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Background of Anatomy and Physiology


Background of Anatomy and Physiology Human skeleton made up of 206 bones 1. Axial skeleton includes a. Bones of skull b. Ribs and sternum c. Vertebral column – PowerPoint PPT presentation

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Title: Background of Anatomy and Physiology

Background of Anatomy and Physiology
  • Human skeleton made up of 206 bones
  • 1. Axial skeleton includes
  • a. Bones of skull
  • b. Ribs and sternum
  • c. Vertebral column
  • 2. Appendicular skeleton includes
  • a. Bones of limbs
  • b. Shoulder girdles
  • c. Pelvic girdle

Classification of bones by shape
Functions of bones
  • 1. Form structure and provide support for soft
  • 2. Protect vital organs from injury
  • 3. Serve to move body parts by providing points
    of attachment for muscles
  • 4. Store minerals
  • 5. Serve as site for hematopoiesis
  • Bone cells include
  • 1. Osteoblasts cells that form bone
  • 2. Osteocytes cells that maintain bone matrix
  • 3. Osteoclasts cells that resorb bone

Clients with Musculoskeletal Disorders
  • Background
  • 1. Normal bone remodeling process involves
    sequence of bone reabsorption and formation
  • 2. Adults replace about 25 of trabecular bone
    (the porous type of bone found in the spine and
    all articulating joints) every 4 months through
    reabsorption of old bone by osteoclasts and
    formation of new bone by osteoblasts

Client with osteoporosis
  • Definition
  • a. Disorder characterized by loss of bone mass,
    increased bone fragility, increased risk for
  • b. Imbalance of processes that influence bone
    growth and maintenance associated with aging,
    but may result from endocrine disorder or
  • c. Significant health threat for Americans
    estimated 28 million persons more common in
    aging women half of women over 50 experience
    osteoporosis-related fracture in lifetime (hip,
    wrist, vertebrae)

Client with osteoporosis
  • Risk Factors
  • Unmodifiable risk factors
  • 1. Aging
  • 2. Gender
  • 3. European Americans and Asians have less bone
    density than African Americans
  • 4. Endocrine disorders affecting metabolism

Client with osteoporosis
  • Modifiable risk factors
  • 1. Calcium deficiency
  • 2. Menopause, decreasing estrogen levels
  • 3. Cigarette smoking
  • 4. Excessive alcohol intake
  • 5. Sedentary life style
  • 6. Use of specific medications

A normal spine at 40 years, and the osteoporotic
changes at ages 60 and 70 years
Client with osteoporosis
  • Pathophysiology
  • a. Diameter of bone increases, thinning outer
    supportive cortex
  • b. Trabeculae (spongy tissue) lost and outer
    cortex thins
  • c. Minimal stress leads to fracture
  • 4. Manifestations (silent disease bone loss
    occurs without symptoms)
  • a. Loss of height
  • b. Progressive curvature of spine (dorsal
    kyphosis, cervical lordosis, accounting for
    dowagers hump)
  • c. Low back pain
  • d. Fractures of forearm, spine or hip

Client with osteoporosis
  • Complications
  • a. Fractures (gt 1.5 million fractures yearly),
    many spontaneous or resulting from everyday
  • b. Persistent pain and associated posture changes
    restrict client activities and ability to perform
  • 6. Collaborative Care
  • a. Stopping or slowing osteoporosis
  • b. Alleviating symptoms
  • c. Preventing complications

Client with osteoporosis
  • Diagnostic Tests
  • a. X-rays
  • b. Quantitative computed tomography (QCT) of
  • c. Dual-energy X-ray absorptiometry (DEXA)
  • d. Alkaline phosphatase (AST)
  • e. Serum bone Gla-protein (osteocalcin) marker of
    osteoclastic activity and is indicator of rate of
    bone turnover used to evaluate effects of

Client with osteoporosis
  • Medications
  • a. Estrogen replacement therapy
  • 1. Recommended for women who have undergone
    surgical menopause before age 50
  • 2. Associated risk for estrogen therapy alone is
    increased risk of endometrial cancer
  • 3. Hormone replacement therapy (estrogen and
    progestin) associated with increased risk for
    cardiovascular disease and breast cancer
  • b. Raloxifene (Evista)
  • c. Biphosphonates
  • 1.Alendronate (Fosamax)
  • 2.Risedronate (Actonel)
  • 3.Etidronate (Didronel)
  • d. Calcitonin (Miacalcin)
  • e. Sodium fluoride

