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Procedure of Performing Ankle Brachial Pressure Index

Share this: Facebook Twitter Reddit LinkedIn WhatsApp 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 patient’s 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 patient’s 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 couldn’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. Share this: Facebook Twitter Reddit LinkedIn WhatsApp
This research paper investigates the “digital divide” a term used in the past years as technology advances worldwide. This advance in technology has allowed many to access the digital world. However, as technology grows so does this gap. Worldwide this is due to either economic, societal, educational or structural factors within one’s life. This inequality due to such factors creates what we now know as the digital divide. This paper will examine these factors which may contribute with the digital divide and the what worldwide has been done to improve the divide. The term “digital divide” was first mentioned by the U.S. Vice-President Al Gore. He used it to emphasise that the united states were “beginning to close the digital divide” (Office of the Vice-President, 1996). This gap was affected by many factors such as the knowledge, income, race and location of the person would cause a divide. However, through Al Gore the world knew of this divide and could finally work to close it. In our modern era we presume that there is global access to the cyberspace across the globe. This access allows for interaction, commerce and learning through the technologies that allow for its access. However, the most common factor which creates a vast divide is poverty. People who are unable to afford the most basics of needs will also be unable to afford the luxuries of phones or personal computers. With our modern era developing vast amounts of smart devices each which need their link to the cyberspace people must own an expensive device or a monthly fee to a service provider. Households in Australia shows that over the past few years this divide has lessened however there are still 5% of households lacking access to internet with children under 15 stretching up to a 20% lack of access to the internet in households with children under 15. That is 1/5th of the households in Australia that are part of this digital divide. With first world countries experiencing this issue the location of people in third world countries which lack both the infrastructure and wealth to have access to the divide furthermore increases the digital divide in our current era. Even the United States of America where most of the internet is hosted is not safe from this divide. Due to their governments student loan system where many students are unable to repay their debts along with other racial issues in the United States these people fall into severe debt and throughout their lives are unable to access the internet. According to recent statistics there are approximately “34 million US citizens who are unable to access the internet as what is offered to them is far too expensive” (Jim Sevier, Bridging the Digital Divide). This poverty thus prevents them from being able to even step foot into the digital world. Due to the current ISP system in many countries having a monopoly over what they do they are able to easily control and provide consumers with the bare minimum speeds that are required to access the net. Australia has taken strides to install a new National Broadband Network (NBN) however since its proposed plan in 2012 various changing governments and their lack of understanding on how signals work the current plan may be easily outdated in the next 5-10 years or so with other countries propping up 5G networks. The infrastructure that the country itself has is a huge factor to how the digital world delivers information to others. It is predicted over the next decade or so 95% of the worlds economics will be done digitally. This means that countries without a connection to the digital world will be heavily left out of this circle of economic growth. Further increasing the divide between their citizens and the information that they value and need. Rural areas such as farms and towns are also heavily impacted by the digital divide. Since most internet service providers see no profit in investing their money for internet around the farms most farmers are forced to build their own broadband network if they wish to connect themselves to the digital world. In Australia one such man called Luke Baker from Bundaberg built his own broadband network after getting frustrated with Australia’s current NBN network speeds. The network he has built with a few of his friends delivers at their best “200 megabits per second, which is double the NBN’s retail offering” (Baker, Bundaberg man Luke Baker Builds own Broadband Network). This dissatisfaction in the infrastructure which the government supplies in 2017 shows how the companies which hold a monopoly in Australia love to intentionally provide slow speeds. Optic fibre networks in other countries deliver up to 1 gigabyte speeds while Australia’s NBN has decided to use a mix of optic fibre and copper. This not also increases costs but also makes it inefficient as full optic fibre is not only resistant to external electromagnetic interference but also easily deliver speeds through light instead of slow electrical signals. However, Australia is not the only country to have issues with their networking. Though a metropolitan man got fed up with internet service providers and ran his own for double their speeds British farmers have also built their own network. This network nets to be around 2000 miles of optic fibre cable. To save money on infrastructure ISPs utilises a wireless mast to deliver data to farmers. However, as trees grew taller the broadcasting of the network were absorbed by the trees wood. Eventually no signal existed. Local farmers assisted Chris Conder as he pioneered to deliver optic fibre to all farms. When he succeeded, he delivered internet speeds as high as 1 gigabit per second, well above the UK’s average 28.9 megabits per second. This job done by a man showed how the current infrastructure of most countries developed through greed for profit from its citizens by large corporations shows how we lack infrastructure worldwide for first world countries. Third world countries however lack both the wealth and infrastructure to even step foot into this digital world. Their citizens are unable to digital world thus preventing them from obtaining valuable information that could reshape their lives. This digital divide is further emphasised as they lack the time to even comprehend the digital world as they struggle to survive on with their lives. However, that is not the only issue. Though wealth
University of jaffna Sri Lanka Week 4 Chapter 5 Flint Water Crisis Essay.

