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27 Cards in this Set
- Front
- Back
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Amputation: Definition
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Surgical removal of all or part of an extremity
*During the past 20 years, major advances made in surgical amputation techniques, prosthetic design, and rehab programs |
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Amputation
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Estimated 400,000 amputees in U.S., with an annual increase of 20,000
Highest incidence among middle and older age-groups secondary to the effects of PVD, atherosclerosis, and vascular changes related to DM |
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Indications: Circulatory impairment from PVD
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Traumatic and thermal injuries
Malignant tumors |
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Indications: Widespread infection
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gangrene, osteomyelitis (infection of bone)
Congenital disorders Non-healing ischemic ulcers |
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Goal
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Preserve extremity length and function while removing all infected, pathological or ischemic tissue
This improves the possibility of good, prosthetic, cosmetic, and functional satisfaction *Figure 61-16 - Levels of amputation |
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Types
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Closed
Disarticulation Open |
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Closed
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Performed to create a weight-bearing residual limb.
Anterior skin flap with dissected soft tissue padding covers the bony part of the residual limb Flap is sutured posteriorly -- not in a weight bearing area Special care is necessary to prevent the accumulation of drainage which can lead to pressure & infection |
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Types (cont): Disarticulation
Types (cont): Open |
Disarticulation: an amputation performed through a joint
Syme's Amputation -- disarticulation at the ankle Open: Guillotine Amputation -- leaves a surface on the residual limb that is not covered with the skin Indicated for control of actual or potential infection |
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Assessment:
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Preexisting illnesses -- vascular and neurologic status
Psychosocial -- anxiety, grief, coping, spiritual distress, support systems |
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Nursing Diagnosis
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Disturbed body image
Impaired skin integrity Chronic pain (phantom limb sensation) Impaired physical mobility Grieving Ineffective role performance |
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Plan/Goals
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Have adequate relief from treatment of underlying health problems (DM, HTN)
Pain control Reach maximum rehab potential with the use of a prosthesis Cope with body image changes Make satisfying lifestyle adjustments |
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Implementation/Health Promotion
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Patient education to prevent amputation
Control of causative illness (PVD, DM, Chronic osteomyelitis, pressure ulcers) Report problems such as change in skin color or temperature, decrease or absence of sensation, tingling, pain, or the presence of a lesion Instruction in proper safety precautions in recreation or in performance of hazardous work |
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Implementation/Acute Intervention
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Tremendous psychological & social implications (grieving process)
Patient's family needs support to arrive at a realistic and positive attitude about the future |
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Implementation/Preop Management
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Reinforce info regarding: reasons for amputation, proposed prosthesis & mobility training program
Encourage verbalization of fears Exercises - *start pre-op* - push ups Discuss general postop care -- positioning, support, residual limb care Explain Phantom Limb Sensation -- stressful/anxiety provoking |
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Phantom Limb Sensation
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Occurs in 80% of patients
Caused by stimulation along nerve(s) pathways that was part of the amputated limb Feelings of coldness, heaviness, cramping, shooting, burning, or crushing pain If pain was present pre-op, pt may experience phantom limb pain As rehab progresses most likely it will go away |
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Implementation/Postop
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Assess hemorrhage - vitals, check dressing
Pain management Assess for infection Minimize edema - avoid dangling residual limb over bedside Active ROM |
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Implementation/Post-op
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OT/PT
-exercise regime -bed/chair transfers -crutch walking -ADL's Prevention of flexion contractures-most common hip flexion Avoid elevation of limb after 1st 24 hours Avoid sitting in chair for >1hour with hips flexed Lie on abdomen for 30 minutes 3-4x a day with hip in extension |
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Proper Residual Limb Bandaging
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Fosters shaping & molding
Supports soft tissue, decreases edema, hastens healing, decreases pain, promotes residual limb shrinkage Compression bandage initially worn at all times except for bathing |
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Proper Residual Limb Bandaging
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Compression Bandage (picture in Lewis 61-18)
-Elastic Roll/Figure Eight wrap (2 wraps) -Residual Limb Shrinker-elastic stocking that fits tightly over limb and lower trunk area Taken off and reapplied several times a day Shrinker bandage washed & changed daily *After healing -- only worn when client is not wearing the prosthesis |
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Implementation: Psychosocial Integrity
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Address issues identified
Amputee support groups Amputee visitor Referral to a community health nurse Family support/education |
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Education (table 61-15)
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Residual limb care:
Inspect daily Wash with bacteriostatic soap--rinse well air dry 20-30 minutes Residual limb sock Do not elevate residual limb Pain management ROM all joints daily Strengthening exercises Lay prone with hip extension 30 minutes 3-4x daily Ambulation/transfer techniques |
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Important Note
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**Residual limb is dynamic
-Constantly changes shape and diameter over time -Finally reaches a stable state *can take years* Might need a couple of prosthetic fittings |
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Prosthesis/Parts
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Socket - holds residual limb
Knee - articulated or jointed Pylon (shin) Ankle Foot *Expensive - require replacement *Replace gel liners and socks |
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Prostheses/Types
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Immediate prosthetic fitting/immediate postoperative fitting
-done in OR -rigid cast like bandage applied with prosthesis with strap attached to waistband *decreased edema, early ambulation *can't visualize surgical site Delayed prosthetic fitting (Elderly patient - risk of infection) -choice for above knee, below elbow, older debilitated, infection -make mold/molder residual limb pocket -cover with residual limb stocking-good fit to prevent skin breakdown Fully weight bear 3 months after surgery |
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How is it kept in place??
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Suction - keeps sheathed limb in socket with special outer sleeve (sheath often gel lined)
Screw mechanism - connects limb sheathed in a special sleeve to bottom of the socket |
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Prosthesis Care
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Clean socket daily with mild soap-rinse thoroughly
Regular maintenance of prosthesis "Good" shoe Old shoe may interfere with gait |
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Summary
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Anything you can do I can do too!!!!!
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