Flashcards in Amputations, Burns, Renal Disease Deck (31)
Causes of amputation
• Congenital limb deficiency
Adults who have limb removed as a result of disease or trauma (NOT congenital limb deficiencies). These pts do not develop sensorimotor skills and self-image without the limb that younger pts with congenital deficiencies do.
Primary cause of amputation of lower limb and upper limb
Lower Limb: dysvascular disease and diabetes
Upper Limb: trauma (work-related accidents, GSW, burns).
Loss of the entire lower limb (LL)
Hemipelvectomy or Hip Disarticulation amputations cause loss of entire LL. Usually due to trauma or malignancy. Very slow healing, and may require skin grafting. In hemipelvectomy, a muscle flap covers the internal organs.
Above-Knee Amputation (AKA)
Transfemoral Amputation. Loss of the knee and everything distal to it. Residual limb length varies from 10-12 inches from greater trochanter. Classified by distance from ischium: Upper, Middle or Lower Third.
Disarticulation Amputation. Loss of knee joint function but allows high level of prosthesis control/mobility.
Below-Knee Amputation (BKA)
Transtibial Amputation. Preserves the knee and eliminates need for mechanical knee joint in prosthesis. Residual limb from 4-6 inches from tibial plateau.
Ankle Disarticulation. Loss of both ankle and foot function; typically from trauma or infection.
From severing of foot through metatarsal bones, but ankle remains.
Excision of the toe and part of the metatarsal.
Causes of LL Amputations
• 95% due to peripheral vascular disease (PVD) (up to half of which are diabetes)
• Trauma 2nd most common
• Malignancy (to prevent spread)
Shaping of Residual Limb
• By wrapping with elastic bandage to control edema post-surgery. Must be skilled/consistent technique to prevent poor shaping.
• Gradually smaller residual limb shrinkers (encourages constant, even shrinkage for prosthesis fitting)
• Jobst compression pump, if wrapping/shrinker ineffective; air-filled sleeve that surrounds, providing constant, equal pressure to shrink limb.
- Both can be used after surgery, and over dressings if a nylon stocking is applied first.
- Shrinker may continually be worn even after prosthesis fitting when not wearing; can take up to 3 months or longer.
- Scar massage may be used to prevent adhesions and enhance surgical site comfort.
Main Components of Prosthesis
• SOCKET (direct connection to prosthesis)
• SOCK/GEL LINER (Adapts to limb volume changes; may be removed)
• SUSPENSION SYSTEM (Attaches socket to limb; belts, straps, wedges or suction)
• PYLON (Attaches socket to terminal device (TD); shock absorber or static)
• TERMINAL DEVICE-TD (Prosthetic foot, stable, weight-bearing surface and shock absorber; variable degrees of mechanical ankle movement/dynamic response)
* Some may include an articulating JOINT
• SMART VARIABLE GEOMETRY SOCKET (SVGS): reduces challenge of adapting to volume changes; adds/removes liquid on basis of pressure during wear to maintain fit.
• STATIC ELASTOMERIC LINER: Liner choice based on variables such as fit, comfort, friction tolerance and price.
Dead epidermis and necrotic dermis attached to wound bed.
Removal of necrotic tissue
Layer of skin that provides THERMOREGULATION through control of skin blood flow, as well as:
• Growth factors
• Epidermal replication
• Dermal repair
Total Body Surface Area (TBSA)
Used to measure burn injury severity.
Rule of 9s
Body broken up into 9% sections, and % of body burned calculated by adding these. (ie: Chest is 9%, Abdomen is 9%, so a front burn of these areas is 18% of body burn)
* Percentages very different for infant. Abdomen or back are 13%. Head 21% (9% for adult). Arms 10% (9% on adult).
Severity of Burn Wound
• Superficial/Partial Thickness
• Deep/Partial Thickness
• Full Thickness (no remaining dermis)
Medical Mgmt of Burn
• Maintain open airway
• Manage edema
• Avoid infection: grafts
• Improve circulation: Escharotomies
• Regulate body fluids
• Assess body for viable graft sites
2 Goals of Skin Grafts
1) Short Term Goal: Skin hydration
2) Long Term Goal: Coverage of burns, cosmetic appeal, maximize ROM
3 Phases of Graft Healing
KELOID: abnormal scar that grows beyond boundaries of original skin injury.
HYPERTROPHIC: widened or unsightly scar that does NOT extend beyond original boundaries of wound. Grows upward. Can develop into Keloid.
Treatment Objectives for Burns
• Prevent deformity (ie: scarring and contractures over joints)
• Increase/Preserve independence with ADLs
• Treatment techniques (scar massage, ROM, strengthening)
Positioning for Burns
* Position of comfort = position of deformity!
• Edema reduction
• Joint alignment
• ROM maintenance/increase
• Elongated tissues
• Joint/scar remodeling
• Promote wound healing
• Relieve pressure points
• Protect grafts
• Wear pressure garments 23 hours/day for 1 year
• Self ROM constantly
• Self scar massage when pressure garment off
• Moisturize daily
• Sunscreen under pressure garments
End Stage Renal Disease (ESRD) symptoms
• Changes in mental status
• Impaired sensation of hands/feet
• Decreased urine output
• Easy bruising/bleeding
**Dialysis is necessary!
Peritoneal Dialysis vs. Hemodialysis
PERITONEAL: Completely via catheter in abdomen where fluid is replaced with automated exchanger. Can be done at home, all night long or every 2-3 hours during day.
HEMODIALYSIS: Done 3x/week at dialysis center via Gortex graft between vein and artery junction, typically in upper arm. May take several hours.
• Removes toxins and wastes and control symptoms