Exercise ContentChapter 5 of our textbook deals with Environmental issues and ways companies pollute our planet.I would like you to research and write a paper about the Flint Water Crisis which started in Flint Michigan in 2014.Research and use minimum 2 articles using our school’s LIRN Database, Proquest is a good source of articles.Do not Google this, I will not accept any google references.Write minimum 2 pages and use APA 7 style format and don’t forget to list your references.ONLY USE FOR REFERENCE THE LIRN OF THE SCHOOL PDF WITH INSTRUCTION TO LOF IN IS ATTACH.
University of jaffna Sri Lanka Week 4 Chapter 5 Flint Water Crisis Essay

Diseases Caused by Alcohol Abuse and its Preventions Research Paper

Recently there was a meeting on alcohol addiction in our university. We were provided with a lot of information about the alcohol addiction in particular, its symptoms, stages of development and many other points. A lot of attention was paid to the stages. The problem of these days occupies different layers of population independently of the social status and nationality. There were also such problems discussed as the properties of alcohol and its effect on motherhood, diseases caused by alcohol abuse and its preventions. Alcoholism is a very complicated and controversial issue that is reckoned to be a chronic and progressive disease (Schuckit, 2000, p. 1). As far as I know, the main three reasons of mortality in the United States are cardiovascular diseases, cancer and alcoholism. Alcoholism takes a leading place in the range of the most dangerous disease. It is important to know that it can also be prevented and it is likely to be cured. Almost every alcohol addicted person who is ready to take appropriate care and is willing to participate in healing is guaranteed to lead a complete and sober life in future. It goes without saying, that member of the families, friends, etc. should pay great attention to such people and to call for help at once noticing the first symptoms. Addicts and their families should clearly understand the seriousness of alcohol addiction and start immediate treatment on the urgent way of recovery. The meeting started from the statement that “the devastation of alcoholism addiction impacts the lives of millions of Americans each day” (Baker, 2004, p. 1). The problem is really serious and we do not even know that many people around us are affected by this disease. I have been always surprised by the amount of variable literature, tests, programs, etc. that allows finding out the alcohol addicted person easily. The most important thing is to find and to help such person. “Addiction refers to a complex behavioral syndrome including abnormal importance of the drug or activity, use of the drug or activity to an extreme degree” that results in corresponding consequences that may be late to cure if one does not call for the appropriate help at once (Behavioral Medicine Associates, 2009). Firstly, at the meeting we were presented the evaluation of the numerous obstacles that prevented addicts to take the necessary help. The participants of the meeting provided vivid discussions including the denial of the alcoholic malady, inefficient actions with the help of friend or relatives suggested regular erroneous pieces of advice of professional assistants such as doctors, pastors and physiologists. Get your 100% original paper on any topic done in as little as 3 hours Learn More There is no wonder, that the alcohol addicted person is a great master to have private conversations with consultants. So, the traditional therapies are usually wrong illusion of addicts and associates. On the other hand, families looking for outside help are rarely aware of the existence of corresponding successful treatment programs. On the contrary, the sad experience of second-class medical centers and organizations using the simplified approaches of alcohol addiction is known all across the world. The most crucial statement of the meeting impressed all the members presenting there: “the scourge of alcoholism and drug addiction may never be lifted from the human family, but effective prevention and treatment can lessen its toll of human tragedy and suffering” (Baker, 2004, p. 2). There is no way to help an addict in case one does not will to. It is very important for the addicted person to feel all harmful consequences of the addiction and of alcohol in particular before giving up this bad habit. There may be different reasons for alcoholic addiction and one of them is the emotional state of a person. The participants of the meeting aired their points of view and there even were several people who told corresponding stories and life situation about the current issue. We were also provided with the specific information about the physical symptoms “upon abrupt discontinuation or drastic reduction of dosage”: constant insomnia, weakness, irritability, increasing of temperature, respiration problems, disorientation, blood pressure, hallucinations, etc. (Behavioral Medicine Associates, 2009). Moreover, we were suggested very interesting and important information that “alcohol and drugs cause a series of temporary changes in the brain that produce a High” (Baker, 2004, p. 4). According to the representatives of Behavioral Medicine Associates, “the specific behavior characterizes alcoholism as the consumption of significant quantities of alcohol on repeated occasions” (2009). It was really a very interesting meeting providing useful information with facts, statistics and data. Alcohol addiction is a problem of the century common for million of people all over the world and it must be solved without postponing. We will write a custom Research Paper on Diseases Caused by Alcohol Abuse and its Preventions specifically for you! Get your first paper with 15% OFF Learn More Reference List Baker O. M. (2004). Understanding alcohol and drug addiction: an Lds perspective. USA: Boston: Cedar Fort. Behavioral Medicine Associates. (2009). Alcohol addiction. Psychiatry and Wellness. Retrieved from Schuckit A. M. (2000). Drug and alcohol abuse: a clinical guide to diagnosis and treatment. USA: Boston: Springer.

