Amputations and Fractures Flashcards
What is the most common pain with surgical amputations due to a chronic condition that has given you pain for a period of time?
Phantom limb pain
Ask what when asking about phantom limb pain?
What the pain is like
What is treatment for overall phantom limb pain?
Calcitonin
How is calcitonin given?
IV infusion during first post-op week to help reduce phantom limb pain
What is given for dull, boring pain?
BB (propanolol)
What is given for knifelike, sharp burning pain
Antiepileptic (gabapentin)
What phantom pain is this given for?
Propranolol
Dull, burning pain
What phantom pain is this given for?
Calcitonin
Overall pain
What phantom pain is this given for?
Antiepileptic
Knifelike, sharp, burning pain
What to give for incision pain post ampuation ?
Analgesics
What to give for muscle pain post amputation?
Antispasmodics (baclofen)
How to wrap limb after amputation?
Figure 8 wrap –tight but not too tight
T/F: Position is very important post amputation
T
What is position for first 24 hours post amputation and why?
Elevated on pillow to help decrease edema and help with drainage
T/F: Contractors will occur if elevated on pillow 36 hr post op
T
Post amputation
___ position for __ minute periods several times a day
Prone; 20 min
Post amputation
What kind of mattress?
How often to turn?
Firm
q2h
Post amputation
Practice what with the limb?
Pushing down limb on soft pillow
What is skeletal traction?
Screws are surgically inserted into BONE (halo traction)
Skeletal traction
Short or long traction time?
What weight limits?
Use longer traction times
15-30 lbs
Skeletal traction
Aids in ____
Bone realignment
Skeletal traction
Weight should not be doing what?
Touching floor or touching end of bed–touching nothing!!!
Skeletal traction
What happens if patient falls down in bed and weight touches floor?
The patient needs assistance using the trapeze bar to pull himself back up
Skeletal traction
How should cords be?
Free, not touching anything else
Skeletal traction
What needs to be in right suspension?
Counterweight
Skeletal traction
T/F: There should be some pressure on skin
F–check this (esp. pelvic area!)
Skeletal traction
Pin in bone so do what?
Pin site care
Skeletal traction
Pin site care–what drainage in the beginning?
Clear is normal in beginning; report anything else to MD
Clean per hospital policy
Skeletal traction
Patient should not be in severe pain. If they are, then what do we do?
Re-align the patient but DO NOT TOUCH THE WEIGHTS!!!
*notify MD position is not working
Skeletal traction
How often to monitor circulation?
q1hr for first 24 then q4h
Complications of fractures
Splinting or casting–what is better?
Splinting
- splinting better to reduce complications
- may need cast if worried pt. won’t wear splint (peds)
Complications of fractures
Check 6 Ps. What are those?
Pain Paresthesia Pallor Paralysis Pulselessness Pressure
Complications of fractures
Check skin. Also check cast…what should cast be like?
One finger should fit underneath; should not be too tight
Complications of fractures
When is it ok to cast?
When swelling has gone down
*ice area to reduce swelling
Acute compartment syndrome
What is this?
Increased pressure causes reduced circulation to area
*due to infection, persistent motor weakness, contractures, myoglobiuric renal failure, hyperkalemia
Acute compartment syndrome
Assess what?
6Ps
Acute compartment syndrome
What happens if there is an immediate increase in pain?
Assess quickly
*use doppler pulse –dont just give pain med
Acute compartment syndrome
Where is this more common?
Hand and lower leg
Acute compartment syndrome
Hallmark symptom?
Severe pain that does not respond to elevation or pain meds
*in severe cases, there may be numbness, tingling, weakness, and paleness of skin
Acute compartment syndrome
Tx?
Remove cast
Fasciotomy (open area to relieve pressure)
Crush Syndrome
What is this?
External crush injury that compresses one or more compartments in leg, arm, or pelvic
Crush Syndrome
Symptoms? (8)
- ACS
- ATN
- Dark brown urine
- HYPOvolemia
- HYPERkalemia (cell breaks and release to BS)
- Muscle weakness
- Pain
- Rhabdomyolysis
Crush Syndrome
What is a lower extremity crush injury at high risk for?
AKI
Fat embolism syndrome
Obstruction of what?
Pulmonary vascular bed by fat globules
Fat embolism syndrome
More specific to ___ bone fracture in the first ___
Long bone fracture in first 48 hr
*comes from yellow marrow with break–gets in BS and lodges into things like lungs
Fat embolism syndrome
Symptoms similar to?
VTE, DVT, PE
Fat embolism syndrome
Difference in symptoms between fat embolism syndrome and VTE/DVT/PE?
Petechia with fat embolism!!!
Fat embolism syndrome
Other symptoms besides petechia?
- Altered mental status
- Tachypnea, tachycardia, fever
- Chest pain, dyspnea, crackles, decreased SaO2
- Mild thrombocytopenia
Fat embolism syndrome
tx?
Supportive care
Oxygen (or vent)
VTE
What is the purpose of elastic stockings?
To prevent thrombophlebitis (common complication following orthopedic surgery)
VTE
Thrmoboemboli can occur up to 6 months after surgery..Why is this important to tell pt?
That the client will need to still wear them after d/c