AMPUTATION - AMPUTATION In general, amputation of limbs is...

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AMPUTATION In general, amputation of limbs is the result of trauma, peripheral vascular disease, tumors, and congenital disorders. For the purpose of this plan of care, amputation refers to the surgical/traumatic removal of a limb. Upper-extremity amputations are generally due to trauma from industrial accidents. Reattachment surgery may be possible for fingers, hands, and arms. Lower-extremity amputations are performed much more frequently than upper-extremity amputations. Five levels are currently used in lower-extremity amputation: foot and ankle, below knee (BKA), knee disarticulation and above (thigh), knee-hip disarticulation; and hemipelvectomy and translumbar amputation. There are two types of amputations: (1) open (provisional), which requires strict aseptic techniques and later revisions, and (2) closed, or “flap.” CARE SETTING Inpatient acute surgical unit and subacute or rehabilitation unit. RELATED CONCERNS Cancer Diabetes mellitus/diabetic ketoacidosis Psychosocial aspects of care Surgical intervention Patient Assessment Database Data depend on underlying reason for surgical procedure, e.g., severe trauma, peripheral vascular/arterial occlusive disease, diabetic neuropathy, osteomyelitis, cancer. ACTIVITY/REST May report: Actual/anticipated limitations imposed by condition/amputation CIRCULATION May exhibit: Presence of edema; absent/diminished pulses in affected limb/digits EGO INTEGRITY May report: Concern about negative effects/anticipated changes in lifestyle, financial situation, reaction of others Feelings of helplessness, powerlessness May exhibit: Anxiety, apprehension, irritability, anger, fearfulness, withdrawal, grief, false cheerfulness NEUROSENSORY May report: Loss of sensation in affected area SAFETY May exhibit: Necrotic/gangrenous area Nonhealing wound, local infection SEXUALITY May report: Concerns about intimate relationships SOCIAL INTERACTION May report: Problems related to illness/condition Concern about role function, reaction of others TEACHING/LEARNING Discharge plan DRG projected mean length of inpatient stay: 5.8–12.7 days considerations: May require assistance with wound care/supplies, adaptation to prosthesis/ambulatory
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devices, transportation, homemaker/maintenance tasks, possibly self-care activities and vocational retraining Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Studies depend on underlying condition necessitating amputation and are used to determine the appropriate level for amputation. X-rays: Identify skeletal abnormalities. CT scan: Identifies soft-tissue and bone destruction, neoplastic lesions, osteomyelitis, hematoma formation. Angiography and blood flow studies: Evaluate circulation/tissue perfusion problems and help predict potential for tissue healing after amputation.
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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AMPUTATION - AMPUTATION In general, amputation of limbs is...

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