What is the definition of amputation and its primary purposes?
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Amputation is the removal of a body part by surgical procedure or trauma, performed to control pain, disease, improve function, or enhance quality of life.
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What is the definition of amputation and its primary purposes?
Amputation is the removal of a body part by surgical procedure or trauma, performed to control pain, disease, improve function, or enhance quality of life.
List the three main causes of amputation and provide examples for each.
What is the most common cause of amputation in the United States?
Poor circulation, particularly peripheral vascular disease due to diabetes mellitus, is the major cause of amputation in the US.
What percentage of lower extremity amputations are due to vascular disease?
Over 80% of lower extremity amputations are due to vascular disease.
What are common nursing diagnoses for patients undergoing amputation?
Body image disturbances, acute pain, risk for dysfunctional grief, risk for depression, impaired physical mobility, and loss of independence.
How can you identify a patient with body image disturbance after amputation?
The patient will avoid looking at the amputated area.
What are the two major types of lower extremity amputations?
Above Knee Amputation (AKA) and Below Knee Amputation (BKA).
Why is the shape of the residual limb important for prosthesis use?
A cone-shaped stump is ideal for prosthesis fitting; improper shape can prevent successful prosthesis use.
List at least three complications that can occur after amputation.
Infection, pain (including phantom limb pain), edema, wound healing issues, and skin breakdown.
What is phantom limb pain and how common is it among new amputees?
Phantom limb pain is pain felt in the missing limb, experienced by 60-70% of new amputees.
What intervention can help reduce phantom limb pain?
Wearing the prosthesis can help reduce phantom limb pain.
What is residual limb pain and what are some possible causes?
Residual limb pain is pain in the remaining limb, caused by poor prosthetic fit, bruising, neuroma, chafing, poor circulation, or nerve damage.
What nursing intervention can help desensitize the stump?
Teaching patients to rub, tap, or strike the stump helps desensitize it.
What are the objectives for residual limb (stump) conditioning?
Achieve a conical shape, maximum shrinkage, absence of tenderness, freely movable scar, firm skin, and normal muscle strength and range.
Why is a strong mindset important for prosthesis use?
A strong and dedicated mindset is crucial for successful prosthesis use; body image disturbance can hinder success even with a well-shaped stump.
What is the recommended wrapping technique for a residual limb?
The figure-8 wrapping technique is recommended, and clips should be avoided.
Why should patients with BKA avoid placing pillows under the stump?
Placing pillows under the stump can cause knee contractures, preventing proper prosthesis fitting.
What is the recommended position for BKA patients to prevent contractures?
Patients should lie on their stomach (prone position) to keep the knee straight.
List criteria for successful prosthetic use evaluation.
Client motivation, self-care skills, family support, absence of hip/knee contractures, and no interfering medical problems.
What daily care should be performed on the residual limb before using a prosthesis?
Daily assessment for skin breakdown using a mirror; any minor cuts must heal before prosthesis use.
What are some key interventions/education points for patients learning to use a prosthesis?
Strengthening exercises, prone positioning, complication prevention, ADL adaptations, prosthetic fitting/use education, pain management, and emotional support.
What assistive devices might be used during rehabilitation after amputation?
Walkers, canes, and crutches.
Why is nutritional counseling important for amputees?
Proper nutrition supports wound healing and overall recovery.
What is the role of the interdisciplinary team in amputation rehabilitation?
The team includes orthopaedists, surgeons, prosthetists, physiatrists, nurses, therapists, social workers, psychologists, and others to provide comprehensive care.
What are the main goals of total joint replacement?
To decrease pain and increase or restore function.
What are the two main procedures used in joint replacement?
Osteotomy (cutting/realigning bone) and arthroplasty (removing/replacing an unhealthy joint).
What is the most common indication for joint replacement?
Severe osteoarthritis (OA).
List some non-surgical interventions for osteoarthritis before considering joint replacement.
Anti-inflammatory medications, weight management, physical therapy, assistive devices, activity modification, acupuncture, and massage.
What are typical symptoms of osteoarthritis?
Joint edema, pain, and stiffness relieved by rest; X-rays show joint space narrowing and osteophytes.
How does rheumatoid arthritis differ from osteoarthritis?
RA is an autoimmune inflammatory disease causing joint swelling and deformation, while OA is a chronic, progressive joint disease mainly due to wear and tear.
What is avascular necrosis and what causes it?
Avascular necrosis is bone tissue death due to loss of blood supply, caused by trauma, intraluminal obliteration, increased marrow pressure, or cytotoxicity.
Why is it important to know the type and fixative of a hip or knee prosthetic?
It influences weight-bearing status and rehabilitation precautions post-operatively.
What imaging techniques are important for assessing bone status before joint replacement?
X-rays and MRIs.
What is the preferred surgical approach for hip arthroplasty?
Anterior lateral approach is preferred over posterior.
What can happen if weight-bearing precautions are not followed after hip arthroplasty?
Failure to follow precautions can result in refracture or dislocation of the prosthesis.
What is a key precaution to prevent hip dislocation after arthroplasty?
Always use a pillow between the knees to prevent adduction and promote abduction.
List four nursing actions after hip arthroplasty.
Give pain meds, take vital signs, measure leg lengths, and assist with joint reduction if needed.
What are common complications after hip arthroplasty?
Loosening/dislocation, infection (e.g., UTIs), blood clots, and pain.
Why are anticoagulants prescribed after joint replacement surgery?
To decrease the risk of thrombus (blood clot) formation.
List three 'Do's' for hip precautions after arthroplasty.
Sit with legs 3-6 inches apart, keep 2 pillows between legs when lying/turning, inform professionals of prosthesis.
List three 'Don'ts' for hip precautions after arthroplasty.
Don't cross legs/ankles, don't bend past 90 degrees at the waist, don't bear full weight on the operative side until cleared.
What visual aids are used to teach hip precautions post-surgery?
Diagrams showing not to bend hip >90°, not to cross legs, and not to twist the operated leg inward.
What are important signs and symptoms of wound infection to teach patients post-op?
Redness, swelling, increased pain, drainage, and fever.
What home safety advice is important for knee replacement patients using crutches?
Assess for scatter rugs and recommend living on the first floor for 3-6 months to prevent falls.
Why might air travel be a concern after joint replacement?
Patients are on anticoagulants, which have implications for travel and risk of blood clots.
What is the recommended living arrangement for knee replacement patients post-op?
Living on the first floor for 3-6 months to avoid stairs and reduce fall risk.