Introduction
Blood pressure is a principal vital sign that is examined by physicians. This is the pressure that circulating blood exerts on the walls of the blood vessels (Irwin & Rippe, 2008, Pp. 132). There are normal ranges of blood pressure, ranges upon which assessment is done so that blood pressure figures above or below signify an anomaly in the body systems (Criner, Barnette & D'alonzo, 2010, Pp. 187). As such, it is important for healthcare providers to be knowledgeable on how to assess blood pressure. This essay is a reflection on a skill learnt in the lab skills on how to use the manual method to measure blood pressure in an individual. The reflective essay will describe the simulated skill learnt in the skills laboratory.
In the description, the essay will touch on the instrumentation required and the process involved in performing the skill. The essay will also identify and reflect on two aspects of measuring blood pressure manually that are required for further development. The essay will also reflect on how an understanding and compassion of measuring blood pressure through manual means will assist a client, colleague or patient to meet their needs for health care. In conclusion, the reflective essay will summarize the learned experience and offer insights on how the knowledge gained in the experience will aid future practice.
Discussion
However, the association does not render the traditional method of measuring blood pressure obsolete. As a matter of fact, the association recommends that a well maintained manual device be available in a clinical setting at all times. It is important to choose the instrument to use very well. There are two variants when measuring blood pressure using the manual method. Firstly, a quality stethoscope and a blood pressure cuff or an appropriate size is required. A measuring instrument like a mercury column or an aneroid sphygmomanometer is also required in order to make the reading (Carter, 2008, Pp. 62).
Description of the skill
Learning how to measure blood pressure using the manual method was unlike any other skill I had learnt in the semester. Firstly, I prepared the ‘patient’ that I was assessing. I allowed the patient seven minutes for relaxing. This is because anxiety leads to an increase in the blood pressure of an individual because of the action of adrenaline of the heart muscles. Before making the first measurements, I made sure that the patient’s posture was as required. To this end, I ensured that both her feet were flat on the floor, she was seated upright and her arm was positioned in a way that it was level with her heart. I also advised the patient that we would not be talking when taking the measurements so as not to skew the readings.
Secondly, I chose the right blood pressure cuff for her upper arm size. Erroneous readings can occur due to the use of an improper blood pressure cuff on the patient (Meah & Kebede-Weshead, 2011, Pp. 78). I wrapped the cuff on the arm of the patient and using the index line, I determined that it was the appropriate cuff for the patient. It was at this point when I unwrapped the cuff from the patient in order to palpate the arm so as to locate the brachial artery. After making sure that the artery markers on the cuff pointed to the brachial artery on the patient’s arm, I snugly wrapped the blood pressure cuff on the patient’s arm.
Thirdly, I palpated the antecubical fossa of the arm wrapped with the cuff for the strongest pulse sounds. It was at that point where I placed the bell of the stethoscope just above the brachial artery. While holding the bell of the stethoscope in position, I inflated the blood pressure cuff by pumping the bulb of the cuff while listening to the sounds. The cuff is inflated until the pressure stops blood flow as evidenced by no sounds via the stethoscope. At this point, the gauge read 40 millimeters of mercury above the patient’s normal reading (Gregory & Mursell, 2010, Pp. 159). The normal reading was gotten from her hospital card. At this point, I started deflating the cuff as recommended by the American Heart Association at three millimeters of mercury per second. This rate is to avoid any erroneous readings that would be made if the deflation was one at a faster rate. While deflating one should be listening for the systolic reading. The sounds I hear resembled a taping noise initially. The first rhythmic sounds are those of the systolic pressure as the blood starts to flow via the previously blocked artery.
The blood pressure readings show both the systolic and diastolic pressure (Pinnock, Lin, & Smith, 2006, Pp. 135). At this point, I had recorded the systolic pressure of the patient. In order to get the reading for the diastolic pressure, I continued listening on the stethoscope as the blood pressure cuff constantly decreased in pressure. This was also characterized by fading in the sounds. The diastolic pressure reading is made when the rhythmic sounds previously heard stop. After recording the diastolic pressure, I counterchecked the readings I had made for accuracy. However, I had to wait for a five minute period before counterchecking the figures for accuracy. Since the patient was not suspect for high blood pressure, I did not deem it necessary to recommend a twenty four hour blood pressure study. Normally, this is done on the premise that blood pressure is higher than normal in the mornings and lower than normal towards the evening (Keir & Keir, 2008, Pp. 179).
