A REFLECTIVE ACCOUNT OF A LEARNT SIMULATED SKILL BLOOD PRESSURE.
The aim of this essay is to reflect and discuss my knowledge acquired in a simulated learning skill experience which forms part of my training as a student nurse in accordance with the Nurses and Midwifery Council (NMC 2010).
(Marieb and Hoehn, 2010, p 703) defined Blood Pressure (BP) as ‘the force per unit area exerted on a vessel wall by the contained blood, and is expressed in millimetres of mercury (mm Hg)’. BP is still one of the essential and widely used assessment tools in healthcare settings. Nurses generally record the arterial BP which is the forced exerted blood that flows through the arteries, to establish a baseline and to determine any risk factors. BP composes of two measurements, the systolic and diastolic pressure. The systolic pressure is when the ventricle contracts and the blood is at the peak normally an average adult is around 120mmHg (Marieb & Hoehn 2010). The diastolic pressure is lower within the arteries and always present when the ventricles are at rest and the aortic valve is close. This essay will discuss the measuring and recording of BP of a colleague in a skills laboratory.
During the skills practice, a colleagues BP was measured in the skills laboratory. There are two methods for recording BP direct and indirect with this session it was the indirect technique. The manual auscultatory method measured in the arm on the brachial artery (Richards, and Edwards, 2008). I introduced myself as a student nurse and then explained the procedure involved systematically to relieve any anxieties. The patient needs to understand the process in order to consent (NMC 2010). Ensuring a relaxed and calm environment is essential, emotional and temperature variation and can affect the readings. Hand washing is essential to reduce and prevent the spread of infections especially cross-infection ((Dougherty and Lister 2011).
I washed and dried my hands appropriately, after which the equipments were assessed. The equipments used were aneroid sphygmomanometer which had been calibrated and working, a range of cuffs to ensure the right size for the hand, a stethoscope, detergent wipes, a pillow for the hand, a pen and my note book for documentation. A sphygmomanometer composes of a compression bag, an inflating bulb that is pumped to increase pressure, a manometer to read the pressure applied and is deflated by a control valve. This colleague was sitting, BP may be taken when patients are sitting or lying down not when moving or talking to ensure accurate readings (Jamieson, Whyte and McCall 2007). Primarily BP may be measured in both arms. There may be variations in results for some people especially the elderly it is recommended that the arm with the highest readings is utilized. Patient’s arms should be free of clothing, positioned at heart level and maintained to ensure accurate reading (British Heart Society 2006). Seated in a comfortable position, palpated the radial and brachial pulse, and then applied the correct size of the sphygmomanometer on the arm. According to the (British Heart Society 2006) 40% of the width and 80% of the arm circumference may be the length of the cuff bladder. Large or small cuffs may result in inaccurate readings. Next palpated the radial pulse then wrapped the cuff round the arm, inflated till the pulse was obliterated. Placed the bladder on the artery and higher to the elbow, allowing the cuffs inferior edge 2 to 3cm over the brachial artery. This will enhance accurate reading allowing easy palpitation of the artery. The patient should be still and quiet through the procedure. Again the brachial artery was palpated, the stethoscope placed firmly on the bare skin on the palpable pulse of the brachial artery as the bulb was used to inflate the cuff immediately for an additional 20 to 30mmHg above the earlier reading (Bickley and Szilagyi 2009). This avoids too much distress as the cuff is inflated not...
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