Client with osteoporosis
  • Nursing Care
  • a. Emphasis is prevention and education of
    clients under age of 35
  • b. Prevention of complications in those with
  • Health Promotion
  • a. Calcium intake
  • 1. Maintain daily intake of calcium at
    recommended levels, in divided doses
  • a. Age 19 50 1000mg
  • b. Age 51-64 1200 mg
  • c. Age 65 and gt 1500 mg)
  • 2. Optimal intake before age 30 35 increases
    peak bone mass
  • 3. Foods high in calcium include milk, milk
    products, salmon, sardines, clams, oysters, dark
    green leafy vegetables
  • 4. Supplementation calcium carbonate (Tums)
    calcium combined with Vitamin D for older adults

Client with osteoporosis
  • Exercise
  • 1. Physical activity that is weight-bearing
  • 2. Walking 20 minutes, 4 or gt times per week
  • Health-related behaviors
  • 1. Include not smoking
  • 2. Avoid excessive alcohol
  • 3. Limit caffeine to 2 3 cups of coffee daily
  • 4. Limit diet soda

Client with osteoporosis
  • Nursing Diagnoses
  • a. Health Seeking Behaviors
  • b. Risk for Injury
  • c. Imbalanced Nutrition Less than body
  • d. Acute Pain
  • Home Care Focus is on education including safety
    and fall prevention inside and outside the home

Client with Pagets Disease (osteitis deformans)
  • Description
  • a. Progressive skeletal disorder with excessive
    metabolic bone activity leading to affected bones
    becoming larger and softer
  • b. Affects femur, pelvis, vertebrae, sacrum,
    sternum, skull
  • c. Relatively rare
  • d. Occurs more often in whites
  • e. Slightly more common in males
  • f. Familial tendency

Client with Pagets Disease (osteitis deformans)
  • Pathophysiology
  • a. Bones are initially soft and bowing occurs
    then become hard and brittle leading to fractures
  • b. Slow progression with 2-stage process
  • 1. Excessive osteoclastic bone resorption
  • 2. Excessive osteoblasticbone formation

Client with Pagets Disease (osteitis deformans)
  • Manifestations
  • a. Most are asymptomatic
  • b. Localized pain of long bones, spine, pelvis,
    cranium pain is mild to moderate deep ache which
    is aggravated by pressure and weight-bearing
    noticed at night and when resting
  • c. Flushing and warmth over areas of bone

Client with Pagets Disease (osteitis deformans)
  • Complications
  • a. Degenerative osteoarthritis
  • b. Pathological fractures
  • c. Nerve palsy syndromes from involvement of
    upper extremities
  • d. Compression of spinal cord causing tetraplegia
  • e. Mental deterioration from skull involvement
    and brain compression

Client with Pagets Disease (osteitis deformans)
  • Collaborative Care
  • a. Pain relief
  • b. Suppression of bone cell activity
  • c. Complication prevention
  • Diagnostic Test
  • a. Xray (often incidental)
  • b. Bone scan

Client with Pagets Disease (osteitis deformans)
  • c. CT scans and MRI
  • d. Serum alkaline phosphatase
  • e. Urinary collagen pyridinoline testing
    indicator of rate of bone resorption

Client with Pagets Disease (osteitis deformans)
  • Medications
  • a. Mild symptoms relieved by aspirin or NSAIDs
  • b. Bone resorption retarded by
  • 1. Biphosphonates calcium supplements are
    prescribed in addition
  • a. Alendronate (Fosamax)
  • b. Pamidronate (Aredia)
  • c. Tiludronate (Skelid)
  • 2. Calcitonic works as analgesic for bone pain
  • a. Salmon calcitonin (Calcimar)
  • b. Human calcitonin (Cibacalcin)

