Basic Patient Assessment- Manual Blood Pressure
In this reflective account I will be using the Gibbs’s Reflective Model (Gibbs 1988). During the six weeks of placement, as a first year paramedic student, I attended a variety of jobs with an Ambulance Paramedic. This included taking baseline observations on patients such as measuring with a manual blood pressure. With this placement it allowed me to learn how to do a basic patient assessment.
The fundamental caring skill that was chosen to demonstrate knowledge and understanding within a reflective framework was recording blood pressure. Blood pressure was chosen because it is a critical physiological function and a fundamental indicator of well-being. It is an important and vital observation, in that it allows early therapeutic intervention should a patient’s status change.
Throughout this procedure of measuring a patient’s blood pressure I had to concentrate and make sure no interruptions could take place as i could miss the sound of the beat. I actually couldn’t get the first sound of a beat on my first attempt so I explained to the patient and gained permission again to take the recording. To which the patient agreed, I felt self-conscious and nervous as I had missed the first sound of a beat but very pleased when I did manage to get the recording a second time.
The skill of recording blood pressure is a vital one for a Paramedic as we cannot always rely on having electronic equipment to hand. I also gained that if different circumstances can have an effect on the pressure reading. Being able to gain a learning skill I was quite worried about this skill but practice made it easier. The more blood pressure recordings that were taken, i realised that not all patients are the same. I also learned that different factors can affect blood pressure, from the patient moving about or lying down which can lead to elevated blood pressure. It has also given me a lot of confidence in myself and confidence with the patients I observed.
There are three important sources of resistance, blood viscosity, and vessel length and vessel diameter. Normal blood pressure is maintained by neural, chemicals and renal controls. Blood pressure varies from not only moment to moment but also between the distributions of the various organs of the body. It is at its lowest in neonates and increases with age, stress, and anxiety. Hypertension (high blood pressure) is also genetic, 50% of people with high blood pressure have an inherited predisposition. Alcohol abuse is also linked to high blood pressure as well as renal disease. Other factors also can include shock, myocardial infarction, and haemorrhage factors that cause a fall in blood pressure as they reduce the cardiac output. Some patients who are taking the oral contraceptive pill can be at risk from hypertension, or anyone whose health status is being assessed.
A conventional method of recording a blood pressure is carried out using a sphygmomanometer. Blood pressures were traditionally recorded this way. But in acute settings they are increasingly recorded electronically. However, Paramedics need to learn how to record a blood pressure manually as electronic devices are not always available until an Ambulance arrives.
Systolic pressure is the maximum pressure of the blood against the wall of the vessel following the ventricular contraction and is taken as an indication of the integrity of the heart, arteries, and arterioles. Diastolic pressure is the minimum pressure of the blood against the wall of the vessel following the closure of the aortic valve and is taken as a direct indication of the blood vessel resistance. Normal blood pressure generally ranges from 100/60mmHg to 140/90mm Hg but can fluctuate within a wide range and can still be considered normal. Hypotension or low Blood Pressure is generally defined in adults as systolic blood pressure below 100mmHg . In many cases hypotension simply reflects individual variations e.g. postural changes that result in lack of normal reflex response leading to low blood pressure.
In the future I will note that blood pressure is measured for one of two reasons, firstly to determine the patient’s blood pressure as a baseline prior to admission and secondly to monitor fluctuations within the blood pressure. Also next time I will make sure to listen carefully to the sounds of the beat and ask for assistance if I couldn’t work a blood pressure reading out. Overall I could have been more confident and taken control of reassuring the patient on the procedure I was doing. I wanted to make sure that I was part of a team that worked well together.
If I had to do this observation again I am going to ask for feedback on what I could improve on taking a blood pressure from my mentor. To get a feedback I will ask on how I would improve on how to take a blood pressure and what would be the easiest way to measure it without missing out the reading.