Amputation and Joint replacements

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What are the common causes of amputations?

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Common causes of amputations include:

  1. Trauma - such as accidents or injuries.
  2. Vascular diseases - including diabetes and peripheral artery disease.
  3. Infections - severe infections that cannot be controlled.
  4. Tumors - malignant or benign tumors affecting limbs.
  5. Congenital conditions - present at birth that affect limb development.

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Causes of Amputation

What are the common causes of amputations?

Common causes of amputations include:

  1. Trauma - such as accidents or injuries.
  2. Vascular diseases - including diabetes and peripheral artery disease.
  3. Infections - severe infections that cannot be controlled.
  4. Tumors - malignant or benign tumors affecting limbs.
  5. Congenital conditions - present at birth that affect limb development.
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Nursing Diagnosis for Amputation Patients

What nursing diagnoses are relevant for patients with amputations?

Relevant nursing diagnoses for patients with amputations include:

  1. Impaired physical mobility - related to loss of limb.
  2. Acute pain - related to surgical procedure or phantom limb sensations.
  3. Risk for infection - due to surgical site or prosthetic use.
  4. Disturbed body image - related to changes in physical appearance.
  5. Ineffective coping - related to loss and adjustment to new lifestyle.
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Nursing Interventions for Amputation Care

What nursing interventions are important for patients with amputations?

Important nursing interventions for patients with amputations include:

  1. Pain management - using medications and alternative therapies.
  2. Wound care - monitoring and caring for the surgical site.
  3. Mobility assistance - helping with mobility aids and rehabilitation exercises.
  4. Patient education - teaching about prosthetic use and care.
  5. Emotional support - providing counseling and support for adjustment.
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Causes of Amputation

What are the primary medical causes of amputation?

The primary medical causes of amputation include:

  • Diabetes
  • Peripheral vascular disease
  • Cancer
  • Gangrene
  • Infection
  • Obesity

These conditions usually lead to amputations of the lower extremity, accounting for 74% of all amputations.

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Causes of Amputation

What types of trauma can lead to amputation and what percentage do they account for?

Types of trauma that can lead to amputation include:

  • Accidents (e.g., crushing injuries, burns, frostbite)

These traumatic amputations often affect the upper extremities and account for 23% of all amputations.

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Causes of Amputation

What are congenital anomalies and how do they relate to amputation?

Congenital anomalies refer to conditions present at birth that can lead to amputation. These can affect either upper or lower extremities and account for 3% of all amputations.

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Statistics on Amputations

What is the estimated number of amputees in the US by 2050?

By 2050, there will be an estimated 3.6 million amputees in the US.

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Statistics on Amputations

What is the peak age range for amputations?

The peak age for amputations is between 41 and 70 years old.

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Causes of Amputation

What is the major cause of amputations in the US?

The major cause of amputations is poor circulation, particularly due to peripheral vascular disease (PVD) associated with diabetes mellitus (DM).

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Statistics on Amputations

What percentage of amputations occur in individuals with diabetes?

Over 50% of amputations occur in individuals with diabetes.

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Types of Amputations: BKA and AKA

What is the most common type of amputation?

The most common type of amputation is lower extremity amputations.

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Statistics on Amputations

What percentage of lower extremity amputations are due to vascular disease?

Over 80% of lower extremity amputations are due to vascular disease.

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Nursing Diagnosis for Amputation Patients

How can a patient with body image disturbances be identified?

A patient with body image disturbances will often avoid looking at the amputated area.

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Types of Amputations: BKA and AKA

What are the two types of amputations discussed?

The two types of amputations discussed are Above the Knee (AKA) and Below the Knee (BKA).

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Types of Amputations: BKA and AKA

What is the ideal shape of a stump for successful prosthesis fitting?

The ideal shape of a stump for successful prosthesis fitting is cone-shaped. If the stump does not have this shape, the patient may not be able to wear a prosthesis.

