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48 Cards in this Set
- Front
- Back
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What clinical indications might result in an amputation?
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- Peripheral vascular problems
- Traumatic injury - Malignant tumors - Infection of the extremity - Congenital disorders |
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What are some causative factors associated with amputation?
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- PVD
- Diabetes mellitus - chronic osteomyelitis - Pressure ulcers - Trauma |
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What is an ankle- brachial index?
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Measures pressure in the limb
Normal >1 |
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What diagnostic tests are used for an amputation?
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- H & P
- Ankle- brachial index - Artheriography/venography - Doppler |
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What are the 2 kinds of amputation?
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- Elective
- Emergency |
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What are the benefits of elective amputation?
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- Time to assess the patient's general health
- Able to monitor other disease processes - Time to instruct patient and family on the need for surgery and the potential for successful rehabilitation |
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What are the 3 goals of amputation?
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- To preserve the length of the extremity
- To preserve function - To remove all pathologic tissue |
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Higher the amputation the harder the _________.
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Ambulation
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A hemipelvectomy is?
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Amputation at the top of the leg
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An AKA is?
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Above knee amputation
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What is BKA?
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Below knee amputation
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What is Symes?
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Right below the ankle amputation
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What is the difference between closed and open amputation?
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Closed creates a weight bearing residual limb that is covered by skin.
Open leaves a surface on the limb not covered with skin. |
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Pre- op nursing management for amputation is?
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- Discuss the reason for the amputation
- Discuss post-op rehab - Instruct on the prosthesis - Instruct on upper extremity exercises if getting lower limb amputation - Discuss phantom limb sensation |
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What percentage of patients get phantom limb sensation?
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80%
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Post op nursing management for a patient with an amputation?
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- Monitor site for S/S of hemorrhage, perfusion of tissues
- Strict sterile technique during dressing changes - Prevention of post-op hip flexion contracture - Proper residual limb bandaging - Avoid dangling of limb to minimize edema |
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Why is it important to have proper residual limb bandaging?
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To have the right shape for a prosthetic
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What 6 things should you assess for in the residual limb of an amputation?
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- Pain
- Limb color - Warmth - Suture line status - Drainage - Edema |
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Do not elevate the amputated limb after ____ hrs to prevent _______.
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- 24
- Contractures |
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What is the best way to prevent a hip contracture on an patient with an amputation?
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Have them lay on their stomach
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What are the two types of prosthetic fitting?
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- Immediate: applied in the OR after amputation
- Delayed: time of placement depends on the healing status of the limb |
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What is the indication of a good prosthetic fit?
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- Presses against muscle
- Space around the shin bone and stump tip |
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Therapy an amputation patient would have/ learn to do?
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- Transfer techniques
- Conditioning exercises - Active ROM - Crutch walking for lower limb amputation |
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How do you prevent an amputation?
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Control causative factors
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What are the 4 types of traumatic amputations?
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- Complete
- Partial - Guillotine - Crush |
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Complete traumatic amputation is?
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- the body part is completely severed from the body
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Partial traumatic amputation is?
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- Some bone or tissue keeps the amputated part attached to the body
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Guillotine traumatic amputation is?
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- Clean, well defined edges
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Crush traumatic amputation is?
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- More soft tissue damage
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Which kind of traumatic amputation is less likely for a successful reattachment?
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Crush
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What happens to potassium in a crush amputation?
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It rises
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Upper or lower extremities are easier to attach?
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Upper
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If you were out in the field and had to care for an recent trauma amputation, how would you care for the limb?
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- Rinse and remove debris
- Wrap limb in clean, damp cloth - Place in a sealed bag and immerse container in a mixture of water or ice - Do not let limb to come in direct contact with the ice - Tag the bag with name, date and time |
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What are the nursing goals for a patient with an amputation?
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- Acceptance of body image
- No evidence of skin breakdown - Pain reduction/relief - Satisfactory mobility |
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Arthroplasty is?
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The reconstruction or replacement of a joint
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What are the benefits of arthroplasty?
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- Relieves pain
- Improves/ maintains ROM - Corrects deformities |
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What are the 3 types of arthroplasty?
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- Hemiarthroplasty (replacement of part of the joint)
- Total joint replacement - Reshaping of the bones of the joints |
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Replacement is available for what joints?
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Elbow, shoulder, finger, hip, knee, ankle, and foot
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What is the difference between cemented and cementless joint replacement?
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Cementless has a longer life and is designed to facilitate the ingrowth of bony tissue into the porous surface
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What is the main thing to avoid after a total hip arthroplasty?
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Avoid extreme internal rotation, adduction, and 90 degree or more flexion of the hip joint for 4-6 weeks.
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What are ways to prevent internal rotation, adduction, and flexion more than 90 degrees?
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- Use abduction pillow
- Hips must be higher than knees when sitting - Knees should never be kept apart - Never cross legs - Use a trochanter roll to prevent external rotation - Keep pillows between legs when turning |
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Post op management for a patient with total hip arthroplasty would include?
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- Ambulate as prescribed
- Monitor circulation and sensation in extremity - Monitor for S/S for shock, hemorrhage - Keep anti-embolic stockings in place - Instruct pt to flex and extend feet and ankles |
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Post op management for a patient with total knee arthroplasty?
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- Monitor for drainage and infection
- Start CPM for 24-48 hours post op - Do not allow the leg to dangle (prevents dislocation) - Do not place pillow under the knee - Avoid weight bearing |
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What should a patient with a TKA do to be discharged?
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Should be walking with cane or walker
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How often should a neurovascular assessment be done on a patient with an arthroplasty?
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Every 2 hours
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What meds may be given to a patient with a arthroplasty to prevent thrombus formation and pulmonary embolism?
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Anticoagulants
- Warfarin (Heparin) - Lovenox - ASA - Comadin (given when going home) |
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What test should you monitor for when giving heparin?
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PTT
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What test should you monitor for when giving comadin?
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INR
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