Clinical Characteristics of Mixed Arteriovenous Leg Ulcers: A Descriptive Study.

PURPOSE: The purpose of this study was to identify the clinical characteristics of mixed arteriovenous leg ulcers (MLU) that differentiated them from venous leg ulcers (VLU). DESIGN: Secondary analysis of data from larger electronic database. SUBJECTS AND SETTING: The sample comprised 1007 persons with lower extremity ulcers. Two hundred sixty three individuals with MLU were compared to 744 individuals with VLU; their ankle brachial indices were 0.51-0.90 and 0.91-.30 respectively. Subjects were drawn from community care settings from across Canada. METHODS: Data concerning baseline demographic and pertinent clinical characteristics including ulcer history were collected using multiple validated instruments. The Leg Ulcer Assessment Tool was used to collect demographic and pertinent medical history, The Short Form Health Survey 12 and the Euro Wuol 5D (EQ-5D) were used to measure health related quality of life, the numeric pain scales was used to measure character and intensity of pain. Groups were compared using χ or Mann-Whitney U. RESULTS: Individuals with MLU were significantly older, has lower body mass index, a history of smoking, and more comorbid conditions than subjects with VLU. In many cases, clinical presentation was indicative of significant arterial insufficiency including cool extremities, shiny, cracked and inelastic skin, impaired capillary refill, and weak pedal pulses. Ulcer pain was highly prevalent, but overall pain rating was similar between groups. Mixed arteriovenous leg ulcers were associated with lower health related quality of life, greater mobility impairments, and more deficits in self-care and usual activities. CONCLUSION: Greater knowledge and understanding of the distinct characteristics of MLU is critical for appropriate screening, prevention, assessment and management of persons with this form of leg ulcer. Pain and health related quality of life factors are important considerations when evaluating and managing these patients.

Advanced cardiac examination: the arterial pulse.

The pulse is a significant indicator of health and can provide valuable information to help make an accurate diagnosis. All nurses should be competent in taking and interpreting the pulse, and developing their expertise in this vital sign. Arterial pulses can be examined at various sites, and this article focuses on techniques for palpating radial, brachial and carotid pulses.

[The pulse, an essential measurement]. / Le pouls, une mesure essentielle.

As has been known for a long time, the measurement of the pulse enables the patient's haemodynamic state to be assessed. Pulse, rate, rhythm and amplitude are indicators that enable monitoring of health status in different situations. Therefore, the nurse, in her daily practice, can and must use this measurement in preference to that provided by devices whose relevance is limited.

Providing best practice in manual pulse measurement.

This article focuses on the knowledge and pulse measurement skills that healthcare professionals require in order to safely care for patients. This paper will define pulse rate and explain why measuring pulse rate is important. In addition, it provides an overview of the different pulse sites, factors affecting the pulse, the equipment and guidelines used and information on significant groups. It will conclude by highlighting the importance of healthcare professionals acquiring the knowledge and skill of pulse monitoring.

Monitoring pulse rate.

This article, part of Nursing Standards clinical skills series, illustrates the sites for palpating the pulse and outlines the correct procedure for monitoring and recording pulse rate. This information will assist nurses to perform the skill safely as part of cardiovascular assessment of the patient.

Monitoring the pulse as part of track and trigger.

This article (part two of four) aims to explore abnormalities of the pulse rate and the related nursing observations and actions. Measurement of the pulse is a fundamental nursing observation, which can detect a range of problems.

A study of the effectiveness of different measuring times and counting methods of human radial pulse rates.

The purpose of this study was to determine the reliability and validity of measuring resting radial pulse rates by the use of three measuring times: 15, 30 and 60 s; and two counting methods: one beginning with zero (0) and the other with one (1). A two-factor within-subjects experimental design was used to determine the mean difference between pulse rates obtained from the radial artery, and the heart rates recorded by simultaneous electrocardiographic (ECG) recordings. The sample comprised 206 students. Mean difference was used to calculate the extent of any differences between radial pulse rates and the rate shown by the ECG. The interaction between measuring time and counting methods was confirmed using a two-factor within-subjects analysis of variance. For all types of measuring time, the counting from zero method produced a greater mean difference than the counting from one method. For all measuring times, the mean difference between radial pulse rates and rates shown by the ECG were non-significant in the counting from one method. In other words, when the pulse rate is counted from one, the rates obtained at 15 or 30 s could be used to predict the one-minute resting pulse rates. The results of this study can contribute to the evidence base for this commonly used aspect of patient care.