Client with Pagets Disease (osteitis deformans)
  • Surgery
  • a. Total hip or knee replacement is usually
    required when client with Pagets disease
    develops degenerative arthritis of hip or knee
  • b. May require surgery for spinal stenosis, nerve
    root compression
  • Nursing Diagnoses
  • a. Chronic Pain
  • 1. May involve wearing a back brace for relief of
    back pain
  • 2. Heat therapy and massage
  • b. Impaired Physical Mobility
  • Home Care manifestations often relieved by

Client with osteomalacia (adult rickets)
  • Metabolic bone disorder characterized by
    inadequate or delayed mineralization of bone
    matrix leading to marked deformities of weight
    bearing bone and pathologic fractures
  • Pathophysiology
  • a. Primary causes are vitamin D deficiency and
  • 1. Vitamin D deficiency
  • a. Present in
  • 1. Older adults
  • 2. Very-low-birth weight infants
  • 3. Strict vegetarians
  • b. Caused by
  • 1. Diet low in vitamin D
  • 2. Impaired intestinal absorption of fats
  • 3. Inadequate sun exposure
  • 4. Some types of renal failure
  • 2. Hypophosphatemia most commonly caused by
    alcohol abuse

Process of vitamin D metabolism in the body
Client with osteomalacia (adult rickets)
  • Other causes
  • 1. Insufficient calcium absorption in intestines,
    due to lack of calcium or resistance to action of
    Vitamin D
  • 2. Increase loss of phosphorus through urine
  • Manifestations
  • a. Bone pain and tenderness
  • b. Common fractures are distal radius and
    proximal femur
  • Collaborative Care requires differential
    diagnosis from osteoporosis

Client with osteomalacia (adult rickets)
  • Diagnostic Tests
  • a. X-ray demonstrates generalized bone
  • b. Serum calcium levels are normal or low
  • c. Serum parathyroid hormone is frequently
    elevated as compensatory response
  • d. Alkaline phosphatase level usually elevated

Client with osteomalacia (adult rickets)
  • Medications
  • a. Treatment of underlying condition
  • b. Vitamin D therapy with calcium and phosphate
  • c. Radiologic evidence of healing apparent within
    weeks of therapy

Client with osteomalacia (adult rickets)
  • Nursing Care
  • a. Assessment of dietary intake of Vitamin D,
    calcium, phosphorus, exposure to ultraviolet
  • b. Management of client responses to bone pain
    and tenderness, fractures, muscle weakness
  • c. Vitamin D sources include dairy products
    fortified with Vitamin D and cod liver oil
  • d. If client takes supplements, must be aware of
    potential for toxicity with fat soluble vitamins
  • e. Fall prevention

Client with osteomyelitis
  • 1. Infection of the bone, may occur as acute,
    subacute, or chronic
  • 2. Consequence of bacteremia, invasion from
    contiguous focus of infection, skin breakdown
    more prevalent in adults over age of 50
  • 3. Pathophysiology
  • a. Usually bacterial in nature most commonly
    Staphylococcus aureus
  • b. Sources of infection
  • 1. Direct contamination of bone from open wounds
  • 2. Complication of surgery
  • 3. Extension of chronic ulcers including venous,
    arterial, diabetic
  • c. Infection develops in bone, which may
    interfere with vascular supply to bone, and
    necrosis occurs difficult for antibiotics to
    reach the bacteria within the bone

  • Osteomyellitis

Client with osteomyelitis
  • Collaborative Care
  • a. Pain relief
  • b. Infection elimination or prevention
  • c. Early diagnosis to prevent bone necrosis by
    early antibiotic therapy
  • d. Often requires bone debridement and long
    course of antibiotics

Client with osteomyelitis
  • Diagnostic Tests
  • a. MRI and CT scans
  • b. Radionucleotides bone scans
  • c. CBC and ESR WBC and ESR are elevated
  • d. Blood and tissue cultures identify infectious
    organism and determine appropriate antibiotic

Client with osteomyelitis
  • Medications
  • a. Antibiotics mandatory to prevent acute case
    from becoming chronic osteomyelitis
  • b. Initially treated as staph infection until
    results of culture are obtained
  • c. Definitive antibiotics prescribed according to
    culture results
  • d. Continued at least 4 6 weeks with
    intravenous or oral antibiotics

