problems related to musculoskeletal & coordination

7/29/2019 Problems Related to Musculoskeletal & Coordination

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Problems Related tMusculoskeletal &Coordination


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Amputation

Removal of a body partCauses Peripheral vascular disease-80% [75% Diabetics]vascular changes/atherosclerosis due to DM

Congenital deformities

Infection

Malignant tumorsTraumatic Unexpected severing of body part Accidents, land mines, farm related injury Common in young secondary to trauma


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Clinical Indications

Circulatory impairment [PVD]Traumatic & Thermal injuries

Malignant tumors

Uncontrolled widespread infection of

extremity-gas gangrene, osteomyelitisCongenital disorders


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Amputation

Psychosocial aspects of the procedure: devastating aphysical impairments that result.

Loss of limb: complete and permanent and

Lead to traumatic change in body image and often in

esteem.Necessitates major life style changes & adjustments


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Pathophysiology: Amputations

Elective Related to complications of PVD &arteriosclerosis

Result in ischemia in distal areas of loweextremities.i.e. Diabetes

Considered only after other interventions not restored circulation to lower extremitLimb salvage


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Pathophysiology: Amputations

Traumaticprimary cause of upper extremity

loss of limb

Accidents [MVA, industrial machine,war time from land mines & bombs[Iraq]

Severe crushing of tissues &significant blood vessel damage

Limb must be amputated in order topreserve function of residual limb

Today some body parts can besalvaged


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Levels of Amputation

Lower extremity (LE) amputations: more frequently done5 types of amputations

Above the knee [AKA]

Below the knee [BKA]

Midfoot amputations (e.g., the Lisfranc and the Chopart

amputations) and the

Syme

Toe Amputation


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Common levels of lower extremityamputation.


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Cultural Awareness

The incidence of lower extremityamputations is greater in black andHispanic populations because theincidence of major diseases leadingamputation, such as diabetes and

arteriosclerosis, is greater in thepopulations.


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Complications

Most common complications of elective or traumatiamputations are:

Hemorrhage-hypovolemic shock from too much bl

Infection- osteomyelitis

Phantom limb pain

Neuroma-tumor of damaged nerve cells

Flexion contractures


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Phantom Limb PainPainful sensation felt in amputated limb immeafter its removed

Described as intense burning, crushing, crampshooting, coldness, heaviness

Experience numbness & tingling-phantom limb seAnxious because pt knows limb is gone but painfelt

Subsides over time

Nurse should recognize pain as REAL & treat aggressively-Ask pain level 0/10

More common in the above the knee amputation [


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Diagnostics

H&PPhysical appearance soft tissues

Skin temperature, sensory function

Presence of peripheral pulses

ANKLE BRACHIAL INDEXArteriography, venography plethymography

Doppler studies

Routine blood work: elevated WBC w/abno

differential-infectious process


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Physical Assessment/ClinicalManifestations

Monitor Neurovascular status in affected extremityCheck circulation in bilateral legs if PVD

Assess skin color, temperature and pulses in both affected &unaffected

Check capillary refill [not a reliable indicator]-in elderly w/thopaque nails, check skin near nail bed

Observe & document any discoloration of skin, edema, presnecrosis and hair on distribution of lower extremity


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Psychosocial AssessmentEvaluate their psychological preparation for a planned amputation, and expect them

through the grieving process.

Assess the patient's feelings about himself or herself to identify areas in which he oemotional support.

Refer the patient to the certified hospital chaplain, other spiritual leader, or social w

Determine the patient's willingness and motivation to withstand prolonged rehabilithe amputation

assess the family's reaction to the surgery or trauma

Assess the patient's and family's coping abilities, and help them identify personal stweaknesses.

Assess the patient's religious, spiritual, and cultural


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-Traumatic Amputation-CriticalRescueCall 911

Assess ABCs

Examine site & Apply direct pressure to amputation with dry gauze or other cloth

Elevate extremity above heart to decrease bleeding

Do not remove dressing

For finger, wrap in dry sterile gauze [if available] or cloth & place in watertight, sealed plastic bag

Place bag in ice water & never directly on ice, at 1 par3 parts water

Transport part to hospital w/patient


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Collaborative Care

The goal of amputation surgery is to preserve extremity lenfunction while removing all infected, pathologic, or ischemi

Closed amputation-creates weight-bearing residual limb [st

Disarticulation-amputation performed through a joint [Sym

Open amputation-leaves a surface on the residual limb thatcovered with skin-done for control of actual or potential inf

Wound closed later by surgical procedure or closed by skin trasurrounding limb-Guillotine amputation


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problems related to musculoskeletal & coordination

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