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27 Cards in this Set

  • Front
  • Back
Amputation: Definition
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
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
Indications: Circulatory impairment from PVD
Traumatic and thermal injuries
Malignant tumors
Indications: Widespread infection
gangrene, osteomyelitis (infection of bone)
Congenital disorders
Non-healing ischemic ulcers
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
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
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
Preexisting illnesses -- vascular and neurologic status
Psychosocial -- anxiety, grief, coping, spiritual distress, support systems
Nursing Diagnosis
Disturbed body image
Impaired skin integrity
Chronic pain (phantom limb sensation)
Impaired physical mobility
Ineffective role performance
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
Implementation/Health Promotion
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
Implementation/Acute Intervention
Tremendous psychological & social implications (grieving process)
Patient's family needs support to arrive at a realistic and positive attitude about the future
Implementation/Preop Management
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
Phantom Limb Sensation
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
Assess hemorrhage - vitals, check dressing
Pain management
Assess for infection
Minimize edema - avoid dangling residual limb over bedside
Active ROM
-exercise regime
-bed/chair transfers
-crutch walking
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
Proper Residual Limb Bandaging
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
Proper Residual Limb Bandaging
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
Implementation: Psychosocial Integrity
Address issues identified
Amputee support groups
Amputee visitor
Referral to a community health nurse
Family support/education
Education (table 61-15)
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
Important Note
**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
Socket - holds residual limb
Knee - articulated or jointed
Pylon (shin)
*Expensive - require replacement
*Replace gel liners and socks
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
How is it kept in place??
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
Prosthesis Care
Clean socket daily with mild soap-rinse thoroughly
Regular maintenance of prosthesis "Good" shoe
Old shoe may interfere with gait
Anything you can do I can do too!!!!!