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Types of Amputations: BKA and AKA

What factors can affect the shape of the stump after an amputation?

Factors that can affect the shape of the stump include:

  1. The surgical technique used by the surgeon.
  2. The way nurses wrap the stump post-surgery.
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Types of Amputations: BKA and AKA

What are some complications associated with amputations?

Complications associated with amputations include:

  • Infection: Prophylactic antibiotics are recommended prior to surgery.
  • Pain: Due to nerve endings at the site.
  • Edema: Can increase pain and pressure on the stump.
  • Wound healing issues: Delayed healing can occur.
  • Skin breakdown: Improper wrapping can lead to skin issues.
  • Phantom limb pain: Pain can occur when peripheral nerves are detached.
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Phantom Limb Pain Management

What percentage of new amputees experience phantom limb pain?

60-70% of new amputees experience phantom limb pain.

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Phantom Limb Pain Management

What is the best intervention for managing phantom limb pain?

The best intervention for phantom limb pain is to have the patient put on the prosthesis, which helps with pain relief.

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Residual Limb Pain and Management

What are some potential causes of residual limb pain?

Potential causes of residual limb pain include:

  1. Poor prosthetic fit due to swelling.
  2. Bruising from fluid retention.
  3. Neuroma formation in unprotected areas.
  4. Chafing or rubbing of the skin.
  5. Poor circulation.
  6. Nerve damage, often from diabetes.
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Residual Limb Pain and Management

What nursing intervention can help desensitize the stump?

Nurses can teach patients to rub, tap, or strike the stump to help desensitize it.

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Phantom Limb Pain Management

How does phantom limb pain change over time?

Phantom limb pain decreases in severity over time but may flare up at various times due to factors like certain foods or swelling/use.

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Phantom Limb Pain Management

Is phantom limb pain more prevalent in traumatic amputations or PVD?

Phantom limb pain is more prevalent in those with traumatic amputations than in those with peripheral vascular disease (PVD).

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Stump Wrapping Techniques

What is the recommended shape for a residual limb to encourage proper fitting of a prosthesis?

The recommended shape for a residual limb is a conical shape. This shape helps in reducing the risk of late phantom limb pain and is essential for the successful fitting of a prosthesis.

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Stump Wrapping Techniques

What are the key objectives for stump conditioning?

The key objectives for stump conditioning include:

  1. Conical Shape
  2. Maximum shrinkage depends on how the stump is wrapped
  3. Absence of tenderness
  4. Freely movable scar
  5. Firm skin
  6. Normal muscle strength and range
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Stump Wrapping Techniques

Why is it important to avoid using clips on ace wraps when wrapping a stump?

Avoiding clips on ace wraps is important because it helps in achieving a better conical shape and reduces the risk of complications such as contractures and phantom limb pain.

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Stump Wrapping Techniques

What position should a patient be in to prevent contractures after a below-the-knee amputation?

A patient should lie on their stomach with their legs extended straight and no pillows underneath the stump to prevent the knee from dropping and creating a contracture.

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Stump Wrapping Techniques

What mindset is important for a patient to successfully wear a prosthesis?

A strong and dedicated mindset is crucial for a patient to successfully wear a prosthesis. Body image disturbance can hinder their willingness to engage with the prosthetic, even if the stump is well-shaped.

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Nursing Interventions for Amputation Care

What are the key criteria for evaluating a client's suitability for prosthetic use?

  1. Client Motivation: The client must be motivated to learn and possess self-care skills.

  2. Family Support: The client and/or family should be capable of learning and have the necessary skills for self-care.

  3. Absence of Contractures: There should be no hip or knee contractures present.

  4. Medical Conditions: Other medical issues (e.g., respiratory, cardiac, stroke, or visual problems) should not hinder the use of the prosthetic limb.

