Amputations n Definitions n Levels of Amputations *Goal = circulation, extremity length & function n Diagnostic Studies Amputation answers

Types of amputations n Open of Guillotine –Required if infection present –Late closure n Closed or Flap –Produce weight bearing stump n Nursing diagnosis –Pre-op –Post-op Complications: hemorrhage, infections Pain Impaired mobility

Interventions n Pre-op –physical and mental preparations –prepare for phantom pain n Post-op –Hemorrhage –Pain and phantom pain –Elevate first hours –Prevent infections –Prevent contraction, prone position –Delayed or immediate fitting

Post-op Care: Immediate and Delayed Prosthesis Fitting n Delayed –Ace wrap –Potential hemorrhage, swelling –Stitches out at 2-3 wks –Temporary prosthesis with full wt at 6 wks n Immediate –Total contact, rigid dressing –Compression dec. edema –Early wt. bearing –inc. chance for Infection

Test Yourself! n Which crutch- walking gait should the B-K amputee with a prosthesis use? –a. swing-through gait –b. 3 point –c. 4 point –d. swing-to gait Amputation home page

Teaching n Stump bandaging –Wrap distal to proximal –Produce cone shape n Stump care –Stump sock, stump shrinker –Keep clean The Goal: cone- shaped, well- healed stump!

Teaching n Weight Control n Temperature control n Muscle strengthening n Positioning n Hydraulic prosthesis

Replanation n Criteria n Interventions –Keep body part –Plastic bag, /ice –Elevate stump –No tourniquet –Saline dressing n Post-op Care –Adequate circulation: arterial/venous –Use of leeches –Prevent infection –Prevent platelet agglutination –Psychological support

What initial action should be taken with traumatic amputation?

What criteria determine the viability of the severed part with amputation? replantation

Indications for Use of Leeches n Useful on tissue with impaired circulation –dusky, blue skin color –brisk capillary return –rapid, dark pinprick response n Contraindicated with impaired arterial circulation