Ankle-Brachial Pressure Index in Determining Leg Ulcers - Essay Example

?Report Executive Summary Mrs. P has an infection in the leg for around 4 weeks and the wound does not show any sign of healing. In this regard, Mrs.P consulted with a medical practitioner. Doppler is identified to be an effective assessment tool for examining leg ulceration. The reports of Doppler test assist in measuring ‘Ankle-Brachial Pressure Index’ (ABPI) in order to determine leg ulcers. Moreover, additional assessments are executed in order to ascertain the type of leg ulcers and factors accountable for this disease. Additionally, health education is offered to health care workers and patients so that treatment and care is offered appropriately for quick recovery. Health education will also facilitate in developing trust with physicians and treatments offered. Table of Contents Table of Contents 3 1. Introduction and Rationale for the Study 5 2. Doppler Assessment - Background Information Regarding Doppler 6 2.1 Evidence in Support 6 6 2.2 Potential Disadvantages 7 7 2.3 Barriers to Implementation 7 3. Underpinning Policy 8 3.1 RCN 8 3.2 SIGN 8 3.3 CREST 9 3.4 Local Trust Policies 9 9 4. Health Education 10 4.1 Implications for the Patient 10 10 4.2 Secondary Intervention as Aids Treatment Decisions, How? 10 10 4.3 Implications for the Trust 10 5. Conclusions 11 5.1 Effective in Aiding Diagnosis 11 5.2 Limitations if used in Isolation 11 5.3 Risk of Misinterpretation 11 5.4 Referral for Vascular Assessment 12 6. Recommendations 12 6.1 Continue to use Doppler 12 6.2 Use in Conjunction with Leg Ulcer Assessment Tool 13 6.3 Ensure Programme of Education is Available for Staff 13 6.4 Ensure Patients Are Educated With Regard To Symptoms and When to Have Doppler Assessment 13 References 15 Bibliography 20 1. Introduction and Rationale for the Study Mrs. P has a wound in her legs for 4 weeks and there was no sign of heal with normal medication and care. On diagnosis by a vascular surgeon, it is identified that Mrs. P has leg ulceration. Moreover, Mrs. P should undertake other assessments with the intention of determining the type of leg ulcer and the factors accountable for this disease. The common health related problem amid the general population is leg ulcers. Leg ulcers are usually identified as wounds in the lower part of the legs. People with poor blood circulation or inappropriate working valves in the veins are the ones affected with leg ulcers. This disease is common in the adult population with age above 65 years. This disease is caused mainly due to certain factors including obesity, smoking and diabetes. The disease takes a longer time to heal due to pathogenic factors in the infected area. Clinically it is identified that there are two types of leg ulcers, which include arterial ulcers and venous ulcers. Venous ulcers are common in leg ulceration. Venous ulcers are found in 1.2-3.2 rate of per 1000 people, which implies that around 70,000 to 190,000 people in the UK are suffering from this disease. The disease is required to be treated in an appropriate manner to minimise the risks associated with deteriorating wound conditions, harming the patients and delay in healing procedures (Posnett, 2008; Rippon & et. al., 2007). The common causes of leg ulcers are venous insufficiency, arterial occlusion, microcirculatory disorders, physical or chemical injury, infectious diseases, vasculitis, neuropathic diseases and haematological disorders among others. Heath care workers offering care and treatment to people with this disease must have adequate knowledge in relation to clinical picture, diagnostic possibilities, pathogenesis and treatment modalities about the causes of leg ulcers. Leg ulcers should be identified and treated suitably in its initial stage as later the risks increases leading to morbidity as along with impaired life quality. Additionally, cost of treatment and care in the initial stage is economical, but in the later stage of this disease cost has shown a considerable amount of rise of around ?200 million and $1 billion on an annual basis in the United Kingdom (UK) and United States of America (US) (Schofield Publishing Ltd, 2007; Mekkes & et. al., 2003). There are various treatments offered on the basis assessment of leg ulcers. Furthermore treatment and care in relation to leg ulcers should be offered to patients after executing a thorough analysis of leg ulcers. In this regard, leg ulcer should be examined on the basis of Doppler test, depth as well as size, previous treatments and pain (NSW Health, 2012). 