Client with osteomyelitis
  • Surgery
  • a. Needle aspiration or percutaneous needle
    biopsy performed to obtain specimen specimen may
    also be obtained during debridement procedure
  • b. Surgical debridement is primary treatment for
    chronic cases wound is opened, irrigated
    drainage tubes may be inserted for irrigation,
    suction, and antibiotic instillation

Client with osteomyelitis
  • Nursing Care
  • a. Persons with chronic osteomyelitis face
    frequent and lengthy treatments
  • b. Client needs to be aware of manifestations of
    recurrent infection (inflammation in area,
    temperature elevation)
  • c. Prognosis is uncertain and client must be
    maintained under care to prevent amputation or
    functional deficits

Client with osteomyelitis
  • Nursing Diagnoses
  • a. Risk for Infection
  • b. Hyperthermia interventions include
    maintenance of adequate fluid intake
  • c. Acute Pain splinting or use of immobilizer
    may limit swelling and improve pain
  • d. Anxiety
  • Home Care
  • a. Often vital part of treatment of osteomyelitis
  • b. Referral to home care agency for support with
    wound treatment, antibiotic administration,
    obtaining supplies, nutritional teaching

Neoplastic Disorders Bone Tumors
  • Description
  • 1. Tumors may be malignant or benign
  • a. Benign tumors grow slowly and do not invade
    surrounding tissues
  • b. Malignant tumors grow rapidly and metastasize
  • 2. Tumors can be primary (rare) or metastatic
    lesions originating from primary tumors of
    prostate, breast, kidney, thyroid, lung

Neoplastic Disorders Bone Tumors
  • Pathophysiology
  • 1. Cause unknown, but connection exists between
    bone activity and development of primary bone
  • 2. Primary tumors cause osteolysis, bone
    breakdown, which weakens bone and leads to bone
  • 3. Malignant bone tumors invade and destroy
    adjacent bone tissue

Neoplastic Disorders Bone Tumors
  • Manifestations often history of fall or blow to
    extremity brings mass to attention
  • 1. Pain
  • 2. Mass
  • 3. Impaired function

Neoplastic Disorders Bone Tumors
  • Diagnostic Tests
  • 1. Xray shows location of tumors and extent of
    bone involvement
  • a. Benign tumors show sharp margins separating
    from normal bones
  • b. Metastatic bone destruction characteristic
    moth-eaten pattern
  • 2. CT scan evaluation of extent of tumor
    invasion into bone, soft tissues, neurovascular
  • 3. MRI determine extent of tumor invasion,
    response of bone tumors to radiation and
    chemotherapy, recurrent disease
  • 4. Needle biopsy to determine exact type of bone
  • 5. Serum alkaline phosphatase elevated with
    malignant bone tumors
  • 6. RBC count elevation
  • 7. Serum calcium elevated with massive bone

Neoplastic Disorders Bone Tumors
  • Treatments
  • 1. Chemotherapy
  • a. Used to shrink tumor before surgery
  • b. Control reoccurrence
  • c. Treat metastasis
  • 2. Radiation
  • a. Often combined with chemotherapy
  • b. Used for pain control with metastatic
  • c. Eliminate tumor remains after surgery
  • 3. Surgery
  • a. Eliminate primary bone tumors to eliminate
    tumors completely may involve excise tumor or
    amputate affected limb
  • b. With some surgeries, cadaver allografts or
    metal prostheses used to replace missing bone to
    avoid amputation

Neoplastic Disorders Bone Tumors
  • Nursing Diagnoses
  • 1. Risk for Injury (pathologic fractures)
  • 2. Acute and Chronic Pain
  • 3. Impaired Physical Mobility
  • 4. Decisional Conflict assist client in gaining
    information for informed decisions regarding
    treatment options
  • Home Care
  • 1. Client education regarding treatment plan,
    wound care, activity and weight bearing
  • 2. Support with referral to prosthetic specialist
    or hospice as case indicates

Client with a Fracture
  • Fracture any break in continuity of bone
  • 1. Occurs when bone is subjected to more kinetic
    energy than the bone can absorb
  • 2. Mechanisms producing fracture
  • a. Direct energy applied at or near site of
  • b. Indirect transmitted from point of impact to
    site where bone is weaker

