amputation

Question 1

AMPUTATION

Answer 1

the partial or complete surgical removal of a limb as the result of a crushing injury, intolerance pain, gangrene, vascular obstruction , uncontrolled infection , or congenital anomalies

Question 2

GOAL FOR AMPUTATION

Answer 2

to preserve the extremity length and function while removing all infected, pathologic or ischemic tissue

Question 3

RISK FACTORS

Answer 3

• age 65 or older
• diabetes
• heart disease
• smoking
• lack of exercise
• poor nutrition
• race :African americans, Hispanics, native americans

Question 4

RISK FACTORS

Answer 4

• age 65 or older
• diabetes
• heart disease
• smoking
• lack of exercise
• poor nutrition
• race :African americans, Hispanics, native americans

Question 5

MAJOR CAUSES

Answer 5

• medical 70% diabetes, PVD, gangrene and infection
• trauma 20% : crushing, burns, frost bite
• congenital 4%
• tumors 4%

Question 6

DIAGNOSTIC STUDIES

Answer 6

• WBC count
• Arteriogram
• Venogram

Question 7

AMPUTATION CONSIDERATION QUESTIONS

Answer 7

• 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 treatment options

Question 8

TYPES OF AMPUTATION : CLOSED

Answer 8

• is used to create a weight bearing extremity
• a skin flap with soft tissue covers the bony part of the (residual) limb or stump
• when would the wound not be closed?

Question 9

TYPES OF AMPUTATION: DISARTICULATION

Answer 9

-performed at the joint

Question 10

TYPES OF AMPUTATION : GUILLOTINE/ OPEN

Answer 10

• leaves the bony end open
• generally used to control or prevent potential infection
• the wound is closed later by second surgery

Question 11

NURSING IMPLICATIONS

Answer 11

• health promotion

- acute (nursing) interventions

Question 12

PRE-OP TEACHING

Answer 12

• discuss the level of amputation
• discuss normal feelings grief/loss
• phantomlimb sensations
• describe dressing process
• pain control
• rehab initiation goals
• discharge plans

Question 13

POST- OP CARE

Answer 13

• pain
• bleeding from site
• vital signs
• stump elevation
• cast care

Question 14

POST- OP TEACHING : POSITIONING

Answer 14

• elevate for 24-48 hours
• keep flat after 24 hours
• prone positioning (at least) 2x daily

Question 15

POST- OP TEACHING : POSITIONING

Answer 15

• elevate for 24-48 hours
• keep flat after 24 hours
• prone positioning (at least) 2x daily

Question 16

POST- OP TEACHING : STUMP CARE

Answer 16

• inspection : discoloration, 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

Question 17

STUMP SHRINKER

Answer 17

• used in place of ACE wrap
• stump socket casted
• weight change
• cleaning of socket - inspection

Question 18

PHANTOM LIMB PAIN

Answer 18

• knife like
• burning
• squeezing
• 85%
• dorsi and plantar flexing the foot

Question 19

MEDICATIONS FOR NEUROPATHIC PAIN

Answer 19

AMITRIPTYLINE (ELAVIL)

GABAPENTIN(NEURONTIN)

PREGABLIN( LYRICA)

Question 20

PSYCHOLOGICAL ASPECTS

Answer 20

• fear
• denial
• bargaining
• death without funeral
• grief
• anger
• depression

Question 21

WHAT TO DO?

Answer 21

• 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

Question 22

PROSTHESIS

Answer 22

• mold of residual limb is taken
• wear all day to prevent swelling
• limb is covered with stocking
• learning to use prosthesis is difficult