Reflection On Personal Practice Of Doppler Pressure Way of measuring Nursing Essay

I followed the District Nursing Team on placement to a Doppler Medical clinic for patients known by their GPs to be evaluated for compression bandages. I got talked through the task of performing Ankle joint Brachial Pressure Index (ABPI), which required the next accessories: Hand-held Doppler ultrasound machine; 8 MHz probe (5 MHz probe if required for large or oedematous limbs); ultrasound transducer gel; sphygmomanometer and cuff and cling film/vapour-permeable film dressing or equivalent.

I was then asked to carry out the task with another nurse. I washed my hands, placed on my gloves and apron. I elevated the foundation to my level therefore i could reach him. Seeking her consent, I asked the individual to remove any small articles of clothing, which might cause strain on the blood vessels proximal to the website where the blood pressure is being assessed.

I assessed the brachial systolic blood pressure by choosing the sphygmomanometer cuff of an appropriate size and wrapped it surrounding the patient's higher arm just above the elbow. I palpated the brachial pulse and applied ultrasound gel. I angled the Doppler probe at 45 degrees to the route of the blood circulation (towards the heart and soul) and fine-tuned the position to find the best indication. The Doppler emitted an audible signal and inflated the sphygmomanometer cuff before signal disappeared. I then deflated the cuff gradually and registered the pressure of which the signal came back. I repeated this process using the patient's other arm. I persisted this process in measuring the ankle systolic pressure by palpating the posterior tibial artery and that of either the anterior tibial or peroneal artery. I then used the higher of these two readings to assess the ABPI using the following equation

ABPI = highest ankle systolic pressure/highest brachial systolic pressure. I then recorded and described the results to the patients. I thanked the patient for her cooperation.

Feelings

Due to the actual fact that I had never completed a Doppler observation before, I experienced extremely anxious and uneasy. These feelings were made increased as I became more alert to being judged; not only by my mentor and other nurses but also by the patients the majority of whom was included with their spouses. I believed the pressure more as there were other patients hanging around to be seen and taking up a lot of time may delay them. Regardless of these, I maintained and completed the task.

Evaluation

Throughout this process I really focused and made sure no interruptions took place as I can miss the sphygmomanometer does sound. I actually couldnt find the first sphygmomanometer noises on my first make an effort so I discussed to the individual and gained permission again to have the tracking to which she agreed, I sensed self-conscious and stressed as I got overlooked the first sphygmomanometer noises but happy when I did manage to get the recording a second time. I feel I have gained a learning skill. The more Doppler recordings I required made me soon realised that no two patients were the same. I also learned that different factors may affect blood pressure, from the patient rushing in later for his visit which can lead to elevated blood pressure. It has additionally given me a great deal of assurance in myself when i upgraded my communication skills.

Analysis

An ABPI is a simple non-invasive method of determining arterial insufficiency in a limb. It compares the ankle and brachial systolic blood vessels pressures. Hook drop in the blood pressure in the lower limbs can be an signal of peripheral vascular disease. Peripheral vascular disease refers to blockage of arteries. Fundamentally, when compared with the biceps and triceps, low blood circulation pressure in the lower part of lower limbs can be an indicator of a serious health. Within the management of calf ulcers, the ABPI forms a fundamental part of the assessment. Accurate assessment is necessary to look for the correct aetiology of the ulcer and exclude those patients with arterial disease for whom compression is dangerous (Stacey et al, 2002).

In normal circumstances, the blood circulation pressure in the low leg area is a lttle bit more than that at the elbow. Where an ABPI is greater than 0. 9, it is supposed to be normal and contains no threat of peripheral vascular disease. If the ABPI value is more than 1. 3, it is an signal of severe peripheral vascular disease. If the individual struggles to lie flat, the hip and legs will be raised to the level of the heart. By elevating the feet, the hydrostatic pressure to the legs is reduced.

In order to prevent cross-infection the Doppler probe should be cleaned double with an liquor impregnated wipe prior to its use (Kibria et al, 2002). It ought to be mentioned that the ABPI should not be undertaken in isolation, but should be utilized in conjunction with a holistic diagnosis, and a medical and professional medical examination of the limb.

Conclusion

There is controversy about the circumstances in which an ABPI should not be performed, so more research is necessary. It's been suggested that an ABPI should not be performed if the patient has a suspected profound vein thrombosis, since there is a risk of emboli; or the individual has cellulitis; or because the task would be too painful; or the patient has severe ischemia; or since there is a risk of further injury.

Action Plan

As an inexperienced learner, I hope to learn more about Doppler and ABPI. I really believe having an underpinning knowledge in the task when planning on taking Doppler blood pressure helps to understand the idea behind the practice. I aim to do more at any given opportunity in conditions of, patient panic; incorrect placement of the patient; incorrect size of sphygmomanometer cuff; adding excessive strain on the blood vessel through the procedure; launching the sphygmomanometer cuff from the individual prematurely; prolonging inflation of the sphygmomanometer cuff or repeated inflation; and moving the Doppler probe during the procedure.

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