Client with a Fracture
  • Classifications of fractures
  • A. Simple (closed) skin intact over fracture or
    compound (open) where skin is interrupted over
    injury and there is increased risk for infection
  • B. Fracture line may be
  • 1. Oblique
  • 2. Spiral
  • 3. Avulsed
  • 4. Comminuted
  • 5. Compressed
  • 6. Impacted
  • 7. Depressed

Common types of fractures
Open fracture
Closed fracture
Client with a Fracture
  • c. Complete fracture involves entire width of
    bone incomplete fracture does not involve the
    entire width of bone
  • d. Stable (nondisplaced) fracture is fracture in
    which bones maintain their anatomic alignment
    unstable (displaced) fracture fracture in which
    bones move out of correct anatomic alignment
  • e. Description according to point of reference
    i.e. midshaft, intrarticular

Client with a Fracture
  • Manifestations
  • a. May be accompanied by soft tissue injuries
    involving muscles, arteries, veins, nerves, skin
  • b. May be alteration in circulation, sensation,
    swelling, pain
  • c. May be obvious deformity or fracture
  • d. May have felt the breakage of bone during the
    injury event

Client with a Fracture
  • Fracture healing
  • a. Phases include
  • 1. Inflammatory phase
  • a. Bleeding and inflammation develop at site of
  • b. Hematoma forms around the bone surface
  • c. Necrosis of osteocytes leads to vasodilation
    and edema
  • d. Collagen forms and allows calcium to be
  • 2. Reparative phase
  • a. Callus begins to form
  • b. Osteoblasts promote formation of new bone
  • c. Osteoclasts destroy dead bone and assist in
    synthesis of new bone

Client with a Fracture
  • Remodeling phase
  • a. Excess callus is removed
  • b. New bone is laid down along the fracture line
  • c. Eventually fracture site is calcified and bone
    is reunited
  • b. Healing of fracture influenced by
  • 1. Age and physical condition of client
  • 2. Type of fracture
  • c. Time
  • 1. Uncomplicated fracture of arm or foot heals in
    6 8 weeks
  • 2. Fractured hip heals in 12 16 weeks

The stages of bone healing
Client with a Fracture
  • Emergency care involves
  • a. Immobilization of fracture
  • 1. Immobilize above and below the deformity
  • 2. Splint to maintain normal anatomical alignment
    and prevent further dislocation or damage
  • 3. Use air splint or splint to body
  • b. Maintenance of tissue perfusion
  • 1. Control obvious bleeding with pressure
  • 2. Assessment of pulses, movement, sensation any
    alteration requires prompt medical evaluation
  • c. Prevention of infection Cover open wounds
    with sterile dressing

Client with a Fracture
  • Diagnostic Tests
  • a. History of incident and initial assessment
  • b. X-ray of bones involved in fracture
  • c. Additional tests as indicated CBC, blood
    chemistries, coagulation studies to assess for
    blood loss, renal function, muscle breakdown,
    excessive bleeding or clotting
  • 8. Medications
  • a. Pain relief according to degree of injury and
    clients assessment of pain (may require
  • b. NSAIDs for anti-inflammatory affect as well as
  • c. Medications to guard against ulcers
  • d. Stool softeners to prevent constipation
  • e. Antibiotics especially with open fractures
  • f. Anticoagulants, if client considered at risk
    for deep vein thrombosis

Client with a Fracture
  • Treatments
  • a. Surgery
  • 1. Indications
  • a. Requires direct visualization and repair
  • b. Fracture associated with long-term
  • c. Severely comminuted fracture, which threatens
    vascular supply

Client with a Fracture
  • Types
  • a. External fixation
  • b. Internal fixation

External fixation of a fracture
Internal fixation hardware
Internal fixation hardware
Client with a Fracture
  • Traction application of straightening or pulling
    force to maintain or return fractured bones in
    normal alignment prevent muscle spasms
  • 1. Weights are used to maintain necessary force
  • 2. Types of traction
  • a. Manual by hand
  • b. Straight pulling force in straight line
    Bucks traction straight skin traction often
    used with fractured hip
  • c. Balanced suspension involves more than one
    force of pull
  • d. Skeletal application of pulling force through
    placement of pins into the bone allows use of
    more weight to maintain alignment increased risk
    of infection