2. Doppler Assessment - Background Information Regarding Doppler 2.1 Evidence in Support Doppler is a non-invasive deceive used for the assessment of blood pressure in the ankle area. The assessment performed with the assistance of this devise will assist in having a better diagnosis and information in relation to the identification of causes accountable for leg ulcers. The Doppler assessment will also assist in determining that whether legs ulceration is arterial ulcers or venous ulcers. In this regard, this device plays an important role in identifying the type of leg ulcers and accordingly appropriate treatment can be offered (AWMA, 2011). Clinically, Doppler test aid in measuring ‘Ankle-Brachial Pressure Index’ (ABPI). The ABPI aid in comparing the blood pressure of the ankle with that of arm signifies the requirement of any future treatment for leg ulcers. The blood pressure within the arms and legs is measured with the assistance of blood pressure cuff and a Doppler ultrasound device respectively (Ruff, 2003). In this context, faint or no sound will signify that there is an obstruction in the flow of blood. In this regard, it is examined that the circulation of blood within the body of Mrs. P has been reduced in the leg, which signifies that Mrs. P is suffering from venous ulcers (NHS, 2012). 2.2 Potential Disadvantages Doppler applied in the assessment of leg ulceration do possesses certain disadvantages. The major disadvantage of utilising ultrasound based Doppler device in the examination of leg ulcerations is that it should be operated by experienced professionals and specialist nurses. Moreover, in the Doppler test, regarding 0.8 as the cut of point is irrelevant for recognising the transition amid venous as well as arterial ulceration. Accordingly, inappropriate treatments may worsen leg ulcers. Another disadvantage of Doppler test is that there is a single cut off point on the basis of which treatment is offered to patients with leg ulcers (Parker, 2012; SMTL, 2001). 2.3 Barriers to Implementation There are certain barriers to implementation which include disruption at the time of evaluation through Doppler as the test is cumbersome. There are patients who are unwilling to have a Doppler test due to the fear of having serious health related problems. Additionally, patients after the Doppler test are not offered with adequate treatment facilities rather they are consulted to contact medical experts for further treatment (Lefebvre & Mason, 2013). In this context, it is observed that Mrs. P hesitated for Doppler test with the fear that some major health related diseases may be identified. 3. Underpinning Policy 3.1 RCN Doppler should be used by professionally trained medical practitioners and nurses in relation to treatment of leg ulcer. It is recommended that nurses should be provided with inadequate training facilities with the objective of assisting health care practitioners to develop their competencies in order to assess leg ulcers effectively (Royal College of Nursing, 2000). Heath care professionals and nurses are offered with adequate training services in order to improve their knowledge and skills so that leg ulcers can be assessed appropriately. Moreover, proper training and practice will assist in identifying leg ulcers in initial stage will minimise risks of major health related issues. These practices are adopted in health care facilities with the aim of minimising compression therapy (Royal College of Nursing, 2000). 3.2 SIGN SIGN support the use of Doppler as one of the major devices for the assessment of arterial insufficiencies. Moreover, SIGN has recommended Doppler to be the best suited device in the assessment procedure for the management of leg ulcer. This assessment tool is used as a current practice in health care facilities in order to assess people with leg ulcers. The guidelines and practices offered by SIGN are adopted by nursing staff and medical practitioners with the intention of assessing patients with leg ulcers (SIGN, 2010). 3.3 CREST Leg Ulcer is one of the common identified health related issue within the general population. In this regard, CREST has recommended that Doppler is an effective device with the assistance of which assessment in relation to ABPI can be performed. Moreover, CREST will assist in analysing flow of blood in legs amid people with leg ulcers. In this regard, CREST has signified that in order to assess leg ulcers appropriately and in a timely manner, Doppler should be used in health care facilities. These practices are used by nurses and professional medical practitioners so that leg ulcers can be analysed efficiently (Activa Healthcare Ltd, 2002). 3.4 Local Trust Policies Leg ulcers are identified as a common heath care problem in majority of the population especially amid people of ages ranging over 65 years. In this regard, with increase in people suffering from leg ulcers, Doppler is determined to be an important tool of assessing leg ulcers. On assessment of Doppler test, the reports are forwarded to medical consultant and carer so that people with leg ulcers are offered with appropriate treatments. Moreover, the device will assist in reducing infections relating to leg ulcerations by providing better treatment and care. These practices are used by nurses and health care professionals so that leg ulcerations can be detected appropriately (NHS Technology Adoption Centre, 2011). 4. Health Education 4.1 Implications for the Patient The patients should be offered with health education in relation to Leg ulcers. Moreover, patients should also be aware of the effective assessment tools for identifying leg ulcers appropriately to foster proper treatment and care. In this context, patients with adequate care and treatment in initial stage will be able to recover and heal quickly (Alnaif & et. al., 2009). 