NU140CL Unit 4 Clinical Journal Example

Twenty Points Apart: A Clinical Journal Taking One Composite Moment, a Manual Blood Pressure That Disagreed With the Automatic Machine, Through Gibbs's Reflective Cycle From Description to Action Plan

[Student Name]

Purdue University Global

NU140CL: Nursing Fundamentals Clinical

Unit 4 Clinical Journal

[Instructor Name]

[Date]

The patient, nurse and instructor are composite; values are bracketed where illustrative.

Description

On my third clinical day my patient was Patient C, a composite 67-year-old recovering from a hernia repair the day before, with a history of high blood pressure. At [0800] the nursing assistant used the automatic machine, which read [108/64]. His usual readings at home, he told me, were around [130/80]. His morning lisinopril had a hold parameter of systolic below [110]. Before telling my nurse the dose should be held, I repeated the reading manually. I noticed he was perched at the bedside, arm dangling, and the adult cuff from the machine looked loose on his large upper arm. I supported his arm on a pillow at heart level, used a large adult cuff, and measured [128/76]. I repeated it two minutes later and got [126/78].

Feelings

I felt anxious. A twenty-point difference meant one reading said hold the medicine and the other said give it, and I was the student who had found the conflict. I worried that my manual technique was the problem, since I had only practiced on classmates. Mixed in was some pride at having thought to check, and some embarrassment at the thought of questioning a reading taken by a nursing assistant who had been on the unit for years. In the end she was glad I rechecked and asked to see which cuff I used.

Evaluation

What went well: I did not accept a reading that did not fit what I knew about the patient, and I repeated it twice. What went less well: I almost reported the first reading as fact, and I did not check the cuff size or arm position before the machine reading was taken.

The number on the screen was precise to the millimeter, and it was still the wrong number because of the cuff and the arm.

Analysis

My instructor and I reviewed the factors afterward. An undersized cuff usually reads falsely high, while one that is too large can read low; a loose cuff and the wrong size can both distort the result. An arm hanging below heart level adds the weight of the column of blood and usually reads higher, not lower, so position alone did not explain why the machine read low. The likelier explanations were the loose cuff, movement while the machine measured, and the machine's own method, which estimates pressure from cuff oscillations rather than detecting sounds (Pickering et al., 2005). My two consistent manual readings, taken with the right cuff and position, were the more trustworthy. My nurse rechecked with me, agreed with [126/78], and gave the lisinopril after reporting the discrepancy.

I also thought about what would have happened if I had not checked. The lisinopril would have been held on the strength of a reading that was probably wrong, and Patient C, whose blood pressure runs high, might have gone the morning without his medicine and with a higher pressure than he needed. Holding a dose is not harmless just because it feels cautious. My nurse pointed out that the reverse error, giving a dose on a falsely reassuring number, would have been more dangerous, which is why the hold parameter exists. Both errors start with trusting a single number without checking how it was obtained.

Conclusion

I learned that a blood pressure reading is only as good as the technique behind it, whether a person or a machine takes it. I also learned that a reading that does not fit the patient's history deserves a second look before it changes a medication decision. A machine is a tool that needs the same care in setup as a manual cuff, and it does not remove the nurse's responsibility for the number. Our fundamentals text emphasizes correct cuff size and arm support at heart level as basic steps that are easy to skip (Potter et al., 2023).

Action Plan

On future shifts I will check cuff size against the arm before any blood pressure, including machine readings, and make sure the arm is supported at heart level. When a reading would change a medication decision and does not match the patient's pattern, I will repeat it manually before reporting. I also plan to ask my instructor to watch one of my manual readings next week to confirm my technique. Using a structured cycle helped me move from feeling anxious to having a plan, which is what Gibbs intended the model to do (Gibbs, 1988).

References

Gibbs, G. (1988). Learning by doing: A guide to teaching and learning methods. Further Education Unit, Oxford Polytechnic.

Pickering, T. G., Hall, J. E., Appel, L. J., Falkner, B. E., Graves, J., Hill, M. N., Jones, D. W., Kurtz, T., Sheps, S. G., & Roccella, E. J. (2005). Recommendations for blood pressure measurement in humans and experimental animals. Circulation, 111(5), 697-716. https://doi.org/10.1161/01.CIR.0000154900.76284.F6

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.