amputation Flashcards
disease
Peripheral vascular disease, diabetes mellitus, arteriosclerosis, and chronic osteomyelitis
Closed amputations
Create a weight-bearing residual limb, important for lower extremity amputations
Open amputations
The severed bone or joint is left uncovered by a skin flap
Required when an actual or potential infection exists, as may occur with gangrene or trauma
Complications
Hemorrhage and hematoma Necrosis Wound dehiscence Gangrene Edema Contracture Pain Infection Phantom limb sensation Phantom limb pain
Nursing Assessment
Record conditions that resulted in need for amputation
Preexisting cardiovascular problems
Family history of diabetes, hypertension, and vascular diseases
Signs and symptoms that relate to the vascular condition or other chronic and acute problems
Diet and fluid intake, intake of salt and alcohol, and use of tobacco
Exercise and rest and sleep habits as well as the effects of the current symptoms on the patient’s usual activities
Patient’s psychosocial background may offer insight into how the patient will tolerate treatments and procedures
Postoperative Nursing Care
Assessment
Monitor vital signs frequently in the first 48 hours
Inspect the dressing frequently for bleeding
If drain receptacle, note color and amount of drainage
Monitor patient’s temperature for elevations that may indicate infection
Note any foul odor from the dressing
After the dressing is removed, inspect the residual limb for edema
Document patient’s pain, including type, location, severity, and response to treatment
Assess for complications stated earlier
The Older Adult Amputee
The loss of a limb can be especially difficult; it is important to provide psychological support
Remind that phantom sensations are not uncommon or bizarre; this can reduce fear or anxiety of these sensations
Pre-operative Assessment
Assess circulatory status
Closely monitor vital signs
Inspect the residual limb (or dressing) for bleeding
Assess pain at the site of the injury and at other locations
Measure and record fluid intake and output
Note patient’s emotional status, and assess understanding of the preoperative activities and postoperative routines
Identify sources of support
Preoperative Nursing Care Interventions
Administer intravenous fluids and blood as ordered
If the dressing becomes saturated with blood, reinforce the dressing
Report continued or excessive bleeding to the physician
Even though preparations for replantation are hurried, be sensitive to the patient’s fear and anxiety
Accept the patient’s feelings
Provide brief, simple explanations
Administer analgesics as ordered for pain
Postoperative Nursing Care: Assessment
Monitor vital signs, intake and output, and level of consciousness
Hourly neurovascular assessment of limb
Doppler device or pulse oximeter to evaluate circulation
Note and record the limb’s color, capillary refill, turgor, temperature, and sensation
Assess limb for edema because massive edema often accompanies replantation
Postoperative Nursing Care: Interventions
Elevate the limb
Abstain from nicotine- and caffeine-containing products for 7 to 10 days postoperatively
Enforce a strict ban on cigarette smoking
Room at 80° F to prevent compensatory vasoconstriction of peripheral tissues
Loosen tight or restrictive gowns or pajamas
Administer ordered drugs; monitor effects
Discuss thoughts and feelings about the replantation, disfigurement, and loss of function
