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Definition of Amputation Statistics Reasons for Amputation Types of Amputation Psychological Support Preparation Types of Surgery, Pre-op, and Post-op Care Surgical Complications Amputation Complications Stump Care Rehabilitation and Prosthesis Case Study & Questions
Amputation: the surgical removal of a part of the body, a limb or part of a limb
Statistics
Canadians with diabetes are 23 times more likely to be hospitalized for a limb amputation than someone without diabetes More than 4,000 Canadians with diabetes had a limb amputated in 2006. 30% of Canadians with diabetes will die within one year of amputation. 69% of limb amputees with diabetes will not survive past five years Lower limb amputations are 4 times more common than upper limb (infection) .
While over 90% of amputations caused by vascular disease involve the lower limb, nearly 70% of amputations caused by trauma involve the upper limb
Statistics
For both males and females, risk of traumatic amputations increased steadily with age, reaching its highest level among people age 85 or older Limb amputations resulting from cancer most commonly involved the lower limb; above-knee and below-knee amputations alone accounted for more than a third (36 percent) of all cancer-related amputations. There were no notable differences by sex or race in the age-specific risk of cancer-related amputations, though rates of limb loss due to cancer were generally higher among individuals other than African Americans. In all age groups, the risk of dysfunctional vascular related amputation was highest among males and individuals who are African American
Congenital deformities
Chronic Osteomyelitis Malignant Tumor
Complications of diabetes that contribute to the increased risk of foot infection include: 1. Neuropathy a. Sensory b. Autonomic c. Motor 2. Peripheral vascular disease . 3. Immuno-compromise
Pre-operative Assessment
Neurovascular and functional status of extremity Function and Condition of residual limb (in case of traumatic amputation) Circulatory status and function of unaffected limb Signs & Symptoms of infection (culture required) Nutritional Status Concurrent medical problems Current medications
Emotional reaction to amputation Circumstances surrounding amputation (ie. Traumatic versus surgical)
Primary Amputation
Monitor for complications Pain management Education & support Promote mobility/ independent self-care Enhancing Body Image Promote wound healing
Rinse well
Dry thoroughly General wound care
Hemorrhage Infection
Complication of Amputations
Joint contractures Energy issues
Acupuncture Exercise Anaesthetics Heat Biofeedback Magnetic Therapy Chiropractic Massage Cold Medications Cranial Sacral Therapy Psychotherapy Desensitization Shrinker Socks Dietary and Herbal Wearing Your Supplements Artificial Limb Electrical Stimulation
Prostheses
Devices to help shape and shrink the residual limb and help client readapt Wrapping of elastic bandages Individual fitting of the prosthesis; special care
BELOW KNEE
KNEE DISARTICULATION
ABOVE KNEE
HIP DISARTICULATION
Prosthetics
There are 5 Stages of Rehabilitation: 1. Healing and Starting Physiotherapy 2. Visiting the Prosthetist
Case Study
John Rocke is a 45-year-old divorcee with no children. He has a history of type one diabetes mellitus and poor control of blood glu- cose levels. Mr. Rocke is unemployed and currently receives un- employment compensation. He lives alone in a second-floor apartment. Mr. Rocke had developed gangrene in the toe and failed to seek prompt medical attention; as a result, a left below- the-knee amputation was necessary.
What type of surgery did Mr. Rocke receive? A. Open B. Closed C. Congential D. Secondary
Case Study
Mr. Rocke is in his second postoperative day and his vital signs are stable. The stump is splinted and has a soft dressing. The wound is approximating well without signs of infection. He has not performed ROM exercises or turning since his surgery, com- plaining of severe crushing pain in his left foot? What type of pain is this? a. Fibromyalgia b. Somatic Pain c. Phantom limb pain d. Imaginary pain
Case Study
Which of the following post-operative complications would Mr. Rocke NOT experience? A. Hemmorrhage B. Joint Contractures C. Skin Breakdown D. Bony Overgrowth
Case Study
When the nurse goes into the room, he yells, "Get out! I dont want anyone to see me like this. What would be a priority nursing diagnosis for this situation?
Case Study
True or False: Mr. Rocke should receive a diet high in protein, vitamins and simple carbohydrates
Case Study
You are planning an education session to provide Mr. Rocke with information about the importance of stump care. Which of the following statements that Mr. Rocke repeats back to you best demonstrates his understanding of good stump care? A. I will wash my stump in the morning with cool water and Axe body wash. B. I will wash my stump at night with fragrance free soap and warm water. C. I will wash my stump in the morning with fragrance free soap and warm water D. I will never wash my stump.
References
Day, R.A., Paul, I., Williams, B., Smeltzer, S., Bare, B.G. (2009) Brunner and Suddarth's Textbook of
Canadian Medical-Surgical Nursing, 2nd ed. Lippincott Williams & Wilkins cawc.net/index.php/public/facts-stats-and-tools/statistics/
Canadian Association of Wound Care. (2011). Statistics on Diabetic Foot Ulcers. Retrieved from http://
Mosby. (2008). Mosby's Dictionary of Medicine, Nursing & Health Professions. 8th ed. A Mosby Title
National Limb Loss Information Center. (2008). Amputation Statistics by Cause Limb Loss in the United States. Retrieved from <http://www.amputeecoalition.org/fact_sheets/amp_stats_cause.html>
National Limb Loss Information Center. Statistics on Hand and Arm Loss. Retrieved from <http:// www.aboutonehandtyping.com/statistics.html> Net Wellness. (2011). Amputation Overview. Retrieved from <http://www.netwellness.org/ healthtopics/amputation/overview.cfm> War Amps (2009) Retrieved from <http://www.waramps.ca/CMSMasterHome.aspx?&LangType =1033>