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Figure 38.5C Skeletal traction
Client with a Fracture
  • Casting rigid device applied to immobilize
    bones and promote healing
  • 1. Extends above and below the fractured bone
    which must be relatively stable
  • 2. Types include
  • a. Plaster 48 hours needed to dry
  • b. Fiberglass dries within one hour
  • d. Electrical bone stimulation application of
    electrical current at the fracture site used to
    treat fractures that are not healing properly
  • 1.Increases migration of osteoblasts and
    osteoclasts to fracture site
  • 2.May be accomplished invasively or noninvasively
  • 3.Contraindicated in presence of infection

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Client with a Fracture
  • Complications
  • a. Compartment syndrome excess pressure in
    limited space, constricting structures within and
    reducing circulation to muscles and nerves
    normal pressure is 10 20 mm Hg
  • 1. Results from hemorrhage and edema following a
    fracture or crush injury or external compression
    of limb, if cast is too tight
  • 2. May result in cyclic ischemia and edema
    increasing risk for loss of limb or sepsis
  • 3. Usually develops within first 48 hours of
  • 4. Manifestations include progressive pain often
    distal to injury not responsive to analgesia,
    decreased sensation, loss of movement pulses may
    remain normal

Client with a Fracture
  • Fat Embolism Syndrome (FES)
  • 1. Fat globules lodge in pulmonary vascular bed
    or peripheral circulation occurs with long bone
    fracture, pressure within bone marrow rises,
    exceeds capillary pressure and fat globules leave
    bone marrow and enter circulation
  • 2. Manifestations characterized by neurologic
    dysfunction, pulmonary insufficiency, petechial
    rash on chest, axilla, and upper arms within few
    hours or week after injury
  • 3. May result in pulmonary edema, atelectasis,
  • 4. Prevention early stabilization of long-bone

Client with a Fracture
  • Deep vein thrombosis (DVT) blood clot forms in
    lining of large vein can lead to pulmonary
  • 1. Prevention early immobilization of fracture
    and early ambulation
  • 2. Prophylactic anticoagulation, antiembolism
    stocking and compression boots
  • 3. Prompt diagnosis of DVT and adequate treatment
  • Infection any complication decreasing blood
    supply increases risk may result from
    contamination at time of injury or during surgery
  • 1. Organisms include Pseudomonas, Staphylococcus
    or Clostridium
  • 2. May lead to osteomyelitis, infection within
    the bone

Client with a Fracture
  • Delayed union prolonged healing of bones beyond
    usual time period
  • 1. Risk Factors include
  • a. Poor nutrition
  • b. Inadequate immobilization
  • c. Prolonged reduction time
  • d. Infection, necrosis, age
  • e. Immunosuppression
  • f. Severe bone trauma
  • 2. Detected by serial x-rays (x-ray findings lag
    1 2 weeks behind the healing process)

Client with a Fracture
  • Nonunion
  • 1. Persistent pain and movement at fracture site
  • 2. Treatments
  • a. Surgery internal fixation, bone grafting
  • b. Debridement if infection present
  • c. Electrical stimulation
  • Reflex Sympathetic Dystrophy
  • 1. Poorly understood post-traumatic condition
  • 2. Manifestations of persistent pain,
    hyperesthesias, swelling, changes in skin color,
    texture, temperature, and decreased motion
  • 3. Treatment includes sympathetic nerve block

Client with a Fracture
  • Nursing Care involved with fractures includes
    management of
  • 1. Pain
  • 2. Impaired physical mobility
  • 3. Impaired tissue perfusion
  • 4. Neurovascular compromise
  • 5. Assessment of clients response to trauma
  • Health Promotion
  • 1. Emphasis is trauma prevention
  • 2. Maintain good bone health including
    weight-bearing exercise, avoiding obesity,
    adequate calcium intake

Client with a Fracture
  • Nursing Diagnoses
  • 1. Acute Pain
  • 2. Risk for Peripheral Neurovascular Dysfunction
  • 3. Risk for Infection
  • 4. Impaired Physical Mobility
  • 5. Risk for Disturbed Sensory Perception Tactile
  • Home Care Client and family teaching focuses on
    individualized needs
  • 1. Cast care
  • 2. Following physicians directions regarding
    weight bearing
  • 3. Home physical therapy referral
  • 4. Obtaining needed equipment

