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Ortho Lecture 1 - Amputations

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by

Sharon Hudacek

on 7 October 2012

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Transcript of Ortho Lecture 1 - Amputations

Nursing alert: If the cast or dressing comes off, the nurse must immediately wrap the residual limb with an elastic compression bandage or edema will develop. Notify the surgeon Keep large tourniquet on hand to apply around stump in event of hemorrhage. Patients can bear full weight on permanent prosthesis in 3 months after amputation.

Review teaching guide box on page 1661 in Lewis Amputations Use only cotton or wool residual limb socks. Elevate foot of the bed for the first few hours to hasten venous return and prevent edema.
Do not elevate stump on pillow..may cause hip contracture. Lay stump flat on bed.
Turn patient to prone position first day post op then next days…30 min 3-4 times daily to prevent hip contracture.
DO not sit for more than 1 hour in a chair
ND: Impaired physical mobility related to loss of extremity Support, accepting atmosphere
Note signs of depression. Patients are usually less depressed if they awaken with prosthesis attached. ND: Grieving related to loss of body part Occurs after surgery or 2-3 months after amputation. It occurs more frequently in above the knee amputations.
Beta blockers (Inderal) for constant dull burning
Anticonvulsants such as Tegretol or Neurontin for knifelike pain.
Antispasmodics such as Baclofen for spasm or cramping.
Sensory alteration related to Phantom limb pain Closed rigid cast dressing is frequently used to provide compression, to support tissue and control pain and prevent contracture.
The residual limb is wrapped with elastic plaster of paris bandages. The plaster cast is equipped to attach a temporary prosthetic extension (pylon). The cast is changed in 10 days.
Medical Management: This theory argues that the brain retains a memory of specific limb positions and that after amputation there is a conflict between the visual system, which literally sees that the limb is missing, and the memory system which remembers the limb as a functioning part of the body.

Weeks, S.R., Anderson-Barnes, V.C., Tsao, J. (2010). "Phantom limb pain: Theories and therapies". The Neurologist 16 (5): 277–286. " Complications to recognize for the nurse assessing this patient:
Hemorrhage- massive hemorrhage due to a loosened suture is the most threatening problem.
Infection- a frequent complication due to the wound often being contaminated, gangrene and the like.
Phantom limb pain- early post op most often related to AKA Nursing Assessment
3 areas:


After the surgeon creates two flaps of skin and tissue, the muscle is cut and the main artery and veins of the femur bone are exposed.
The surgeon severs the main artery and veins. New connections are formed between them, restoring blood circulation. The sciatic nerve is then pulled down, clamped and tied, and severed.
The surgeon saws through the exposed femur bone.
The muscles are closed and sutured over the bone. The remaining skin flaps are then sutured together, creating a stump. Most likely replantation involves the digits.
Wrap in cool dry cloth and moisten with normal saline or bottled water.
Place body part in a sealed plastic bag.
Place bag in ice water (NEVER SHOULD ICE TOUCH THE AMPUTATED PART) Replantation CAUSES
Peripheral vascular disease--often a post diabetes mellitus, frostbite, burns, electrical burns, tumor.

Osteogenic sarcoma. Amputations Nursing Care - Amputation

Stump care- observe rigid dressing for signs of oozing. If blood stain appears, mark it and observe every 10 minutes. Report excessive oozing. Kaplan p. 351-352- important chart Immediate Post-Op Prosthesis (IPOPs) Disadvantage is that you cannot see the site – a cast-like bandage is on the residual limb and this prosthetic is attached post op. PYLON- IPOP post op 90% of amputees experience this Nerves- severed- CNS- afferent impulse
Pain is immediate post op (MUST MEDICATE), seems to decrease with time.
Intense burning or crushing
“Numbness or tingling”
Pain is often triggered by touching the residual or remaining limb. Phantom Limb Pain It is performed at the most distal point that will heal successfully. It depends on circulation of the part and functional usefulness to meet the requirements of a prosthesis.
Preservation of the knee and elbow joint are desirable. Therapeutic amputation
What would you do if a body part is severed unexpectedly (i.e. chain saw)? Traumatic Amputation
Nursing responsibility? 1.“I should use only mild soap and water to clean the limb.”
2.“I can apply lotion to the residual limb to keep the skin from cracking.”
3. “Tincture of iodine or alcohol could be used to toughen the limb.”
4.“I can elevate the residual limb on a pillow to prevent swelling when I am sitting or lying down.” 4. The nurse teaches a 58-year-old patient who had an above-the-knee amputation how to care for the residual limb. Which of the following statements by the patient indicates that teaching was effective? Teach residual limb care- inspect daily at home- mirror. Expose to air.
Do not apply lotions Kaplan- p. 351-2 “Proprioceptive memory.
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