VOL: 96, ISSUE: 42, PAGE NO: 47
JUNE JONES, CLINICAL NURSE SPECIALIST IN LEG ULCERS, CHURCHTOWN COMMUNITY CLINIC, SOUTHPORT, MERSEYSIDEGeneral patient assessment
General patient assessment
A structured assessment that includes clinical history and physical examination is essential to determine pathologies underlying leg ulceration and why the patient has a wound that may be failing to heal. Such an assessment should be conducted not only on the first occurrence of the ulcer but also on any recurrence, and should be ongoing thereafter. It is only then that an appropriate treatment plan can be formulated. Observation of the ulcer alone is insufficient to determine the aetiology: the patient's past medical history and current medication will provide clues as to its underlying cause. The assessment should also identify any psychological or social factors that could have an impact on treatment, concordance and quality of life as well as the patient's understanding of the disease process. Ideally, a healthcare professional trained in leg ulcer management should perform the assessment.
It is important that any arterial insufficiency is detected so as to avoid inappropriate or even dangerous therapy being initiated. Both limbs should be assessed, irrespective of whether both are ulcerated. Research suggests that diagnosis should not be based solely on the absence or presence of pedal pulses, as this is a poor indicator of the presence of arterial disease (Moffatt and O'Hare, 1995).
The hand-held Doppler which measures ankle brachial pressure index (ABPI) forms the basis of arterial assessment. Practitioners require training and supervision in this technique otherwise ABPI measurements can be unreliable.