.

[Tdc8250]

Thank you that makes sense!!! I understand it better now

[Tdc8250]

Thank you!!!

[KelRN215, BSN, RN]

We just had an exam in class and one of our questions was the following:

a patient with a wrist fracture has a short arm cast with impaired venous return distal to the cast, which of the following would be indicative of the patients condition?

A.) bounding pulse pressure

B.)

C.)

D.) pain unrelieved by opioids

and i cant remember the other two options but the answer was D...I chose A because if blood flow isn't returning to the heart wouldn't the pressure in the veins distal to the fracture become higher? I asked my teacher the rationale behind the question, and she said that if the patient is in pain that is unrelieved it is because of the lack of oxygen getting to the arm from impaired circulation. Which makes sense, but wouldn't a bounding pulse distal to the cast also be a sign? I'm just trying to better understand the rationale on why A wouldn't be an option!

What are you feeling when you feel a pulse? Veins don't pulse. You feel pulses in an artery. And, as others have pointed out, you can't feel a radial pulse in a patient with a casted wrist because the cast is going to cover the wrist and hand. "Bounding pulse pressure" isn't a thing.

[Tdc8250]

Thank you for your clarity!

[Mavrick, BSN, RN]

Confusing rationale. Lack of oxygen to an extremity is caused by impaired arterial flow not venous. Arteries deliver oxygenated blood to body parts.

Impaired venous flow is evidenced by distal swelling (fat fingers).

Bounding pulse = a thing.

Pulse pressure = a thing.

Bounding pulse pressure = not a thing.

[bgxyrnf, MSN, RN]

pulse pressure isn't something that is felt

Au contraire: Pulse pressure is precisely what *is* felt.

As you well know, the DBP is always there and the SBP is the peak. What your finger picks up is the differential pressure, not the absolute pressure... that is, the difference between SBP and DBP... and presumably why the great "they" named it the 'pulse' pressure