Marking Key Amputation

AMPUTATION
(i) Draw and lable the femur:
N.B Check diagram in Wilson and Ross page 390, Figure 15.38.
(12%.)
(ii) 5 Indications of Amputation:
1. Infection such as gangrene
2. Vascular disease (peripheral)
3. Trauma crushing injuries
4. Burns (electric)
5. Congenital deformities
6. Chronic osteomyelitis
(a)Identify and explain 4 investigations (12%)

1. X-ray of the bone - to confirm diagnosis
2. Serum alkaline phosphate - will be elevated
3. Bone scan - to detect extent of cancer
4. Chest x-ray - to eliminate metastasis
5. Renal and liver function test to check effect on these organs
6. Bone biopsy - to confirm the diagnosis after identifying cancer cells.
DISCUSS THE POST OP CARE THE FIRST 72 HOURS; (50%)
Objectives (2%)
1. To prevent complications e.g. pain, haemorrhage

2. To maintain psychological stability
Breathing:
 Ensure patent airway by good positioning

 Patient lies flat on the bed with no pillows
 Recumbent position with head tilted on one side (Give 3%)
Observations:
*1/4 hourly vital signs obs and general condition

 Then 1/2 hourly, e.t.c.
 Low blood pressure may denote passive bleeding or severe blood loss in
theatre. Give I.V fluids such as normal saline should the BP be low.
 High pulse rate denotes bleeding or severe blood loss
 Observe and watch for bleeding from the stump.
 Observe for rest of stump by putting a well folded towel in between two
said bags to rest the stump.
 Observe for signs of pain and give appropriate measures. Give 7%.
Pain Relief: 5%
 Surgical be controlled by narcotics such as pethidine 100 mgs PRN

 Evacuation of accumulating fluid and blood by a drain and bag help to
relieve pain.
 This is to prevent haematoma formation which causes severe pain
 Change of position relieves discomfort and pain arising from bony
prominence pressure.
 Placing towel above the stump placed in position by two sand bags on
each side reduces movement of stump which causes discomfort arising
from spasm
Phantom pain on the removed part is prevented by keeping patient occupied.

Minor tranquillisers may be given. Give 5%.
Care of stump - 7%
 Elevate the foot of the bed to prevent swelling of the stump as elevation
promotes drainage.
 Observe for bleeding from the stump which could be from a loosed suture
by collaborating with vital signs.
 Bed cradle be placed on the bed to lift the weight of beddings as this may
spike spasms.
 Observe the change of colour of bandage as this may indicate infection.
 Don't open the dressing or bandage any how to prevent infection from
setting in.
 Prevent infection by administering prophylactic broad spectrum
antibiotics as ordered.
 The bandage is left intact in all the 72 hours. Give 7%.
Psychological Care:
 Loss of limb causes severe grieving

 Be understanding if change of behaviour is seen e.g. crying, withdrawal.
Depression, etc.
 As a nurse acknowledge the loss
 Create an accepting and supportive atmosphere
 Spiritual care by the clergy is very important
 Be a good listener.
 Allow the patient to ventilate
 Explain the change of bed by cradles, sand bags, drains, bed elevation for
co-operation.
 Relief of pain will help greatly in reducing anxiety
 Explain on the use of crutches.
 Support patient in coping process.
Exercise and Ambulation: 4%
 Patient will be bed ridden for a long time even in the whole of 72 hours.
 Chest exercises to prevent pneumonia.
 Passive exercises of other limbs to prevent contractures.
 Turnings two hourly to prevent bed sores formation but also to prevent
constipation. Give 4%
Nutrition 3%
 Patient begins to eat once he has fully recovered from anaesthesia.

 Food rich in proteins and vitamins for healing of stump
 Encourage a lot of fluids to encourage defecation and urination since bed
riddeness causes stone formation.
Elimination: 2%
 Promote urination by giving plenty oral fluids

 Give a laxative to promote opening bowels
Hygiene - 3%
 Bed bath for self esteem and blood circulation

 Pressure area care to prevent bedsores and two hourly turnings
 Encourage patient to do what he can e.g. mouth care.
Health education: 3%
 Walking exercises with crutches

 Teach how to wrap the residual stump
 Advise patient to care for the other limb to prevent injury. Total 50%.
For
 sub headings 1% - Objectives - 2%.
(a)Four complications and prevention:
1. Oedema 1%
2. Fat embolism 1%
3. Gas gangrene of stump 1%
4. Deformity of stump 1%
5. Reactionary/secondary haemorrhage. 1%
Prevention:
1. Haemorrhage: 3%
 Prevention is by good ligating in theatre, prevention of infection and

resulting the stump.
2. Fat Embolism: 3%
 Good suturing in theatre will have to be ensured to prevent this.
3. Gas Gangreme: 3%
 This is prevented by ensuring sterility in theatre

 Do not open the wound or bandage in the whole of 72 hours.
4. Oedema of stump: 3%
 Prevent this by keeping the bandage on the stump tight

 If it comes out then re-tie it tight back
 Elevation of foot bed.
5. Deformity of stump: 3%
 Avoid hip flexion

Good bandaging technique to ensure good alignment and narrowing of the
distal stump for possible fixation of prosthesis. Total = 16%, 1% for listing,
3% for prevention, for 4 total is 16%.=44%


Marking Key Amputation

Uploaded by

Copyright:

Available Formats

Marking Key Amputation

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Marking Key Amputation

Uploaded by

Copyright:

Available Formats

AMPUTATION

(i) Draw and lable the femur:

(a)Identify and explain 4 investigations (12%)

DISCUSS THE POST OP CARE THE FIRST 72 HOURS; (50%)

1. To prevent complications e.g. pain, haemorrhage

 Ensure patent airway by good positioning

*1/4 hourly vital signs obs and general condition

 Surgical be controlled by narcotics such as pethidine 100 mgs PRN

Phantom pain on the removed part is prevented by keeping patient occupied.

 Loss of limb causes severe grieving

Exercise and Ambulation: 4%

 Patient begins to eat once he has fully recovered from anaesthesia.

 Promote urination by giving plenty oral fluids

 Bed bath for self esteem and blood circulation

 Walking exercises with crutches

(a)Four complications and prevention:

 Prevention is by good ligating in theatre, prevention of infection and

 Good suturing in theatre will have to be ensured to prevent this.

 This is prevented by ensuring sterility in theatre

 Prevent this by keeping the bandage on the stump tight

 Avoid hip flexion

You might also like