amputation Flashcards
AMPUTATION
the partial or complete surgical removal of a limb as the result of a crushing injury, intolerance pain, gangrene, vascular obstruction , uncontrolled infection , or congenital anomalies
GOAL FOR AMPUTATION
to preserve the extremity length and function while removing all infected, pathologic or ischemic tissue
RISK FACTORS
- age 65 or older
- diabetes
- heart disease
- smoking
- lack of exercise
- poor nutrition
- race :African americans, Hispanics, native americans
RISK FACTORS
- age 65 or older
- diabetes
- heart disease
- smoking
- lack of exercise
- poor nutrition
- race :African americans, Hispanics, native americans
MAJOR CAUSES
- medical 70% diabetes, PVD, gangrene and infection
- trauma 20% : crushing, burns, frost bite
- congenital 4%
- tumors 4%
DIAGNOSTIC STUDIES
- WBC count
- Arteriogram
- Venogram
AMPUTATION CONSIDERATION QUESTIONS
- is there complete separation
- can the segments be reconnected or salvaged
- what will be the function of the salvaged limb versus amputations
- is there time for other treatment options
TYPES OF AMPUTATION : CLOSED
- is used to create a weight bearing extremity
- a skin flap with soft tissue covers the bony part of the (residual) limb or stump
- when would the wound not be closed?
TYPES OF AMPUTATION: DISARTICULATION
-performed at the joint
TYPES OF AMPUTATION : GUILLOTINE/ OPEN
- leaves the bony end open
- generally used to control or prevent potential infection
- the wound is closed later by second surgery
NURSING IMPLICATIONS
- health promotion
- acute (nursing) interventions
PRE-OP TEACHING
- discuss the level of amputation
- discuss normal feelings grief/loss
- phantomlimb sensations
- describe dressing process
- pain control
- rehab initiation goals
- discharge plans
POST- OP CARE
- pain
- bleeding from site
- vital signs
- stump elevation
- cast care
POST- OP TEACHING : POSITIONING
- elevate for 24-48 hours
- keep flat after 24 hours
- prone positioning (at least) 2x daily
POST- OP TEACHING : POSITIONING
- elevate for 24-48 hours
- keep flat after 24 hours
- prone positioning (at least) 2x daily
POST- OP TEACHING : STUMP CARE
- inspection : discoloration, breaks
- wash with soapy water and dry
- stump wrapping: edema up to 4 months
- reapply up to 3 times per day
- no alcohol
- no lotion
STUMP SHRINKER
- used in place of ACE wrap
- stump socket casted
- weight change
- cleaning of socket - inspection
PHANTOM LIMB PAIN
- knife like
- burning
- squeezing
- 85%
- dorsi and plantar flexing the foot
MEDICATIONS FOR NEUROPATHIC PAIN
AMITRIPTYLINE (ELAVIL)
GABAPENTIN(NEURONTIN)
PREGABLIN( LYRICA)
PSYCHOLOGICAL ASPECTS
- fear
- denial
- bargaining
- death without funeral
- grief
- anger
- depression
WHAT TO DO?
- listen
- open communication
- realistic encouragement
- education at the appropriate level
- allow time to vent feelings
- support groups
- be aware of where you are and how you act
PROSTHESIS
- mold of residual limb is taken
- wear all day to prevent swelling
- limb is covered with stocking
- learning to use prosthesis is difficult
