Amputations and Fractures

Question 1

What is the most common pain with surgical amputations due to a chronic condition that has given you pain for a period of time?

Answer 1

Phantom limb pain

Question 2

Ask what when asking about phantom limb pain?

Answer 2

What the pain is like

Question 3

What is treatment for overall phantom limb pain?

Answer 3

Calcitonin

Question 4

How is calcitonin given?

Answer 4

IV infusion during first post-op week to help reduce phantom limb pain

Question 5

What is given for dull, boring pain?

Answer 5

BB (propanolol)

Question 6

What is given for knifelike, sharp burning pain

Answer 6

Antiepileptic (gabapentin)

Question 7

What phantom pain is this given for?

Propranolol

Answer 7

Dull, burning pain

Question 8

What phantom pain is this given for?

Calcitonin

Answer 8

Overall pain

Question 9

What phantom pain is this given for?

Antiepileptic

Answer 9

Knifelike, sharp, burning pain

Question 10

What to give for incision pain post ampuation ?

Answer 10

Analgesics

Question 11

What to give for muscle pain post amputation?

Answer 11

Antispasmodics (baclofen)

Question 12

How to wrap limb after amputation?

Answer 12

Figure 8 wrap –tight but not too tight

Question 13

T/F: Position is very important post amputation

Answer 13

T

Question 14

What is position for first 24 hours post amputation and why?

Answer 14

Elevated on pillow to help decrease edema and help with drainage

Question 15

T/F: Contractors will occur if elevated on pillow 36 hr post op

Answer 15

T

Question 16

Post amputation

___ position for __ minute periods several times a day

Answer 16

Prone; 20 min

Question 17

Post amputation

What kind of mattress?
How often to turn?

Answer 17

Firm

q2h

Question 18

Post amputation

Practice what with the limb?

Answer 18

Pushing down limb on soft pillow

Question 19

What is skeletal traction?

Answer 19

Screws are surgically inserted into BONE (halo traction)

Question 20

Skeletal traction

Short or long traction time?
What weight limits?

Answer 20

Use longer traction times

15-30 lbs

Question 21

Skeletal traction

Aids in ____

Answer 21

Bone realignment

Question 22

Skeletal traction

Weight should not be doing what?

Answer 22

Touching floor or touching end of bed–touching nothing!!!

Question 23

Skeletal traction

What happens if patient falls down in bed and weight touches floor?

Answer 23

The patient needs assistance using the trapeze bar to pull himself back up

Question 24

Skeletal traction

How should cords be?

Answer 24

Free, not touching anything else

Question 25

Skeletal traction What needs to be in right suspension?

Answer 25

Counterweight

Question 26

Skeletal traction T/F: There should be some pressure on skin

Answer 26

F--check this (esp. pelvic area!)

Question 27

Skeletal traction Pin in bone so do what?

Answer 27

Pin site care

Question 28

Skeletal traction Pin site care--what drainage in the beginning?

Answer 28

Clear is normal in beginning; report anything else to MD Clean per hospital policy

Question 29

Skeletal traction Patient should not be in severe pain. If they are, then what do we do?

Answer 29

Re-align the patient but DO NOT TOUCH THE WEIGHTS!!! *notify MD position is not working

Question 30

Skeletal traction How often to monitor circulation?

Answer 30

q1hr for first 24 then q4h

Question 31

Complications of fractures Splinting or casting--what is better?

Answer 31

Splinting * splinting better to reduce complications * may need cast if worried pt. won't wear splint (peds)

Question 32

Complications of fractures Check 6 Ps. What are those?

Answer 32

``` Pain Paresthesia Pallor Paralysis Pulselessness Pressure ```

Question 33

Complications of fractures Check skin. Also check cast...what should cast be like?

Answer 33

One finger should fit underneath; should not be too tight

Question 34

Complications of fractures When is it ok to cast?

Answer 34

When swelling has gone down *ice area to reduce swelling

Question 35

Acute compartment syndrome What is this?

Answer 35

Increased pressure causes reduced circulation to area *due to infection, persistent motor weakness, contractures, myoglobiuric renal failure, hyperkalemia

Question 36

Acute compartment syndrome Assess what?

Answer 36

6Ps

Question 37

Acute compartment syndrome What happens if there is an immediate increase in pain?

Answer 37

Assess quickly *use doppler pulse --dont just give pain med

Question 38

Acute compartment syndrome Where is this more common?

Answer 38

Hand and lower leg

Question 39

Acute compartment syndrome Hallmark symptom?

Answer 39

Severe pain that does not respond to elevation or pain meds *in severe cases, there may be numbness, tingling, weakness, and paleness of skin

Question 40

Acute compartment syndrome Tx?

Answer 40

Remove cast Fasciotomy (open area to relieve pressure)

Question 41

Crush Syndrome What is this?

Answer 41

External crush injury that compresses one or more compartments in leg, arm, or pelvic

Question 42

Crush Syndrome Symptoms? (8)

Answer 42

- ACS - ATN - Dark brown urine - HYPOvolemia - HYPERkalemia (cell breaks and release to BS) - Muscle weakness - Pain - Rhabdomyolysis

Question 43

Crush Syndrome What is a lower extremity crush injury at high risk for?

Answer 43

AKI

Question 44

Fat embolism syndrome Obstruction of what?

Answer 44

Pulmonary vascular bed by fat globules

Question 45

Fat embolism syndrome More specific to ___ bone fracture in the first ___

Answer 45

Long bone fracture in first 48 hr *comes from yellow marrow with break--gets in BS and lodges into things like lungs

Question 46

Fat embolism syndrome Symptoms similar to?

Answer 46

VTE, DVT, PE

Question 47

Fat embolism syndrome Difference in symptoms between fat embolism syndrome and VTE/DVT/PE?

Answer 47

Petechia with fat embolism!!!

Question 48

Fat embolism syndrome Other symptoms besides petechia?

Answer 48

- Altered mental status - Tachypnea, tachycardia, fever - Chest pain, dyspnea, crackles, decreased SaO2 - Mild thrombocytopenia

Question 49

Fat embolism syndrome tx?

Answer 49

Supportive care Oxygen (or vent)

Question 50

VTE What is the purpose of elastic stockings?

Answer 50

To prevent thrombophlebitis (common complication following orthopedic surgery)

Question 51

VTE Thrmoboemboli can occur up to 6 months after surgery..Why is this important to tell pt?

Answer 51

That the client will need to still wear them after d/c