honors US History and Honors American Lit work

cheap assignment writing service honors US History and Honors American Lit work. I’m working on a History exercise and need support.

Assignment 1 US HISTORY
Graded Assignment
Unit Test, Part 2: Entering the Modern Era
Complete this teacher-scored portion of the Unit Test and submit it to your teacher by the due date for full credit.
Select one of the essay questions below to answer.
(20 points)


John D. Rockefeller said, “If you want to succeed you should strike out on new paths, rather than travel the worn paths of accepted success.” Entrepreneurs in the late 1800s took Rockefeller’s advice to heart and broke new ground, especially in steel, banking, and Rockefeller’s own oil industry. Write a well-constructed essay that describes the business techniques and innovations the industrialists of the late 1800s used to achieve success.

The nineteenth century could be called the railroad era. Crews made up largely of immigrants completed the first transcontinental railroad on May 10, 1869, opening a nationwide transportation network that had a tremendous impact on business, agriculture, and labor. Write an essay describing the impact of the railroads on other businesses and why the government attempted to regulate the railroads.

Realism, Regionalism, and Naturalism Unit Test, Part 2
Answer the questions fully, using examples from the reading selections to support your answers. You may refer to your Journeys anthology to answer these questions. When you are finished, submit this assignment to your teacher by the due date for full credit.
Total score: ____ of 55 points
(Score for Question 1: ___ of 15 points)

Consider both Hamlin Garland’s “The Return of a Private” and Mark Twain’s “The Notorious Jumping Frog of Calaveras County” as works of regionalist fiction. In a response of at least two paragraphs, compare and contrast these stories as examples of regionalism. How are they similar? How are they different? Be sure to include specific details and examples from both stories in your response.

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(Score for Question 2: ___ of 15 points)

What tenets of realism are evident in Zitkala-Sa’s “The School Days of an Indian Girl”? How does Zitkala-Sa’s realistic representation of her experiences affect readers?

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(Score for Question 3: ___ of 25 points)

Prior to this test, you read “There Was Crimson Clash of War” by Stephen Crane. What happens in this poem? What is the theme or central message conveyed by the work? Do you think this work should be categorized as an example of literary realism or naturalism or both? Why or why not? Use examples from the text to support your response.