As espoused earlier, this learning experience was unlike no other in the semester. However, some aspects of the learned skill needed further development. During the practice of the learned skill, I felt that the following aspects of measuring blood pressure using manual means needed further development. Firstly, listening to the rhythmic sounds in the brachial artery using a stethoscope needs further development. In my practice, the first sounds after the deflating the cuff was similar to tapping sounds. These later cleared up into more audible sounds. Experience is required when listening to these sounds.
Otherwise, a nurse who is inexperienced may miss out on the first rhythmic sounds hence affecting the accuracy of the results. I attribute my ability to distinguish the sounds from the literature I had read from the American Heart Association journals and increased concentration. Another aspect that requires further development is getting the pulse at the elbow of the hand where the brachial artery is visible. I reckon that other sites should be established in order to cater for situations where this site cannot be used, for instance in cases of amputation of the hand at the shoulder. During my practice, I did not experience this. However, in an anticipatory mode, I cannot help but be ready when I encounter such a situation during my practice.
Understanding the manual method of measuring blood pressure is important in the practice of nursing. A nurse is tasked to care for the health care needs of the patient above other things. As a vital sign, it is important for the nurse to have a clear understanding and compassion about using the manual methods (Allen & Harper, 2011, Pp.56). This is because it is important when determining different causes of action that might be taken on a client. Blood pressure measurement is core to developing a nursing diagnosis which in turn is important in the care of a patient in a clinical setting.
Conclusion
The experience in the skills laboratory has taught me a vital skill, measuring blood pressure using the manual method. Through the learning process, I have learnt the sources of error when making the readings for systolic and diastolic pressure. I have also learnt how to avoid these errors using ways that have been approved and recommended by the American Heart Association. I have also learnt on how to choose the right instrumentation to use during the procedure and the various ways of checking for the appropriateness of the various parts of the manual devices. Through the experience in the skills laboratory, I can sufficiently say that I can now make accurate measurement of blood pressure using the traditional method.
The skill learnt is of very big significance in my future practice. As espoused in the discussion, blood pressure is a vital sign in assessing a patient. The skill learnt will not only better my practice but also give me confidence when I am attending to my patients. In my future practice, I would want to join the Doctors without Borders in charitable work in third world and disaster prone areas. This skill is important as there may not be automated blood pressure devices in these areas.
References
Allen, C., & Harper, V. (2011). Laboratory Manual for Anatomy and Physiology. Hoboken, NJ, Wiley.
Carter, P. J. (2008). Lippincott's textbook for nursing assistants: a humanistic approach to care giving. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins.
Criner, G. J., Barnette, R. E., & D'alonzo, G. E. (2010). Critical care study guide: text and review. New York, Springer.
Gibson, J. L., Shah, B. M., & Umberger, R. (2013). Clinical medical assisting: an introduction to the fundamentals of practice. Burlington, MA, Jones & Bartlett Learning.
Gregory, P., & Mursell, I. (2010). Manual of clinical paramedic procedures. Chichester, U.K., Wiley-Blackwell.
Griffin, B. P. (2013). Manual of cardiovascular medicine. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins.
Irwin, R. S., & Rippe, J. M. (2008). Irwin and Rippe's intensive care medicine. Philadelphia, Wolters Kluwer Health/Lippincott Williams & Wilkins.
Keir, L., & Keir, L. (2008). Medical assisting: administrative and clinical competencies. Clifton Park, NY, Thomson Delmar Learning.
Meah, M., & Kebede-Weshead, E. (2011). Essential laboratory skills for biosciences. Chichester, West Sussex, UK, John Wiley & Sons.
Pinnock, C. A., Lin, T., & Smith, T. (2006). Fundamentals of anaesthesia. Cambridge, Cambridge University Press.