  5. Mindset: A negative mindset can interfere with the use of the prosthetic limb, along with physical limitations.

  6. Positioning: The patient should lie on their stomach for 30 minutes to keep the knees straight.

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Nursing Interventions for Amputation Care

What exercises are recommended for patients to strengthen and improve endurance after amputation?

  • Normal muscle power and range is essential.
  • Prone position for stump extension is advised.
  • Focus on prevention of complications such as contractures.
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Nursing Interventions for Amputation Care

What daily assessment should a patient with a prosthetic limb perform on their stump?

Patients should assess their stump every day for any skin breakdown using a mirror. Any minor cuts or skin limitations must heal before wearing a prosthesis.

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Phantom Limb Pain Management

What pain management strategies should be employed for patients with below the knee amputation experiencing foot pain?

For patients with below the knee amputation complaining of foot pain, the nurse can:

  1. Provide pain medication.
  2. Explain the concept of phantom limb pain.
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Nursing Diagnosis for Amputation Patients

What types of emotional support should be provided to patients after amputation?

Patients may experience an altered body image; therefore, it is crucial to provide emotional support and encouragement throughout their recovery process.

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Nursing Interventions for Amputation Care

What adaptations can be made to assist patients in performing activities of daily living (ADLs) after amputation?

  • Use of assistive devices such as walkers, canes, or crutches.
  • Nutritional counseling for wound healing.
  • Vocational counseling to discuss returning to work with a prosthesis and necessary modifications.
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Nursing Interventions for Amputation Care

What community reintegration strategies should be considered for patients post-amputation?

  • Focus on community reintegration and home safety/adaptations.
  • Discuss necessary adaptations to the home environment to ensure safety and accessibility.
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Residual Limb Pain and Management

What is the purpose of residual limb wrapping or the use of a shrinker?

The purpose of residual limb wrapping or using a shrinker is to reduce swelling, shape the limb for prosthetic fitting, and promote healing. Proper wrapping techniques help in maintaining the residual limb's shape and preventing complications such as contractures.

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Nursing Interventions for Amputation Care

What are the steps for proper care of a prosthesis?

  1. Clean the prosthesis daily with mild soap and water.
  2. Inspect the prosthesis for any signs of wear or damage.
  3. Ensure that all components are functioning properly.
  4. Store the prosthesis in a safe, dry place when not in use.
  5. Follow the manufacturer's instructions for maintenance and care.
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Nursing Interventions for Amputation Care

What is the purpose of using linear or special socks with a prosthesis?

Linear or special socks are used to provide cushioning, improve comfort, and help with the fit of the prosthesis. They also assist in moisture management and can help prevent skin irritation or breakdown.

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Nursing Interventions for Amputation Care

What are the key steps in properly donning and doffing a prosthesis?

Donning a Prosthesis:

  1. Prepare the residual limb by cleaning and drying it.
  2. Apply any necessary liners or socks.
  3. Position the prosthesis correctly.
  4. Secure the prosthesis in place.

Doffing a Prosthesis:

  1. Loosen any straps or fasteners.
  2. Carefully remove the prosthesis from the limb.
  3. Clean the residual limb and prosthesis as needed.
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Total Joint Replacement Goals and Indications

What are the goals of total joint replacement?

The goals of total joint replacement include:

  1. Pain relief: Alleviating chronic pain associated with joint conditions.
  2. Improved function: Enhancing the range of motion and overall functionality of the joint.
  3. Restoration of mobility: Allowing patients to return to daily activities and improve their quality of life.
  4. Correction of deformity: Addressing any structural abnormalities in the joint.
  5. Long-term durability: Providing a lasting solution to joint issues.
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Total Joint Replacement Goals and Indications

What are the indications for total joint replacement?

Indications for total joint replacement typically include:

  1. Severe joint pain: Persistent pain that limits daily activities.
  2. Joint stiffness: Reduced range of motion that affects mobility.
  3. Joint deformity: Structural changes in the joint that impair function.
  4. Failure of conservative treatments: Ineffectiveness of medications, physical therapy, or other non-surgical interventions.
  5. Degenerative joint diseases: Conditions such as osteoarthritis or rheumatoid arthritis that severely impact joint function.
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Post-Operative Care and Precautions for Joint Repl...

