Chapter 46: Amputations

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A nurse is aware that a patient who is having his leg amputated is also having a prosthesis fitted during at the same time as the surgery. Which fact should the preoperative teaching plan include?

A rigid dressing will be applied to accommodate the prosthesis.

A patient asks when he should expect to be up and walking after his below-the-knee amputation. Which time period describes when the nurse should assure him that most people with amputations can fully bear weight?

3 months

A nurse is conducting a safety seminar and reminds the audience that upper extremity amputations are most frequently caused by trauma. Which population has the highest incidence of this type of amputation?

Young men

An 80-year-old man with diabetes has had vascular problems with his feet and lower legs for 10 years and is scheduled for a left below-the-knee amputation. Which remark by the patient indicates an understanding of the procedure?

“If this heals well, how long until I get a prosthesis?”

Which routine preoperative diagnostic tests are appropriate for a patient anticipating a below-the-knee amputation?

Pulse volume recording and white blood cell (WBC) count

Which site describes where the limb is severed with an elbow disarticulation?

Through the elbow joint

A patient with peripheral vascular disease (PVD) and diabetes asks what he can do to help prevent an amputation. Which of the following is the best response of the nurse?

“Stopping smoking would help prevent vasoconstriction.”

Which statement correctly identifies why a closed amputation is usually performed?

To create a weight-bearing residual limb

What controls the movement with a myoelectrically controlled prosthesis?

Patient’s muscle movement and the prosthesis

A patient who had a below-the-knee amputation 24 hours earlier is complaining of burning pain in his left foot. Which intervention is most appropriate for the nurse to implement?

Medicate the patient with the prescribed pain remedy.

During the admission of a patient scheduled for an amputation, a patient relates that she is a practicing Orthodox Jew. Which arrangements are appropriate for the nurse to make for this patient?

The amputated part should be buried.

Which goal is an appropriate outcome for a patient with feelings of anxiety related to a perceived threat of disability?

Anxiety is relieved; the patient verbalizes concern related to disability.

Which potential complication is the greatest danger in the early postoperative period after an amputation?

Hemorrhage

A nurse is caring for a patient who has undergone replantation of a body part. Which physical issue might the saliva of leeches be used to treat in this patient?

Venous congestion

A patient who amputated his thumb in a lawnmower accident hands the emergency department nurse his thumb in a glass jar. Which action is the best for the nurse to implement?

Wrap the thumb in a cloth saturated with normal saline and place it in a baggie.

A patient who has a below-the-elbow prosthesis shows the home health care nurse the residual limb, which is red, edematous, and warm to touch. Which action should the nurse instruct this patient to do?

Leave the prosthesis off and notify physician.

A child comes to the school nurse with his index finger partially amputated and hanging by a shred of skin and muscle. Which action is the best for the nurse to implement?

Wrap the hand and finger securely and place it on an ice water–filled plastic bag.

Which nursing action should be implemented in the postoperative care for a patient with replantation of the right thumb?

Elevating the hand but keeping it below the level of the heart

A nurse is caring for a patient with a recent below-the-knee amputation. Which action should the nurse recommend to this patient to prevent the loss of calcium and protein?

Ambulate 30 minutes a day.

Which signs are late indicators of hemorrhage in the postoperative period after an amputation?

Cyanosis and hypotension

Which outcome is measured by the following goal statement: “The patient will verbalize an understanding of microvascular precautions”?

Patient knowledge of therapeutic measures

Which postoperative observation must be reported to the physician immediately?

Bright-red bleeding

A home health care nurse suspects a neuroma in a patient who had an above-the-knee amputation 1 month earlier. Which complaint by the patient led the nurse to suspect a neuroma?

Sharp severe pain in the residual limb

Which action should a nurse implement to diminish swelling of the residual limb in the postoperative period after an above-the-knee amputation?

Elevate the foot of the bed on blocks.

Which major situational occurrences might lead to amputations? (Select all that apply.)

Trauma, Disease, Tumors, Congenital defects

Which purpose relates to a closed amputation? (Select all that apply.)

Prepare a weight-bearing limb., Cover the stump with tissue and muscle.

Which information should a nurse modify in a teaching plan for an older adult who has had an above-the-knee amputation? (Select all that apply.)

Offer smaller units of information at a time., Increase time for learning., Clarify the reality of phantom pain., Include frequent repetition.

A nurse clarifies that the precise term for the patient’s amputation, which will be through the knee joint, is called _________ .

disarticulation

An amputation of a gangrenous limb that is left open for 10 days before closure is classified as a staged or ___________ amputation.

guillotine

To reduce the possibility of hip contractures in a patient with an above-the-knee amputation, a nurse periodically places the patient in a(n) _______ position.

prone

Preoperative exercises for a patient undergoing a lower-extremity amputation include _________ training.

upper body

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