Procedure of Performing Ankle Brachial Pressure Index

Procedure of Performing Ankle Brachial Pressure Index Description I accompanied the District Nursing Team on placement to a Doppler Clinic for patients referred by their GPs to be assessed for compression bandages. I was talked through the procedure of performing Ankle Brachial Pressure Index (ABPI), which required the following equipments: 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, put on my gloves and apron. I raised the bed to my level so I could reach him. Seeking her consent, I asked the patient to remove any tight articles of clothing, which may cause pressure on the blood vessels proximal to the site where the blood pressure is being measured. I measured the brachial systolic blood pressure by selecting a sphygmomanometer cuff of an appropriate size and wrapped it around the patients upper arm just above the elbow. I palpated the brachial pulse and applied ultrasound gel. I angled the Doppler probe at 45 degrees to the direction of the blood flow (towards the heart) and adjusted the position to locate the best signal. The Doppler emitted an audible signal and inflated the sphygmomanometer cuff until the signal disappeared. I then deflated the cuff slowly and recorded the pressure at which the signal returned. I repeated this procedure using the patients other arm. I continued this procedure 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 calculate the ABPI using the following equation: ABPI = highest ankle systolic pressure/highest brachial systolic pressure. I then recorded and explained the results to the patients. I thanked the patient for her cooperation. Feelings Due to the fact that I had never completed a Doppler observation before, I felt extremely anxious and uneasy. These feelings were made greater as I became more aware of being judged; not only by my mentor and other nurses but also by the patients most of whom came with their spouses. I felt the pressure more as there were other patients waiting to be seen and taking up too much time may delay them. In spite of these, I preserved and completed the task. Evaluation Throughout this procedure I really concentrated and made sure no interruptions took place as I can miss the sphygmomanometer sounds. I actually couldnà ¢Ã¢â€š ¬Ã¢â€ž ¢t get the first sphygmomanometer sounds on my first attempt so I explained to the patient and gained permission again to take the recording to which she agreed, I felt self-conscious and nervous as I had missed the first sphygmomanometer sounds but very pleased when I did manage to get the recording a second time. I feel I have gained a learning skill. The more Doppler recordings I took made me soon realised that no two patients were the same. I also learned that different factors can affect blood pressure, from the patient rushing in late for his appointment which can lead to elevated blood pressure. It has also given me a lot of confidence in myself as I improved my communication skills. Analysis An ABPI is a simple non-invasive method of identifying arterial insufficiency within a limb. It compares the ankle and brachial systolic blood pressures. A slight drop in the blood pressure in the legs can be an indicator of peripheral vascular disease. Peripheral vascular disease refers to blockage of arteries. Basically, as compared to the arms, low blood pressure in the lower part of legs can be an indicator of a serious health. In the management of leg ulcers, the ABPI forms a fundamental part of the assessment. Accurate assessment is necessary to determine 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 pressure in the lower leg area is a bit more than that at the elbow. Where an ABPI is greater than 0.9, it is supposed to be normal and holds no risk of peripheral vascular disease. If the ABPI value is more than 1.3, it is an indicator of severe peripheral vascular disease. If the patient is unable to lie flat, the legs will be elevated to the level of the heart. By elevating the legs, the hydrostatic pressure to the legs is reduced. In order to prevent cross-infection the Doppler probe should be cleaned twice with an alcohol impregnated wipe prior to its use (Kibria et al, 2002). It should be noted that the ABPI should not be undertaken in isolation, but should be used in conjunction with a holistic assessment, and a medical and clinical examination of the limb. Conclusion There is controversy about the circumstances in which an ABPI should not be performed, so more research is required. It has been suggested that an ABPI should not be performed if the patient has a suspected deep vein thrombosis, because there is a risk of emboli; or the patient has cellulitis; or because the procedure would be too painful; or the patient has severe ischemia; or because there is a risk of further tissue damage. Action Plan As an inexperienced learner, I hope to read more about Doppler and ABPI. I believe having an underpinning knowledge in the procedure for taking Doppler blood pressure helps to understand the theory behind the practice. I aim to do more at any given opportunity in terms of, patient anxiety; incorrect positioning of the patient; incorrect size of sphygmomanometer cuff; putting excessive pressure on the blood vessel during the procedure; releasing the sphygmomanometer cuff from the patient too quickly; prolonging inflation of the sphygmomanometer cuff or repeated inflation; and moving the Doppler probe during the procedure.

