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Muscular-Skeletal

Muscular-Skeletal. Lecture 3. Amputation. Pg 1080. Amputation. “removal of a body part, often an extremity”. Amputation. Common Causes Peripheral Vascular Disease (PVD) Trauma Osteomyelitis Tumor. osteosarcoma. Which of the following type of amputation is the most common?

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Muscular-Skeletal

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  1. Muscular-Skeletal Lecture 3

  2. Amputation • Pg 1080

  3. Amputation • “removal of a body part, often an extremity”

  4. Amputation • Common Causes • Peripheral Vascular Disease (PVD) • Trauma • Osteomyelitis • Tumor • osteosarcoma

  5. Which of the following type of amputation is the most common? • Upper extremity • Lower extremity

  6. Amputation • Reason • Relieve symptoms • hfunction • h quality of life

  7. Which of the following is the preferred type of amputation • AKA • BKA

  8. Amputation • Most distal point

  9. AmputationNursing Assessment • Pre-op • Neurovascular status • CMS • Doppler • Ultrasound

  10. AmputationNursing Assessment • Pre-op • Function • S&S of infection • C&S • Lymph nodes • Psych. status

  11. Amputation • Complications • Hemorrhage • Hematoma • Infection • Skin breakdown • Edema • Phantom limb pain • Contracture

  12. Table Question • What would you identify as the priority nursing diagnosis for a client who is post-op BKA?

  13. NrsDx: for Amputation • Acute pain • Disturbed sensory perception • Impaired skin integrity • Grieving • Self-care deficit • Impaired physical mobility

  14. Acute Pain

  15. NrsDx: Acute Pain • Opioid • Evacuation • Δ position • Sandbag • Distraction

  16. NrsDx: Altered Sensory Perception • h activity • Rehab • Distraction • Rx • Analgesics • Tricyclic antidepressants • Anticonvulsants

  17. NrsDx: Impaired skin integrity • Gentle • Aseptic tech. • Diet • h protein • vitamins • Residual limb shaping • Elastic dressing • Cast

  18. Which of the following techniques is correct for obtaining a wound culture specimen from a surgical site? • Thoroughly irrigate the wound before collecting the specimen. • Use a sterile swab and wipe the crusty area around the outside of the wound. • Gently roll a sterile swab from the center of the wound outward to collect drainage. • Use a sterile swab to collect drainage from the dressing.

  19. NURSING ALERT • If the cast or elastic dressing comes off, the residual limb must be immediately wrap with an elastic compression bandage. If not, excessive edema will develop leading to a delay in rehabilitation. • Notify the surgeon so that another cast can be applied promptly

  20. NrsDx: Impaired body imageNrsDx: Grieving • Relationship of trust • Pt. care for limb • Independence • Realistic goals • Support systems • Referrals

  21. NrsDx: Self Care Deficit • Practice • Nursing impact

  22. NrsDx: Impaired physical mobility • Prevent contractures • Avoid • Abduction • External rotation • Flexion • Prone* • ROM • Upper body exercises

  23. Nursing Alert • The residual limb should not be placed on a pillow because a flexion contracture of the hip may result.

  24. A client hospitalized with MRSA (methicillin-resistant staph aureus) is placed on contact precautions. Which statement is true regarding precautions for infections spread by contact? • The client should be placed in a room with negative pressure. • Infection requires close contact; therefore, the door may remain open. • Transmission is highly likely, so the client should wear a mask at all times. • Infection requires skin-to-skin contact and is prevented by hand washing, gloves, and a gown.

  25. A client who is admitted with an above-the-knee amputation tells the nurse that his foot hurts and itches. Which response by the nurse indicates understanding of phantom limb pain? • "The pain will go away in a few days.“ • "The pain is due to peripheral nervous system interruptions. I will get you some pain medication." • "The pain is psychological because your foot is no longer there." • “The pain and itching are due to the infection you had before the surgery."

  26. The primary reason for rapid continuous rewarming of the area affected by frostbite is to: • Lessen the amount of cellular damage • Prevent the formation of blisters • Promote movement • Prevent pain and discomfort

  27. You are assigned to care for a patient with a Below the Knee Amputation (BKA). Among the patient’s orders is one which states that the patient should be placed in the prone position twice daily. The nurse knows that the reason for this is: • Changing the patient’s position will help to prevent skin breakdown • To observe the stump for signs of infection • To assist the patient in doing ROM (Range of Motion) exercises • To stretch the flexor muscles and prevent flexion contractures

  28. Small Group Questions • Look at the list of complications associated with an amputation. Identify ways to assess for each complication and treatment. • Describe the assessment of a patient going into surgery for a non-traumatic BKA.

  29. What is the number onereason people go to their doctor? • Respiratory infection • Back pain • Ear infection • Head aches • Complaint of symptoms assoc. with heart attacks

  30. What is the number TWO reason people go to their doctor? • Complaints of arthritis in the hands • Back pain • Ear infection • Head aches • Complaint of symptoms assoc. with heart attacks

  31. Low Back Pain • Pg1117

  32. Low Back Pain • Multiple causes

  33. Spinal Column • Vertebrae • Intervertebral disk

  34. Intervertebral disks • Youth • Cartilage • nucleus pulposus • Age • Cartilage  • Dense • △ Shape

  35. Spinal Column • Facet joints • Ligaments • Muscles

  36. Spinal Curves • Shock Absorbers http://www.spineuniverse.com/anatomy/cervical-spine-anatomy-animation

  37. Disk degeneration • Most common areas • L4 – L5 • L5 – S1

  38. Disk protrusion • AKA • Herniated nucleus pulposus • “Slipped disk” •  pressure on the nerve •  “Radiating” pain • “Sciatica”

  39. Low Back PainS&S • Acute • < 3 months • Chronic • > 3 months

  40. Low Back PainS&S • Muscle spasm • i Lumbar curve

  41. If a paravertebral muscle is in spasm, how would you describe the muscle tone? • Atonic • Flaccid • Increased muscle tone • Decreased muscle tone

  42. Low Back PainAssessment • Hx & PE • Reflexes • CSM • Pain.

  43. Low Back PainMedical Management • If no serious problem  • No additional testing • for 4 weeks.

  44. Low Back PainMedical Management • Self-limiting • 4 wks • With • Rx • Rest • Relaxation

  45. Medical Management: Rx • Analgesics • Acetaminophen • NSAIDs • Muscle Relaxants • Cyclobenzaprine (Flexeril) • S/E • Drowsiness

  46. Medical Management: Rx • Tri-cyclic Antidepressants • Amitriptyline (Elavil)

  47. Low Back PainMedical Management • Rest • No • Twisting • Bending • Lifting • Reaching

  48. Low Back PainMedical Management • Bed rest • 1-2 days • Δ position frequently • No sitting > 50 min. • Gradual

  49. Nonpharmacologic Interventions • Relaxation • Heat • Spinal manipulation

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