Discussing The Practice Of Manually Measuring Blood Pressure Nursing Essay

Discussing The Practice Of Manually Measuring Blood Pressure Nursing Essay In this assignment I have chosen to discuss a manual blood pressure a clinical skill in which I have become competent in practising. Developing the ability to perform a practical skill safely is necessary for all nursing students (Nursing and Midwifery Council NMC 2008). I will reflect on this skill using a reflective model I will be using the Gibbs model (1998) which consists of five elements description, feelings, evaluation, analysis conclusion and a action plan. I have chosen this skill as in all the clinical placements I have been placed in blood pressure monitoring has always been used but the electronic method preferred. While observing other healthcare professionals performing this skill I have encountered different standards and conflicting evidence. Having both the skills and the knowledge of how to take a manual blood pressure is essential for patient safety (NMC 2008). Achieving competence in this area has become more difficult since the introduction of the electronic BP monitors. I have researched the topic of blood pressure monitoring to give myself a greater knowledge. The patient was an 86 year old gentleman with hypertension (see Profile). High blood pressure is a very common condition in modern society if left undetected can lead to life threatening conditions (British Hypertension Society BHS 2009). It is estimated that 6.5% of patients have been wrongly diagnosed as hypersensitive having their blood pressure taken using an electronic method (Coe and Houghton 2002). Having the skill of taking a manual blood pressure is important for patientà ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬Ãƒ ¢Ã¢â‚¬Å¾Ã‚ ¢s safety and health. Description I was asked by my mentor while in clinical placement to perform a manual blood pressure. The electronic method that was usually used was faulty and an accurate reading could not be obtained. As a student nurse I had been taught the skill in university and practiced on fellow students but not had much opportunity to perform the skill on placement. Following a discussion with my mentor I collected the equipment to make sure it was all available and in working order. I returned to the patient and asked if I could carry out the procedure and washed my hands before starting. I then assessed the position of the patient to make sure I had access and that he had no restricting clothing on and that he was in a comfortable position. Placing a pillow under his elbow I placed a medium sized blood pressure cuff on the upper arm of the patient. The cuff was centred using the arrow on the cuff over the brachial artery. I then located the brachial pulse and placed my fingers over the pulse. Making sure the valve of the bladder was closed I inflated the blood pressure cuff until I could no longer feel the pulse, this is the estimated systolic pressure I then deflated the cuff. Leaving for a few seconds before continuing I located the brachial pulse again and placed the diaphragm of the stethoscope over this point. I inflated the cuff again to the estimated systolic I have previously gained adding 30mmhg. When reaching this point I began to deflate the cuff slowly and listen for the first beat or korotoff sounds. This would give me the systolic pressure and then continued to listen for the last beat which is the diastolic pressure. The last beat was very hard to listen for as the patient in the next bed began to cough so had to inflate the cuff again and listen until I could confirm the reading. After finishing the procedure I left the patient comfortable and went to clean the equipment, to document and report the result to my mentor. After performing the skill on the patient my mentor asked me to perform the skill on her to give me more practice after explaining to her I had not had much experience. While doing this she advised me on tips that would help me improve practice. She suggested that if the area was noisy that I could watch for a slight flicker on the needle of the sphygmomanometer to identify the first and last beat. Another tip was that I could use the radial artery instead of the brachial artery. My mentor also mentioned to make sure that the patient did not have their legs crossed. Feelings After this procedure I felt that I had performed the skill well even though I had not had a lot of practice performing the skill. Being asked to do the manual blood pressure I initially had reservation at whether I was competent at the procedure but think this was just lack of confidence. On reflection I would have had more confidence in myself if I had more opportunity to practice the skill in clinical practice. Evaluation A positive outcome is that I now feel more confident to perform the skill of taking a manual blood pressure accurately. Having performed the skill on my