What care-planning needs should be considered after total joint replacement?

Care-planning needs after total joint replacement include:

  1. Pain management: Developing a strategy for effective pain control post-surgery.
  2. Physical therapy: Implementing a rehabilitation program to restore mobility and strength.
  3. Monitoring for complications: Regular assessments for signs of infection, blood clots, or other post-operative issues.
  4. Patient education: Informing the patient about activity restrictions and precautions.
  5. Follow-up appointments: Scheduling regular check-ups to assess recovery progress.
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Post-Operative Care and Precautions for Joint Repl...

What hip precautions should be described after joint replacement?

Hip precautions after joint replacement typically include:

  1. Avoiding hip flexion: Keeping the hip from bending beyond 90 degrees.
  2. Avoiding crossing legs: Preventing the legs from crossing at the knees or ankles.
  3. Avoiding internal rotation: Not turning the operated leg inward.
  4. Using assistive devices: Employing walkers or crutches as needed for stability.
  5. Following activity guidelines: Adhering to specific recommendations from healthcare providers regarding movement and activity levels.
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Total Joint Replacement Goals and Indications

What are the primary goals of total joint replacement?

The primary goals of total joint replacement are to decrease pain and to increase or restore function, which typically requires surgical intervention.

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Total Joint Replacement Goals and Indications

What is the most common form of arthritis that may lead to joint replacement?

The most common form of arthritis that may lead to joint replacement is Osteoarthritis. It affects 15.9% of adults aged 25 and older and 39.6% of adults aged 65 and older.

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Total Joint Replacement Goals and Indications

What are some contributing factors to the need for joint replacement?

Contributing factors to the need for joint replacement include age, genetics, gender, previous injuries, muscle weakness, and obesity.

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Total Joint Replacement Goals and Indications

What assessments should nurses perform for patients considering joint replacement?

Nurses should perform assessments to check for nerve damage, with one indication being numbness in the affected area.

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Total Joint Replacement Goals and Indications

What are some non-surgical interventions to consider before knee replacement?

Non-surgical interventions to consider before knee replacement include:

  1. Anti-inflammatory medications
  2. Weight management
  3. Physical therapy (10 sessions)
  4. Assistive devices (canes, walkers)
  5. Activity modification to relieve pain
  6. Acupuncture
  7. Massage

These are typically explored before considering surgery as a last resort.

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Nursing Diagnosis for Amputation Patients

What are the typical symptoms of osteoarthritis?

Typical symptoms of osteoarthritis include:

  • Joint edema
  • Pain
  • Stiffness Rest usually relieves these symptoms.
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Nursing Diagnosis for Amputation Patients

What findings are typically observed in X-rays of osteoarthritis patients?

X-rays of patients with osteoarthritis typically show:

  • Joint space narrowing
  • Osteophytes
  • Bony sclerosis
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Nursing Diagnosis for Amputation Patients

How does rheumatoid arthritis differ from osteoarthritis in terms of its nature?

FeatureRheumatoid Arthritis (RA)Osteoarthritis (OA)
NatureAutoimmune, inflammatory diseaseDegenerative joint disease
CauseImmune system attacks healthy cellsWear and tear of joint cartilage
InflammationProminentLess prominent
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Nursing Diagnosis for Amputation Patients

What demographic is more affected by both osteoarthritis and rheumatoid arthritis?

Both osteoarthritis and rheumatoid arthritis affect women more than men, with a ratio of approximately 3:5 for osteoarthritis.

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Nursing Diagnosis for Amputation Patients

What are the effects of rheumatoid arthritis on finger joints?

In rheumatoid arthritis, the finger joints can become deformed, leading to changes in their shape.

