Phantom limb

Can be elective due to complications of the vascular disease often of diabetes. ex. Gangrene, trauma (burns, crushing injury, electrical burns, frostbite, explosions) Vascular disease accounts for 82% of all amputations with 97% results in lower limb amputations. This is called dysvascular amputation. Men and African-Americans are at a higher risk for dysvascular amputations and the risk increases with age Amputation Cont. Upper limb amputations occurs less frequently compared to lower limb amputation and happens due to trauma or malignant tumors.

Objective of the surgery is to conserve as much limb length as possible to function with or without prosthesis and preservation of knee and elbow joints are always desirable, if possible. Two key components of the body that is significant in healing are muscle and tissue perfusion. Caregivers assess this by physical examination and diagnostic tools such as: Doppler flow studies with duplex ultrasound, segmental blood pressure determinations, and transcutaneous partial pressure of arterial oxygen. It is also performed at the distal point of a limb that will heal successfully.

Levels of Amputation The site of amputation is determined by two factors: adequate blood supply for healing and functional usefulness for prosthesis compatibility. Amputations are described in regards to the extremity and its location. AE- above elbow BE- below elbow AK/A- above knee BK/A- below knee Syme- ankle disarticulation (amputation through the ankle joint) Disarticulation- amputation through a joint Complications Hemorrhage or massive bleeding Infection (always a risk with any surgical procedure) Skin breakdown (irritation with prosthesis use).

Phantom limb pain due to severed peripheral nerve Joint contractures (cause by positioning and protective flexion withdrawal pattern) Nursing Assessments and Actions History and physical assessment Assess the function & condition of the residual limb if pt experienced a traumatic amputation (ex. Motorcycle crash that resulted in amputation) Assess the circulatory and function of the unaffected limb. Collection of culture and sensitivity samples to determine the choice of antibiotic to use in case if an infection occurs Nursing Assessments and Actions cont.

Identification and treatment of any concurrent health problems (ex. Anemia, dehydration, diabetes) –for patient to withstand surgical procedure. Psychological and emotional assessment of patient (if patient is aware and ready for the surgery) Assess patient’s nutritional status (high protein diet is essential for recovery and healing) Diagnosis Acute pain r/t amputation Impaired skin integrity r/t surgical amputation Distributed body image r/t amputation Grieving and/or risk for complicated grieving r/t loss of body part and resulting disability.

Self-care deficit: feeding, bathing, dressing, toileting, r/t amputation Impaired physical mobility r/t amputation Planning and Goals Pain relief Wound healing Altered body image acceptance Grieving process resolution Self-care independence Physical mobility restoration Absence of complications Nursing Interventions Relieving pain (ex. Phantom pain) Surgical pain can be effectively controlled by opioid analgesics Position change can improve client’s comfort level Medications:

Opioid analgesics, beta blocker (for dull & burning discomfort), anti-seizure medications (for controlling stabbing and cramping pain), Tricyclic antidepressants (for phantom pain) Nursing Interventions cont. Promoting Wound Healing Residual limb must be handled gently to prevent infection and osteomyelitis (infection and inflammation of the bone) If a cast or elastic dressing inadvertently comes off, the nurse must immediately wrap the residual limb with an elastic compression bandage to prevent excessive edema from developing in a short time, resulting in delay rehabilitation.

Enhancing body image Identifying patient’s strengths and resources to facilitate rehab Helping the patient to resolve grieving (Nurses creates an accepting and supportive atmosphere to encourage expression of feelings by the patient and family) Helping to achieve physical mobility Proper body positioning to prevent: hip or knee joint contractures in patients w/ lower limb amputation Encourage patients to use assistive devices Nursing Interventions cont. Monitoring and Managing Potential Complication Monitor for infection, massive hemorrhage due to loosened sutures, skin breakdown from immobilization and prosthesis usage. EVALUATE.

Phantom limb syndrome was first described by Ambroise Pare in 1552. Pare, a French surgeon. Pare noticed this phenomenon in soldiers who felt pain in their amputated limbs. Then in 1871, Mitchell coined the term “phantom limb”. Phantom limb syndrome …

Phantom limb syndrome was first described by Ambroise Pare in 1552. Pare, a French surgeon. Pare noticed this phenomenon in soldiers who felt pain in their amputated limbs. Then in 1871, Mitchell coined the term “phantom limb”. Phantom limb syndrome …

During the Civil War, doctors were often forced to improvise with prescriptions, anesthesia, and amputations to save the lives of severely wounded soldiers. Even though medical decisions during the Civil war were gruesome and often pointless, and advanced our medical …

During the Civil War, doctors were often forced to improvise with prescriptions, anesthesia, and amputations to save the lives of severely wounded soldiers. Even though medical decisions during the Civil war were gruesome and often pointless, and advanced our medical …

The medical practices used during the Civil War era were not very advanced and took a big toll on the war itself. Many of the soldiers, both Union and Confederate, returned home with missing body parts, were shell shocked, or …

Whether a patient has Type 1 or Type 2 diabetes makes no difference when it comes to the effects on wound care. Several problems arise with diabetics and the way there body works to heal a wound and what problems …

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