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Problems Related tMusculoskeletal &Coordination
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Amputation
Removal of a body partCauses Peripheral vascular disease-80% [75% Diabetics]vascular changes/atherosclerosis due to DM
Congenital deformities
Infection
Malignant tumorsTraumatic Unexpected severing of body part Accidents, land mines, farm related injury Common in young secondary to trauma
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Clinical Indications
Circulatory impairment [PVD]Traumatic & Thermal injuries
Malignant tumors
Uncontrolled widespread infection of
extremity-gas gangrene, osteomyelitisCongenital disorders
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Amputation
Psychosocial aspects of the procedure: devastating aphysical impairments that result.
Loss of limb: complete and permanent and
Lead to traumatic change in body image and often in
esteem.Necessitates major life style changes & adjustments
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Pathophysiology: Amputations
Elective Related to complications of PVD &arteriosclerosis
Result in ischemia in distal areas of loweextremities.i.e. Diabetes
Considered only after other interventions not restored circulation to lower extremitLimb salvage
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Pathophysiology: Amputations
Traumaticprimary cause of upper extremity
loss of limb
Accidents [MVA, industrial machine,war time from land mines & bombs[Iraq]
Severe crushing of tissues &significant blood vessel damage
Limb must be amputated in order topreserve function of residual limb
Today some body parts can besalvaged
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Levels of Amputation
Lower extremity (LE) amputations: more frequently done5 types of amputations
Above the knee [AKA]
Below the knee [BKA]
Midfoot amputations (e.g., the Lisfranc and the Chopart
amputations) and the
Syme
Toe Amputation
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Common levels of lower extremityamputation.
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Cultural Awareness
The incidence of lower extremityamputations is greater in black andHispanic populations because theincidence of major diseases leadingamputation, such as diabetes and
arteriosclerosis, is greater in thepopulations.
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Complications
Most common complications of elective or traumatiamputations are:
Hemorrhage-hypovolemic shock from too much bl
Infection- osteomyelitis
Phantom limb pain
Neuroma-tumor of damaged nerve cells
Flexion contractures
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Phantom Limb PainPainful sensation felt in amputated limb immeafter its removed
Described as intense burning, crushing, crampshooting, coldness, heaviness
Experience numbness & tingling-phantom limb seAnxious because pt knows limb is gone but painfelt
Subsides over time
Nurse should recognize pain as REAL & treat aggressively-Ask pain level 0/10
More common in the above the knee amputation [
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Diagnostics
H&PPhysical appearance soft tissues
Skin temperature, sensory function
Presence of peripheral pulses
ANKLE BRACHIAL INDEXArteriography, venography plethymography
Doppler studies
Routine blood work: elevated WBC w/abno
differential-infectious process
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Physical Assessment/ClinicalManifestations
Monitor Neurovascular status in affected extremityCheck circulation in bilateral legs if PVD
Assess skin color, temperature and pulses in both affected &unaffected
Check capillary refill [not a reliable indicator]-in elderly w/thopaque nails, check skin near nail bed
Observe & document any discoloration of skin, edema, presnecrosis and hair on distribution of lower extremity
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Psychosocial AssessmentEvaluate their psychological preparation for a planned amputation, and expect them
through the grieving process.
Assess the patient's feelings about himself or herself to identify areas in which he oemotional support.
Refer the patient to the certified hospital chaplain, other spiritual leader, or social w
Determine the patient's willingness and motivation to withstand prolonged rehabilithe amputation
assess the family's reaction to the surgery or trauma
Assess the patient's and family's coping abilities, and help them identify personal stweaknesses.
Assess the patient's religious, spiritual, and cultural
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-Traumatic Amputation-CriticalRescueCall 911
Assess ABCs
Examine site & Apply direct pressure to amputation with dry gauze or other cloth
Elevate extremity above heart to decrease bleeding
Do not remove dressing
For finger, wrap in dry sterile gauze [if available] or cloth & place in watertight, sealed plastic bag
Place bag in ice water & never directly on ice, at 1 par3 parts water
Transport part to hospital w/patient
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Collaborative Care
The goal of amputation surgery is to preserve extremity lenfunction while removing all infected, pathologic, or ischemi
Closed amputation-creates weight-bearing residual limb [st
Disarticulation-amputation performed through a joint [Sym
Open amputation-leaves a surface on the residual limb thatcovered with skin-done for control of actual or potential inf
Wound closed later by surgical procedure or closed by skin trasurrounding limb-Guillotine amputation
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