Hydrogen Peroxide and Iodide Kinetics Essay

(Be sure to state references for any cited value at the end of this report. Additionally, all report material must be in INK – pencil or white-out will render the work ineligible for mark appeal) 1.What observations and conclusions can you note about each of the three reactions that occurred in the test tubes where you combined potassium iodide, KI, and hydrogen peroxide, H2O2 (in part 1) of the experiment? (Give a detailed explanation of any observations that you made, i.e., what made the colour change, what reactions happened?) ANSWER: 2.Use the information below to develop the necessary calculations for the rate of reaction from the solutions in part B of the experiment †¢Calculate the initial molarity of iodide ion in each of the solutions, once your solutions are mixed. Remember: The KI stock solution concentration was known: , and you used a specific volume of the solution, -. However, at the start of the reaction you must account for the fact that the total volume of each solution was 200 mL. ANSWER: †¢Calculate the initial molarity of the hydrogen peroxide in each of your solutions, once the solutions have been mixed. Remember: The H2O2 stock solution concentration was known: , and you used a specific volume of the solution, . However, at the start of the reaction you must account for the fact that the total volume of each solution was 200 mL. ANSWER: †¢Calculate the number of moles of sodium thiosulfate, Na2S2O3, that was initially present in each solution. Remember: The Na2S2O3 stock solution concentration was known: and you used a specific volume of the solution, . This information is used to determine the number of moles. ANSWER: †¢Balance the reaction that occurred in each of the solutions. Refer to Eq. 1, 3, and 4 in the laboratory instructions for the components that are involved. ANSWER: †¢Calculate the number of moles of hydrogen peroxide that has reacted: Note: You will need to use stoichiometry to determine this. ANSWER: †¢Calculate the change in concentration of hydrogen peroxide in each case, i.e., moles of H2O2 reacted per litre of solution. Hint: Recall the total volume, and you have calculated the number of moles that reacted, previously. ANSWER: †¢Calculate the rate of the reaction, which is simply the change in concentration of H2O2 (calculated above) divided by the time it took for the reaction to complete. i.e., the numbers of moles per litre of peroxide consumed divided by the number of seconds required to react completely. ANSWER: †¢Complete the table below – you can manually do the calculations to fill all of the cells, or it is possible to use a spreadsheet program to calculate the values. (RECOMMENDED) The process you have used above can be repeated to provide the values for each of the entries in the table. ANSWER: 3.Use the following steps to calculate the values of a and b as described in the lab procedure (under the heading: The rate law and our process for obtaining a, b, and k.) In the solutions A, B and C, the concentration of hydrogen peroxide used was the same. Therefore, these solutions are a suitable series for an examination of the dependence of the rate of reaction on the concentration of the iodide ion. Similarly, solutions C, D, and E have the same concentration of iodide ion. Therefore, those solutions can be used to examine the dependence of the rate of reaction on the concentration of hydrogen peroxide. Recalling Eq. 5 – Eq. 7 in the laboratory instructions, by plotting ln(rate) against ln[I-], using data from solutions A, B, and C, we can determine the value of a for this reaction. Similarly, by preparing a plot of ln(rate) against ln[H2O2] using the data from solutions C, D and E, we can evaluate b for this reaction. See the laboratory instructions near Eq. 5-7 for an explanation of how a and b can be determined from the slopes of the straight lines of best-fit that should be obtained using the experimental data-points. †¢Graph 1: Plot ln(rate) against ln[I-] using the data from the table for solutions A, B, and C. Add the best-fit straight line through your experimental points and determine the slope of this line. This is best accomplished by using a spreadsheet program to generate the graphs, and adding a â€Å"regression line† or â€Å"trendline† with the equation for the line displayed. The value of the slope from this line will be the value of b (as shown in Equation 6 of the lab manual). Remember: the final value of b should be integer or half-integer. ANSWER: †¢Graph 2: Plot ln(rate) against ln[H2O2] using the data from the table for solutions C, D, and E. Add the best-fit straight line through your experimental points and determine the slope of this line. This is best accomplished by using a spreadsheet program to generate the graphs, and adding a â€Å"regression line† or â€Å"trendline† with the equation for the line displayed. The value of the slope of this line is the value of a (as shown in Equation 7 of the lab manual). Remember: the final value of a should be integer or half-integer. ANSWER: 4.Using Equation 2 of the lab manual, calculate the values of k (at room temperature) for each reaction trial you performed, using your values of a, b, and the rate and concentration information in the table. You should end up with 5 values of k, for the five trials that you performed at room temperature. ANSWER: Calculate the average value of k. Use this value of k, and the values of a and b to write out the general rate law for the reaction, (see Eq. 2). ANSWER: 5.Using the rate of reaction for solution A at room temperature, and the rate of the reaction at elevated temperature, use Eq. 10 from the lab procedure to calculate the activation energy, Ea. (Note: pay attention to the units of the gas constant, R)

Hitler Was The Master Of Nazi Germany - 2003 Words

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Organizational Behavior A Study Of The Way People...

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