mentor after performing on the patient and being given tips that would improve my practice has given me the confidence to perform the skill. I also now have a better knowledge of the evidence based practice of taking a manual blood pressure after reading about the subject and the importance of accurately measuring the blood pressure. This includes different factor that can affect blood pressure and prevent from obtaining an accurate reading. However the negative of the situation is the manual blood pressure monitoring is not widely used in some clinical areas and they are heavily reliant on the electronic method. Analysis My mentor asked me to perform the manual blood pressure because the electronic method was not obtaining a reading. Discussing the procedure before with her gave me confidence to perform the skill, and the importance of being able to perform the skill accurately. Having a holistic approach this is one of the skills of looking at the whole patients and not just certain aspects. Being a holistic nurse is having the knowledge and theories behind the skill. Having the evidence based practice knowing what can affect the blood pressure and taking these factors into consideration. Collecting the equipment before starting the procedure making sure that it is all in working order before hand helps make sure that you are going to obtain a correct reading. Assessing the environment before starting the procedure doing a risk assessment making sure you have adequate access to the patient will help to improve practice. Gaining consent from the patient before beginning the procedure is following the nursing and midwifery code (2008). Gaining consent from a patient must be done before any clinical procedure is commenced and patients have the right to refuse treatment or care and a nurse must respect the wishes of the patient. Gaining consent helps to ensure the patient understands the procedure that is being performed. Washing hands before a procedure using the ayliffe technique encourages good practice (World Health Organisation 2002). Using evidence based research it has been discovered that cross infection between patients has reduced with the introduction of the wash your hands campaign (NSPA 2008). Making sure that the patient does not have any restrictive clothing on the arms and that the arm is supported at heart level. Evidence has show that blood pressure can be 10 à ¢Ãƒ ¢Ã¢â‚¬Å¡Ã‚ ¬ 12 mmhg higher when the blood pressure is taken with the arm dangling giving a false high reading (Mallett Dougherty 2008). Using the correct size cuff is very important as using the incorrect cuff can give a false reading (Perry Potter 2007). Making sure the cuff fits snugly on the upper arm covering about 80% of the arm (BHS 2009). Using the arrow on the cuff help to centre the cuff in the correct place and help to locate the brachial artery which is situated in the crook of the arm. Covering only 80% of the arm also gives enough access to use the stethoscope not doing this may result in the sounds not being able to be heard adequately. Locating the brachial pulse and feeling for until it disappears this is the estimated systolic and adding 30mmhg to the pressure when inflated (Baillie 2005) this is so unnecessary pressure is not added to the arm while the skill is being performed. Using the radial artery instead of the brachial artery does give better access and I have found that it is easier to find on most patients. Using the tips given to me by my mentor I know feel that I have the knowledge to accurately perform a manual blood pressure. Gain supporting evidence from The Royal Marsden Manual (Mallett Dougherty 2008) and other sources has helped me to improve my practice which has given me more confidence to perform this skill with accuracy and competence. Conclusion I am pleased that I was given the opportunity by my mentor to improve my practice in performing the skill of taking a manual blood pressure. I am now more confident in performing the skill and can understand the importance of providing an accurate reading. The measuring of a manual blood pressure is an important skill and the evidence based practice is also a vital part of the procedure. When checking a blood pressure the most accurate method to use is a manual blood pressure (National Institute for Health and Clinical Excellence NICE 2004) Action Plan I am going to take every opportunity where possible to perform manual blood pressure monitoring as I feel that I am confident and competent enough to do so. Having this skill means that if electronic medical devices fail that I have the ability to carry on with my duties and will not affect patient care. The knowledge that I have gained from my mentor about the tips on performing a manual blood pressure I can pass on to my fellow students and other health care professionals and they can also improve their knowledge and performance on taking a manual blood pressure. In doing this I can hopefully improve patient care and make the care more individual to the patent. Words 1,634