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Type your name and the date at the top of this page. Type or paste your draft into this document. Be sure that your draft is double-spaced, 12 point Times new Roman font. Save the file as AML_S1_09.04_Critical_Skills_Practice_FirstInitial_LastName.doc.
Example: AML_S1_09.04_Critical_Skills_Practice_M_Smith.doc
Total score: ____ of 50 points
Read the prompt below. Consider your position on the issue. Then write an essay response. You have 30 minutes to complete this assignment. Your assignment will be graded based on the Persuasive Prompt Grading Rubric. The rubric can be found in your Unit Resources.
It is not uncommon for the evening news to talk about the local, state, or national budget. Controlling finances is an important issue for governments at many levels. Families also must control their finances. Some families create budgets that they stick to carefully, recording all outgoing and incoming money so that they never spend more than they bring in. Other families keep at least a mental count of where their finances stand. But what about young people—people your age?
Should young people be required by parents to have a budget and stick to it? Plan and write a response in which you state and explain your position on this issue. Be sure to provide support for your stand in the form of sound reasoning and relevant examples.
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Semester Test, Part 2
The semester test has two parts. Part 1 has 45 online, computer-scored questions. Part 2 has 3 offline, teacher-scored questions. Complete the offline portion of the Semester Test now. Read each question carefully. Answer in the space provided.
When you finish, submit it to the teacher. Remember: You need to complete both parts of the test by the due date to receive full credit.
Total score: ____ of 40 points
(Score for Question 1: ___ of 10 points)

Over the course of the semester, you have seen how literature can be used for a variety of purposes. Now select one text from this semester that was written to explain to its audience how communities can survive in a new land, a second text written to contribute to the creation of a new nation, and a third text written to help develop a national literature. Then briefly explain how each text you chose serves its purpose.

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(Score for Question 2: ___ of 10 points)

In America, the movement known as romanticism took two forms: Bright Romanticism, or Transcendentalism, and Dark Romanticism. How is Henry David Thoreau’s Walden, from which you read an excerpt, a good example of a Bright Romantic work? How is Nathaniel Hawthorne’s story “The Birthmark” a good example of Dark Romanticism? Refer to specific details from the works as you respond.

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(Score for Question 3: ___ of 20 points)

Nick Carraway is readers’ guide through the events of The Great Gatsby. In some ways, he is a good guide, and readers benefit from hearing his observations. In others, he is a faulty guide. Analyze the pros and cons of Nick’s narration. Cite specific examples from the novel in your response.


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honors US History and Honors American Lit work

Implementation Strategies

Implementation Strategies.

Using the paper started in Week One, add an additional 3 to 4 pages (1,050 to 1,400 words) describing your strategies for managing the project as follows:Develop a project communication plan to describe how stakeholders and managers will be kept informed regarding project progress. This will include the form of communication (status reports, meetings, etc.), frequency, and specific project milestones that will aid in determining where the implementation stands.Describe the various kinds of documentation that will be required to support the future system operation, including both user and technical documentation.Describe the Change Control Process that will be employed on the project to properly manage any disruptions to the progress of the project.Evaluate out-sourcing of implementation tasks, using consulting services versus performing them in-house, describing the costs, benefits, and challenges associated with each option.Incorporate feedback from your previous assignments.Format your paper consistent with APA guidelines.Update your project plan to include the tasks associated with this week’s assignment.Zip your assignment into one file.
Implementation Strategies

Technology and Early Childhood Education

Technology and Early Childhood Education.

There is considerable discussion and a wide body of research about technology and its place in early childhood education. Write a short analysis paper examining the role of technology in early childhood education. How does technology fit into a developmentally appropriate program? How does technology relate to children with diverse backgrounds? What uses does it have with regard to adapting educational activities? Are there any connections between technology and classroom management? The paper should be two to three pages in addition to the title page and the reference page. Use at least four references in addition to your text.
Technology and Early Childhood Education