Amputation Flashcards
Amputation
partial or complete surgical removal of a limb
Difference between minor and major amputation
Prognosis is better for minor amputations.
Goal for amputation
preserve the extremity length and function while removing all infected, pathologic, or ischemic tissue
Risk Factors for Amputations
- 65 or older
- DM
- heart dz
- smoking
- lack of exercise
- poor nutrition
- AA, Hispanics, Native Americans
Major causes of Amputations
- Medical: 70 percent DM, PVD, gangrene, and infection
- Trauma: 22 percent, crushing, burns, frost bite
- Congenital: 4 percent
- Tumors: 4 percent
Diagnostic Studies for Amputation
- WBC
- Arteriogram
- Venogram
Amputation 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 tx options?
Closed Amputation
- used to create a weight bearing extremity
- skin flap with soft tissue covers the bony part of the residual limb or stump
Disarticulation
performed at the joint
Guillotine/Open Amputation
- leaves the bony end open
- generally used to control or prevent potential infection
- wound is closed later by second surgeon
Pre-op teaching
- discuss level of amputation
- discuss normal feelings grief/loss
- phantom limb sensations
- dressing process
- pain control
- rehab goals
- discharge plans
Post-op Care
- pain
- bleeding from site
- VS
- Stump elevation
- cast care
Post-op Teaching: Positioning
- elevate for 24-48 hours
- keep flat after 24 hours
- prone positioning at least 2x daily
Stump Care
- inspect for discoloration and 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
Phantom Limb Pain
- knifelike
- burning
- squeezing
- 85 percent
- dorsi and plantar flexing the foot
Meds for Neuropathic Pain
- Amitriptyline (Elavil)
- Gabapentin (Neurontin)
- Pregablin (Lyrica)
Psychological Aspects
- fear
- denial
- bargaining
- death without funeral
- grief
- anger
- depression
What to do when patient has psychological worries?
- 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
Prothesis
- mold of residual limb is taken
- wear all day to prevent swelling
- limb is covered with stocking
- learning to use is difficult