Computer Communications: Bus Network :: essays research papers

Computer Communications: Bus Network Bus Network, in computer science, a topology (configuration) for a local area network in which all nodes are connected to a main communications line (bus). On a bus network, each node monitors activity on the line. Messages are detected by all nodes but are accepted only by the node(s) to which they are addressed. Because a bus network relies on a common data â€Å"highway,† a malfunctioning node simply ceases to communicate; it doesn't disrupt operation as it might on a ring network, in which messages are passed from one node to the next. To avoid collisions that occur when two or more nodes try to use the line at the same time, bus networks commonly rely on collision detection or Token Passing to regulate traffic.Star NetworkStar Network, in computer science, a local area network in which each device (node) is connected to a central computer in a star-shaped configuration (topology); commonly, a network consisting of a central computer (the hub) surrounded by terminals. In a star network, messages pass directly from a node to the central computer, which handles any further routing (as to another node) that might be necessary. A star network is reliable in the sense that a node can fail without affecting any other node on the network. Its weakness, however, is that failure of the central computer results in a shutdown of the entire network. And because each node is individually wired to the hub, cabling costs can be high.Ring networkRing Network, in computer science, a local area network in which devices (nodes) are connected in a closed loop, or ring. Messages in a ring network pass in one direction, from node to node. As a message travels around the ring, each node examines the destination address attached to the message. If the address is the same as the address assigned to the node, the node accepts the message; otherwise, it regenerates the signal and passes the message along to the next node in the circle. Such regeneration allows a ring network to cover larger distances than star and bus networks. It can also be designed to bypass any malfunctioning or failed node. Because of the closed loop, however, new nodes can be difficult to add. A ring network is diagrammed below.Asynchrous Transfer ModeATM is a new networking technology standard for high-speed, high-capacity voice, data, text andvideo transmission that will soon transform the way businesses and all types of organizationscommunicate. It will enable the management of information, integration of systems andcommunications between individuals in ways that, to some extent, haven't even been conceived yet.

Macbeth English CW Essay

Malcolm calls Macbeth and Lady Macbeth ‘this dead butcher and his fiend like queen,’ (Act 5, Scene 9, Line 36). Do you think that Lady Macbeth has any redeeming qualities? In this essay I will try to show that Lady Macbeth, although she is evil, does have some redeeming qualities. I think that Lady Macbeth does have redeeming qualities and that she shows these at different points throughout the play. I think that we can see Lady Macbeth as a different person because we see what happens at points when Malcolm doesn’t. We know that Lady Macbeth was not responsible for the killing of Banquo and The thane of Fife’s wife and children. However, there is ambiguity over the question of whether Lady Macbeth is a witch or not. In these times a witch could have been identified by her ability to predict the future, fly, sail in sieves, bring on night in daytime and their ‘damned spot’. This is a supposed red mark on a witch’s body from where the devil has supposedly sucked blood. In act 1, scene 5 she says: ‘Come, you spirits That tend on mortal thoughts, unsex me here And fill me from the crown to the toe topfull Of direst cruelty’ This suggests that she wants evil spirits to take over to allow her to do what needs to happen. This makes us think that she may be a witch. In Elizabethan times people were quite scared of witches and King James, the king at the time, was especially fascinated by witches. In act 1, scene 5 Lady Macbeth seems very pleased to receive Macbeth’s letter but we see her say that she doesn’t think that Macbeth will be brave enough to murder Duncan for the crown. We also see that she is ambitious and ruthless when she says: ‘And chastise with the valour of my tongue All that impedes thee from the golden round,’ But she appears to be ambitious for her husband and not for herself. I think that this is a redeeming quality as she just wants to help her husband, as she doesn’t think he will go through with it because he is not tough enough. This seems fiend like as to suggest to kill a king is awful, made even worse by the fact that he will be sleeping and unarmed. A soldier would only consider killing and armed man, in battle morally right but to kill a guest is morally wrong. This is also regicide, and Shakespeare was taking a big risk putting such a controversial thing into one of his plays. I think that Lady Macbeth might horrify the audience with her language here especially when she says: ‘Which fate and metaphysical aid doth seem To have thee crowned withal.’ I think that the audience would have been particularly shocked with the words ‘metaphysical aid’ as these are supernatural forces. I think that the audience would have been shocked further when Lady Macbeth says: ‘Come, you spirits That tend on mortal thoughts, unsex me here And fill me from the crown to the toe topfull Of direst cruelty’ Here Lady Macbeth calls to the evil spirits and asks them to full her with cruelty. This would have suggested that she either was a witch or wanted to become a witch. For the audience at this time this would have been horrifying. The words that Shakespeare uses suggest that Lady Macbeth’s head is full of thoughts of becoming queen, especially when she says, ‘crown’. Also the alliteration in the phrase, ‘to the toe topfull’, stresses the ‘t’ sounds and stresses the syllables of ‘topfull’. Then Shakespeare uses soft ‘s’ sounds, which sound like hissing, suggest Lady Macbeth’s association with evil. The association with evil comes from the story of Adam and Eve. In the Bible Adam and Eve are tempted by a snake to take an apple from the tree. This snake was in fact the devil and this therefore associates a snake (or hissing sounds) with the devil and evil. I don’t think that Macbeth’s and Lady Macbeth’s relationship is conventional for the time as she seems to have a more male role. She seems stronger than Macbeth and in a way seems to have a power over him. She hasn’t even spoken to him yet and she has already decided what the plan of action is going to be in order for him to become king. In Act 1, Scene 6, we see Lady Macbeth welcoming Duncan to her house. In this scene she plays the role of the hostess and seems to be extremely evil in this scene. We have just seen her telling Macbeth about the plan to kill Duncan and now she is being really nice to Duncan. This will cause the audience to dislike her as we can see that she is obviously not a very nice person. This shows her as being really two faced and insincere towards Duncan. She is being, as she tells Macbeth to be later on, the innocent flower but the serpent underneath. In Act 1, Scene 7, we see Macbeth talking to himself and saying that he has no motives or good reasons to kill Duncan. But then Lady Macbeth comes in and uses blackmail and she taunts him to get him to go through with this, and to get her own way. ‘When you durst do it, then you were a man. And to be more than what you were, you would Be so much more the man.’ This suggest that Lady Macbeth thinks that Macbeth is a coward and therefore not a man. This is fiend like as she is blackmailing Macbeth into doing it. She is telling him he is not a man, and to be unmanned was a bad thing in Elizabethan times. Lady Macbeth, therefore, looks like she is very responsible for Duncan’s death as it wouldn’t have even happened if Lady Macbeth hadn’t persuaded Macbeth to do it. In this scene Macbeth appears to be weak and not the dominant person in this relationship. Also she doesn’t appear to show any recognition that what she is doing is so wrong. I think that Lady Macbeth would shock the audience when she says that she would rather kill her own child than break such a promise as this one. ‘†¦I have given suck and know How tender ’tis to love the babe that milks me: I would, while it was smiling in my face, Have plucked my nipple from his boneless gums And dashed the brains out, had I so sworn†¦Ã¢â‚¬â„¢ This also shoes Lady Macbeth’s fiend like qualities. This statement would have shocked the audience greatly. She says that she would kill her own baby while it was smiling at her while she was breast feeding it if she had sworn to do so. This is a shocking statement and I think it would have shocked anyone. This truly shows how evil she is. This statement also raises another point of ambiguity. Lady Macbeth says, ‘I have given suck†¦Ã¢â‚¬â„¢ This suggests that she has had a baby but there appears to be no child now. This raises the question of where the child is or if it is even alive. In Act 2, Scene 2 Lady Macbeth appears to have a few redeeming qualities. The fact that she has had to have a drink because she isn’t feeling brave is a redeeming quality. Also the fact that her thought are flicking around shows her tension and suggests that she is not as impenetrably ruthless as she seems. ‘†¦He is about it. The doors are open, and the surfeited grooms Do mock their charge with snores.’ This is another redeeming quality as it may shows her feeling guilty. Also when she says: ‘†¦Had he not resembled My father as he slept, I had done’t.’ This shows that she does have compassion as she couldn’t kill someone who looked like her father. Also in this scene when Macbeth comes back from killing Duncan, Macbeth and Lady Macbeth have a frantic, disjointed conversation while Macbeth is holding the daggers. This conversation last for thirty seven lines and it is only on the last line that Lady Macbeth realises that Macbeth is still holding the daggers. This shows how panic stricken they are and how neither is thinking clearly. This is a redeeming quality as this suggests that Lady Macbeth feels guilty and worried. In Act 2, Scene 3, Lady Macbeth faints when she hears that Duncan has been murdered. This is ambiguous as we don’t know if she is actually fainting or whether she is trying to cover up the situation. However this point is ambiguous as there are a number of reasons for why she might have fainted. She could be surprised (or even dismayed) that Macbeth is acting on his own or she might be shocked at Macbeth’s rashness when he kills the guards. Another point is that she might genuinely be upset at Macbeth’s gory description, as she said that Duncan reminded her of her father. The story which is probably more likely is that she is trying to draw attention away from the fact that Macbeth killed the guards to stop him from looking so guilty. This shows how evil she is. She doesn’t want people to focus on it too much and she also doesn’t want to be blamed. In Act 3, Scene 2, we see that Macbeth and Lady Macbeth have drifted apart ad become more distant. Macbeth has become more independent as well. We see this when we see that Macbeth has made plans to kill Banquo, but Lady Macbeth is not involved. This is a redeeming quality as we see that Lady Macbeth has nothing to do with this murder, only they murder of Duncan which was to help her husband anyway. She seems to be affected by this as she asks him what will happen, ‘What’s to be done?’, but Macbeth won’t tell her. In Act 3, Scene 4, we see the banquet held by Macbeth. Lady Macbeth seems to be different at the start of this scene as Macbeth says, ‘our hostess keeps her state’. These suggest that Lady Macbeth is sitting quietly, away from everyone else. This shows that she is not acting like the conventional hostess. This also ambiguous and suggests that Lady Macbeth may have begun to lose her mind already or she may be feeling isolated as she and Macbeth have drift apart. This could also shows that she is feeling guilty which is a redeeming quality. However, as soon as Macbeth leaves the feast Lady Macbeth goes after him to remind him that he mustn’t leave and that he needs to go and be the host. When Macbeth starts to see Banquo and behave weirdly, Lady Macbeth covers up for him but tells him to stop being stupid and entertain the guests. ‘You have displaced the mirth, broke the good meeting With most admired disorder.’ Here she is scorning Macbeth for ruining the banquet and drawing attention to himself. Lady Macbeth does not seem to feel guilty in this scene but she does seem afraid. I don’t think that she shows signs of feeling in this scene as she still blackmails and taunts Macbeth to get him to sit down and act as though everything is normal. Act 5, Scene 1 is the last scene that we see with Lady Macbeth in it. I think that Shakespeare uses the sleepwalking in this scene so that all can be revealed by Lady Macbeth to another character. I think that in this scene we begin to feel sorry for Lady Macbeth and I think that she has some redeeming qualities in this scene. One is that she acknowledges that she has done something wrong. ‘What will these hands ne’er be clean?’ This shows that she thinks she has blood on her hands and she wants then to be clean. She obviously feels guilty as she is having nightmares about it all. Also in this scene Lady Macbeth begins to speak in prose. Shakespeare always makes his main characters speak in verse but Lady Macbeth no longer speaks in verse. This shows that she is mad and is no longer important to the play. Also I think another redeeming quality is that she seems to feel responsible for all the deaths throughout the play, even tough she was only really responsible for one of the deaths, Duncan’s. I think that in this scene we begin to feel sorry for Lady Macbeth and like her a bit more. This scene shows that she does have redeeming qualities and that she isn’t completely evil. I don’t think that lady Macbeth is a ‘fiend like queen’. I think she is evil but has many redeeming qualities which make her seem a lot better as you go through the play. I also think that the fact that we see more of Lady Macbeth than Malcolm does mean we have the opportunity to see these redeeming qualities whereas Malcolm might not. I think that the moral of this play is don’t kill the king. It is not honourable or good and it will come back to haunt you.

Rutherford B. Hayes Facts and Brief Biography