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Causes of Amputation

What is avascular necrosis and what causes it?

Avascular necrosis is the death of bone tissue due to ischemia or loss of blood supply. It can occur due to major trauma, such as hip fractures or dislocations, or through other means including intraluminal obliteration, increased marrow pressure, or cytotoxicity.

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Statistics on Amputations

What imaging techniques are important for assessing avascular necrosis?

X-rays and MRIs are important for assessing the status of the bone in cases of avascular necrosis. They help visualize the necrosis that first forms in the yellow bone marrow.

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Nursing Interventions for Amputation Care

Why is understanding the types of prosthesis important in rehabilitation care?

Understanding the types of prosthesis and fixative is crucial for rehabilitation care as it helps healthcare professionals determine and estimate precautions related to healing and the efficacy of the materials used, such as whether a hip prosthetic is cemented or non-cemented, which can influence weight-bearing status.

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Post-Operative Care and Precautions for Joint Repl...

What are the hip precautions that should be followed after hip arthroplasty?

  • Always follow the prescribed weight-bearing status.
  • Weight-bearing status is determined by the surgeon based on the condition of the bone and type of surgery.
  • The rehab nurse should be aware of the weight-bearing status before transfers or ambulation to prevent complications.
  • Use a fracture bedpan to avoid strain.
  • Place a pillow between the knees to prevent adduction, which can lead to dislocation of the prosthesis.
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Post-Operative Care and Precautions for Joint Repl...

What can happen if weight-bearing precautions are not followed after hip arthroplasty?

Failure to follow weight-bearing precautions can result in:

  • Refracture of the bone
  • Dislocation of the prosthesis
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Post-Operative Care and Precautions for Joint Repl...

What position should be maintained to prevent complications after hip arthroplasty?

To prevent complications, the patient should maintain abduction and avoid adduction. This means:

  • Do not cross legs.
  • Avoid bending more than 90 degrees at the hip.
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Post-Operative Care and Precautions for Joint Repl...

What are the four essential tasks that nurses must perform post-operatively?

  1. Give pain medications
  2. Take vital signs
  3. Measure the legs
  4. Pull the joint back
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Post-Operative Care and Precautions for Joint Repl...

What are some common complications after joint replacement surgery?

  • Loosening of dislocation
  • Infection (e.g., UTIs)
  • Blood clots (patients must go home with anticoagulants to decrease thrombus formation)
  • Pain (assess leg lengths for dislocation)
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Post-Operative Care and Precautions for Joint Repl...

What are the recommended hip precautions after arthroplasty?

Do:

  • Sit with legs 3-6 inches apart
  • Keep 2 pillows between legs when lying or turning
  • Inform professionals of having a prosthesis
  • Continue leg strengthening and ROM exercises
  • Report signs of infection

Don't:

  • Cross legs or ankles
  • Bend past 90 degrees at the waist
  • Bear full weight on the operative side until permitted by the physician
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Post-Operative Care and Precautions for Joint Repl...

What are the precautions to prevent hip dislocation after a total hip replacement?

  1. Do not bend the operated hip greater than 90 degrees while sitting.
  2. Avoid crossing legs or bringing the operated leg past the midline of the body.
  3. Do not turn or twist the operated leg inward.
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Post-Operative Care and Precautions for Joint Repl...

What are the signs and symptoms of wound infection after joint replacement surgery?

  • Redness around the wound
  • Swelling or increased warmth
  • Increased pain at the site
  • Pus or drainage from the wound
  • Fever or chills
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Post-Operative Care and Precautions for Joint Repl...

What are the implications for air travel for a person with joint replacement?

Patients with joint replacements will go home with anticoagulants to decrease the risk of thrombus formation (blood clots).

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Fall Prevention

What should a home health nurse assess for when a patient is going home with crutches after knee replacement?

The nurse should assess for scatter rugs in the house to prevent falls.

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