Client with an Amputation
  • Partial or total removal of body part resulting
    from traumatic event or chronic condition
  • B. Causes of amputation
  • 1. PVD is major cause
  • 2. Trauma is major cause of upper extremity
  • 3. Other traumatic events resulting in amputation
    include frostbite, burns, electrocution
  • C. Underlying cause of amputation is interruption
    in blood flow either acute or chronic

Client with an Amputation
  • Levels of amputation
  • 1. Determined by local (ischemia and gangrene)
    and system factors (cardiovascular status, renal
    function, severity of diabetes mellitus)
  • 2. Goals
  • a. Alleviate symptoms
  • b. Maintain health tissue
  • c. Increase functional outcome joints are
    preserved whenever possible to allow for greater
  • Types of amputation
  • 1. Open (guillotine) performed when infection is
    present and remains open to drain
  • 2. Closed (flap) wound is closed with flap of
    skin sutured in place over stump

Common sites of amputation
Client with an Amputation
  • Amputation site healing
  • 1. Immediate post-operative assess circulation
    to stump
  • 2. Rigid or compression dressing is applied to
    prevent infection and minimize edema
  • 3. Stump is wrapped in Ace bandage to allow a
    conical shape to form and prevent edema applied
    from distal to the proximal extremity

Client with an Amputation
  • Complications
  • 1. Infection
  • a. Local
  • 1. Drainage or odor
  • 2. Redness
  • 3. Positive wound culture
  • 4. Increased discomfort at suture line
  • b. System
  • 1. Fever, chills
  • 2. Increased heart rate or decreased blood
  • 3. Positive wound or blood cultures

Client with an Amputation
  • Delayed healing
  • a. Slower rate of healing than normal
  • b. Factors include
  • 1. Poor or inadequate nutrition
  • 2. Poor blood flow, possibly related to smoking
  • 3. Decreased cardiac output limits circulation
  • Chronic stump pain
  • a. Results from neuroma formation causing severe
    burning pain
  • b. Treatments include
  • 1. Medications
  • 2. Nerve blocks
  • 3. Transcutaneous electrical nerve stimulation
  • 4. Surgical stump reconstruction

Client with an Amputation
  • Phantom limb pain/ phantom limb sensation
  • a. Majority of amputees have sensations such as
    tingling, numbness, cramping or itching in the
    phantom foot or hand, often self-limited
  • b. Phantom limb pain is pain often difficult to
    treat may be referred to pain clinic for
    comprehensive pain management

Phantom Limb Pain
  • Phantom limb pain is a frequent complication of
  • Client complains of pain at the site of the
    removed body part, most often shortly after
  • Pain is intense burning feeling, crushing
    sensation or cramping.
  • Some clients feel that the removed body part is
    in a distorted position.

Management of Pain
  • Phantom limb pain must be distinguished from
    stump pain because they are managed differently.
  • Recognize that this pain is real and interferes
    with the amputees activities of daily living.
  • (Continued)

Management of Pain (Continued)
  • Some studies have shown that opioids are not as
    effective for phantom limb pain as they are for
    residual limb pain.
  • Other drugs include intravenous infusion
    calcitonin, beta blockers, anticonvulsants, and

Client with an Amputation
  • Contracture
  • a. Abnormal flexion and fixation of joint caused
    by muscle atrophy and shortening
  • b. Common complication associated with above the
    knee amputation
  • c. Interventions include
  • 1. Lying prone for periods throughout day
  • 2. Active and passive range of motion
  • 3. Avoid prolonged sitting

Client with an Amputation
  • Prosthesis
  • a. Type depends on level of amputation, clients
    occupation and life style
  • b. Client with lower extremity amputation often
    fitted with early walking aids pneumatic device
    that fits over stump and allows early ambulation,
    decreased postoperative swelling

Client with an Amputation
  • Nursing Diagnoses
  • a. Acute Pain
  • b. Risk for Infection
  • c. Impaired Skin Integrity
  • d. Risk for Dysfunctional Grieving
  • e. Disturbed Body Image
  • f. Impaired Physical Mobility
  • Home Care Education and information for client
    and family regarding stump care, prosthesis
    fitting and care, assistive devices, exercises,
    rehabilitation, safety issues

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Stump dressing