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M6 13-005

Exam 16: Orthopedics and Amputees

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