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M6 13-005
Exam 16: Orthopedics and Amputees
| Term | Definition |
|---|---|
| Reasons Amputations are Performed | Malignant Tumors. Injuries. Impaired circulation. Congenital deformities. Infections. Life-threatening disorders (arterial thrombosis and gas bacillus infections). |
| Amputations Preoperative Assessment: Subjective Data | Question to determine the patient's understanding of the injury or disease process Assess and document complaints of pain and neurovascular impairment Level of orientation |
| Amputations Preoperative Assessment: Objective data | Vital signs Arterial blood flow Wound drainage Upper body strength Nutritional status |
| Amputations Preoperative Assessment: Diagnostic Tests | CBC BUN Urinalysis Electrocardiogram (ECG) |
| If the amputation is related to a traumatic injury the physician's interventions will be aimed at: | restoring circulating blood volume Controlling pain Preventing infection in the wound Facilitating the use of prosthesis |
| If amputation is elective, the physician's assessment will also include: | Patient's emotional, psychological, and physiological status Presence of infection Discussing the use of prosthesis |
| Amputations Postoperative Assessment: Subjective Data | Phantom Pain Can be very frightening Occurs between the nerve tracts that register pain |
| Amputations Postoperative Assessment: Objective Data | Observe for hemorrhage Monitoring drainage Assess and protect the remaining extremity Assess for neurovascular impairment (hourly) Assess for pulmonary complications and vascular collapse in older patients |
| Amputation Nursing Interventions | Pain management Prevention of deformities Prevention of contractures Abduction deformities Flexion hip deformities can be prevented postoperatively by raising the foot of the bed slightly to elevate the residual extremity. |
| Amputee patient teaching | Facilitate mobility and prevent muscle atrophy Exercises; push-ups from a prone position and sit-ups from a seated position Phenomenon of phantom limb sensation Application of “stump shrinkers” |
| Phantom Pain | Pain, tingling, or burning sensation in the amputated limb. Can be very frightening to the patient Severed nerve tracts continue to send signals to the brain. Phantom pain is NORMAL |
| Treatments for Severe & Persistent Phantom Pain | Stump revision with reamputation at a higher level Local infiltration of the stump with anesthetic Mechanical percussion, rubbing Sympathetic nerve block |
| Commonly Used Medications | Indomethacin (Indocin). Ibuprofen (Motrin). Naproxen (naprosyn). |
| Indomethacin (indocin): | analgesic, anti-inflammatory |
| Indomethacin (indocin): side effects | headache, vertigo, insomnia, confusion, can decrease effect of ACE inhibitors |
| Indomethacin (indocin): Nursing Implications | give with food, milk or antacid; discontinue if CNS symptoms develop and notify physician. Monitor B/P |
| Ibuprofen (Motrin): | analgesic, anti-inflammatory |
| Ibuprofen (Motrin):Side Effects | headache, vertigo, insomnia, confusion, can decrease effect of ACE inhibitors. Less irritating to GI tract; fluid retention can cause hypertension |
| Ibuprofen (Motrin): Nursing Implications | Monitor B/P taking with food may delay absorption |
| Naproxen (naprosyn): | analgesic, anti-inflammatory |
| Naproxen (naprosyn): Side Effects | drowsiness, headache, vertigo, insomnia, confusion, can decrease effect of ACE inhibitors. Less irritating to GI tract; fluid retention can cause hypertension |
| Naproxen (naprosyn): nursing Implications | give with food or milk or antacid. Avoid driving until dosage effect is established |
| Additional patient education amputees | Take oral calcium with Vitamin D for better absorption Take oral calcium alone Take oral calcium with meals to enhance absorption an minimize gastric distress NSAIDS –monitor for signs of GI bleed |
| Give an example of a disease process that may increase a patient's risk for decreased circulation | Diabetes, arteriosclerosis |
| You are preparing a 77 year old patient for an amputation of a lower extremity, when performing your nursing assessment, what is the key objective data that is documented? | VS, Arterial Blood Flow, Wound, Nutritional status, and upper body strength |
| What are nursing interventions aimed at preventing? | Deformities |
| Phantom pain can best be described as? | Pain, tingling or burning sensation at the amputated site |
Created by:
jtzuetrong
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