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Amputation
• Common Causes– Peripheral Vascular
Disease (PVD)– Trauma– Osteomyelitis– Tumor
• osteosarcoma
Amputation
• Complications– Hemorrhage– Hematoma– Infection– Skin breakdown– Edema– Phantom limb pain– Contracture
Table Question
• What would you identify as the priority nursing diagnosis for a client who is post-op BKA?
Nrs Dx: for Amputation
• Acute pain• Disturbed sensory perception• Impaired skin integrity• Grieving • Self-care deficit• Impaired physical mobility
Nrs Dx: Altered Sensory Perception
• h activity• Rehab• Distraction• Rx– Analgesics– Tricyclic antidepressants– Anticonvulsants
Nrs Dx: Impaired skin integrity
• Gentle• Aseptic tech.• Diet– h protein– vitamins
• Residual limb shaping– Elastic dressing– Cast
Which of the following techniques is correct for obtaining a wound culture specimen from a surgical site?
A. Thoroughly irrigate the wound before collecting the specimen.
B. Use a sterile swab and wipe the crusty area around the outside of the wound.
C. Gently roll a sterile swab from the center of the wound outward to collect drainage.
D. Use a sterile swab to collect drainage from the dressing.
NURSING ALERT• If the cast or elastic dressing comes off, the
residual limb must be immediately wrap with an elastic compression bandage. If not, excessive edema will develop leading to a delay in rehabilitation.
• Notify the surgeon so that another cast can be applied promptly
Nrs Dx: Impaired body imageNrs Dx: Grieving
• Relationship of trust• Pt. care for limb• Independence• Realistic goals• Support systems• Referrals
Nrs Dx: Impaired physical mobility
• Prevent contractures• Avoid– Abduction– External rotation– Flexion
• Prone*• ROM• Upper body exercises
Nursing Alert• The residual limb should not be
placed on a pillow because a flexion contracture of the hip may result.
A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on contact precautions. Which statement is true regarding precautions for infections spread by contact? A. The client should be placed in a room with
negative pressure. B. Infection requires close contact; therefore, the
door may remain open. C. Transmission is highly likely, so the client should
wear a mask at all times. D. Infection requires skin-to-skin contact and is
prevented by hand washing, gloves, and a gown.
A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates understanding of phantom limb pain?A. "The pain will go away in a few days.“B. "The pain is due to peripheral nervous system
interruptions. I will get you some pain medication."
C. "The pain is psychological because your foot is no longer there."
D. “The pain and itching are due to the infection you had before the surgery."
The primary reason for rapid continuous rewarming of the area affected by frostbite is to:A. Lessen the amount of cellular
damage B. Prevent the formation of blisters C. Promote movement D. Prevent pain and discomfort
You are assigned to care for a patient with a Below the Knee Amputation (BKA). Among the patient’s orders is one which states that the patient should be placed in the prone position twice daily. The nurse knows that the reason for this is:A. Changing the patient’s position will help to
prevent skin breakdownB. To observe the stump for signs of infectionC. To assist the patient in doing ROM (Range of
Motion) exercisesD. To stretch the flexor muscles and prevent
flexion contractures
Small Group Questions
1. Look at the list of complications associated with an amputation. Identify ways to assess for each complication and treatment.
2. Describe the assessment of a patient going into surgery for a non-traumatic BKA.
What is the number one reason people go to their doctor?
A. Respiratory infectionB. Back painC. Ear infectionD. Head achesE. Complaint of symptoms assoc. with heart
attacks
What is the number TWO reason people go to their doctor?
A. Complaints of arthritis in the handsB. Back painC. Ear infectionD. Head achesE. Complaint of symptoms assoc. with heart
attacks
Term # vertebrae Body area Abrv.Cervical 7 Neck C1 – C7 Thoracic 12 Chest T1 – T12Lumbar 5 Low back L1 – L5Sacrum 5 (fused) Pelvis S1 – S5 Coccyx 3 Tailbone
Spinal Curves
• Shock Absorbers
http://www.spineuniverse.com/anatomy/cervical-spine-anatomy-animation
Disk protrusion
• AKA– Herniated nucleus
pulposus– “Slipped disk”
• pressure on the nerve
• “Radiating” pain• “Sciatica”
If a paravertebral muscle is in spasm, how would you describe the muscle
tone?
A. AtonicB. FlaccidC. Increased muscle toneD. Decreased muscle tone
Medical Management: Rx
• Analgesics– Acetaminophen– NSAIDs
• Muscle Relaxants– Cyclobenzaprine
(Flexeril) – S/E• Drowsiness
Low Back PainMedical Management
• Bed rest – 1-2 days
• Δ position frequently
• No sitting > 50 min. • Gradual
Low Back PainNursing interventions
• Assess pain – i analgesics
• Mattress– Firm– No sag
• Lumbar flexion
Low Back PainNursing interventions
• h activities gradually• Low stress exercise• 2 wks abd. & trunk
exercises• Improve posture
Good body mechanics: Standing
• Short duration• 1 foot on a stool • ⌀ high hills• ⌀ flexion• Shift wt • Stand on cushion • ⌀ Lock knees
Good body mechanics: Sitting
• Short duration• Chair– Straight back – Arm rests
• Knees h than hips• Back support• i extension • Alt. sitting / walking
Good body mechanics: Lifting
• NEVER BEND AT THE WAIST!