4.2 Secondary Intervention as Aids Treatment Decisions, How? Secondary intervention will assist in educating patients and people in community to be aware about leg ulcerations and the health related issues associated with it. Health care workers should be trained and measures should be undertaken with the objective of ensuring people of a community are diagnosed and offered with medications in order to minimise risks of leg ulcerations. In this respect, secondary intervention will assist in preventions as along with control of leg ulceration (WHO, 2013). 4.3 Implications for the Trust Health education is offered to patients and the health care workers in order to build and obtain trust amid them so that appropriate medication can be offered. Moreover, awareness of patients about their health issues will assist them in healing from their health problems quickly. Patients on appropriate diagnosis are seemed to be fully dependent on physicians for their treatment and care. Health education is also recognised to be efficient for developing a better relationship amid medical practitioners and patients. In this context, patients with proper health education develop trust for the equipment used i.e. Doppler for treatment and cost related with the treatments for leg ulceration. Furthermore, medical practitioners as well as the workers are offered with adequate training services and policies so that an enhanced relationship is developed amid patients and heath care facilities (Rowe & Calnan, 2006; Kao & et. al., 1998). Contextually, Mrs. P with appropriate health education will be aware of her illness and treatments to be offered on the basis of care, medication, cost associated and medical devices. 5. Conclusions 5.1 Effective in Aiding Diagnosis Doppler is one of the most effective devices for the assessment of leg ulceration in an appropriate manner. Moreover, on the basis of assessment report obtained from Doppler test is used by medical practitioners for further treatment and care. 5.2 Limitations if used in Isolation Doppler is an important assessment tool used for diagnosis of leg ulceration. This device should not be used in isolation as the assessment report obtained from Doppler test will not provide adequate information about the type of leg ulceration. 5.3 Risk of Misinterpretation Doppler test should be used by professional medical practitioners and nurses as inappropriate diagnosis will lead to mistreatment worsening leg ulcers. Moreover, with mistreatment, the Doppler test will become insignificant as patients will lose trust and take legitimate actions. 5.4 Referral for Vascular Assessment Doppler is used for as a tool for measuring ABPI with the intention of diagnosis of leg ulceration. Moreover, additional assessments should be performed with the intention of identifying the appropriate causes and treatments required by vascular surgeon and the specialist nurses. Mrs. P understands the various importance and limitations of Doppler and on the basis of which she will be able to acquire appropriate treatment and care. 6. Recommendations 6.1 Continue to use Doppler Doppler is an effective assessment tool used for the purpose of examining leg ulceration. Medical team on the basis of this report and further investigations are able to provide appropriate treatment and care services for their quick recovery. In this regard, Doppler should be used in health care facilities. Additionally, if the ABPI reading is more than 1.3 then Doppler should be used in future for assessment of ABPI (NHS South Essex, 2010). 6.2 Use in Conjunction with Leg Ulcer Assessment Tool Doppler test assist in recognising leg ulcers, but additional assessments should be executed with the intention of determining the various factors which include pathogens and type of leg ulcer so that appropriate treatment and care are offered to patients (Rayner & et. al., 2009). 6.3 Ensure Programme of Education is Available for Staff Doppler and other medical devices used for the assessment and treatment of leg ulcerations should be used by trained nurses and professional medical practitioners. Moreover, health care workers should be offered with education and training services so that appropriate treatment can be offered as mistreatment will worsen leg ulcers (Aldeen, 2007). 6.4 Ensure Patients Are Educated With Regard To Symptoms and When to Have Doppler Assessment It is essential that patients are offered with health education services as patients will be aware of their illness and accordingly will develop trust towards the medication, treatment and care offered. Patients will also be able to identify the symptoms accountable for leg ulcers and undertake Doppler test so that with appropriate treatment and medication patients are healed quickly. Moreover, patients will also build a better relationship with physicians (Kunimoto & et. al., 2001). In this context, Mrs. P should undertake Doppler and other assessment tests, so that with appropriate diagnosis, the factors as well as causes in relation to leg ulceration can be recognised effectively. 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