• Bend knees• Squat• Hold item close Lift
with your legs
No-No’s!• Bending at the waist• lifting without bending
knees• twisting and lifting• Slouching• Holding breath when
lifting
Carpal Tunnel Syndrome
• “Entrapment neuropathy”
• http://video.about.com/ergonomics/Carpal-Tunnel-Syndrome.htm
Carpal Tunnel SyndromeEtiology
• Men vs Women?– Women
• Age?– 30-60
• Risk Factor– Repetitive
movements
Carpal Tunnel SyndromeAssessment & Dx
• Tinel’s sign– Percussing over the
median nerve • Tingling• Numbness• Pain
– Test = +
Carpal Tunnel SyndromeSurgery
• Open nerve release • Endoscopic laser• Local anesthetic• Cut carpal ligament
Small Group Questions
1. What medications are frequently prescribed to a clinic with acute low back pain? What are their actions
2. What are the 3-R’s of Low Back pain treatment?3. Mr. Jones is suffering from acute back pain, what
would you advice him to do? (What would your teaching plan include)?
4. Describe the pathophysiology of carpal tunnel syndrome.
5. Demonstrate how to perform the Tinel sign.
Osteoporosis:Pathophysiology / Hormones
• Age related changes• i Calcitonin– Resorption• i
– Formation• h
Osteoporosis:Pathophysiology
• Porous• Brittle• Fragile • Fx easily
• http://www.youtube.com/watch?v=rHyeZhcoZcQ
Osteoporosis
• > 10 million Am. Have osteoporosis
• 33.6 million have osteopenia
• Men vs Women– Men < Women
OsteoporosisS&S
• Collapsed vertebra • Asymptomatic • Kyphosis • i height
• protruding abdomen• Pulm. insufficiency
OsteoporosisRisk Factors
• Age• Men vs Women– WOMEN
• Small framed vs. large framed– Small framed
• Caucasian vs. Asian– Asian
OsteoporosisAssessment
• Bone densitometry – Detect bone mineral
density (BMD)
• http://www.youtube.com/watch?v=heTObdmOU8o
OsteoporosisMedical management
• PREVENTION!!!!!!• Diet– Calcium
• h
– Vitamin• D
• Exercise– Weight bearing
OsteoporosisMedical Management
• Rx– Calcium
• 1,000 mg/day
– Vit. D• 600 IU/day
– Vit. C• 2,000 mg/day
OsteoporosisMedical Management: Rx
• Calcium Supplement• Caltrate / Citracal• Split dose• S/E– Abd. distention– Constipation
OsteoporosisMedical Management: Rx
• Bisphosphonates• Action– i bone resorption– h bone density
• Nrs implications– AM– Water – NPO (ā & ṗ)– Hold Ca+ – ⌀ lye down
OsteoporosisMedical Management: FX
• Colles Fx• Distal Radius• D/T– Fall on open hand
• Reduced• Active ROM
OsteoporosisMedical Management: FX
• Compression Fx of vertebrae
• Conservative*• If acute pain – Vertebroplasty
OsteoporosisNrs Process
• Acute Pain– D/T compression fx
• Rest– Supine– Side-lying– △ position frequently– Flex knees– No twisting
• h activity as pain i
Paget’s diseasePathophysiology
• Rapid Bone Turnover• h # of osteoclasts • h bone resorption• F/B• h osteoblast activity • Bone replacement
Paget’s diseasePathophysiology
• Disorganized bone replacement
• Vascular • Weak • Pathologic fractures• bowed legs – Misalignment– Pain
Paget’s DiseaseMedical Management
• Pain– Rx• NSAIDs
• Gait– Assistive devices– Shoe lifts– PT
• Wt. control
Paget’s DiseaseMedical Management: Rx
• Calcitonin• Action– i bone resorption– i osteoclasts
• Route– Sub q– Nasal
Small Group Questions
1. What is the pathophysiology of Osteoporosis?2. What effect do the hormones calcitonin, estrogen and
PTH have on bone remodeling?3. What are Bisphosphonates? What advice would you give
to a client with these?4. What is a Colles’ fracture? What is a compression fx (of
the vertebrae)5. What is the pathophysiology of Paget’s Disease and
Osteomalacia?6. How are Paget’s Disease and Osteomalacia similar and
how are they different?
During a home visit, a client with AIDS tells the nurse that he has been exposed to measles. Which action by the nurse is most appropriate?
A. Administer an antibiotic B. Contact the physician for an order for
immune globulin C. Administer an antiviral D. Tell the client that he should remain in
isolation for 2 weeks
A client is discharged home with a prescription for Coumadin (sodium warfarin). The client should be instructed to: A. Have a Protime done monthly B. Eat more fruits and vegetables C. Drink more liquids D. Avoid crowds