amputation
The most common cause of amputations in adults is this chronic disease complication.
What is peripheral vascular disease (often due to diabetes)?
Rationale:
The majority of adult amputations result from poor circulation and tissue necrosis related to diabetes or peripheral artery disease. Trauma is less common in adults.
This is the earliest and most reliable symptom of compartment syndrome, often reported by patients.
What is pain out of proportion to the injury?
Rationale:
Pain out of proportion and not relieved by opioids is an early indicator of compartment syndrome. Early recognition is critical to prevent tissue necrosis.
This type of fracture occurs when the bone breaks and pierces the skin, increasing risk for infection.
What is an open (compound) fracture?
Rationale:
Open fractures break the skin, exposing bone and surrounding tissue to pathogens. Infection prevention, including sterile dressing and antibiotics, is critical.
This life-threatening condition occurs in clients with SCI above T6 and presents with sudden severe hypertension, pounding headache, and bradycardia.
What is autonomic dysreflexia?
This type of CP is characterized by stiff, tight muscles and exaggerated reflexes, often affecting the legs more than the arms.
What is spastic cerebral palsy?
This type of amputation involves removal of a limb below the knee while preserving the knee joint.
What is a below-knee amputation (BKA)?
Rationale:
A BKA preserves the knee, allowing better mobility with prosthetics. Above-knee amputations (AKA) require more energy for ambulation.
This type of compartment syndrome develops within hours of a fracture, crush injury, or tight cast, compromising circulation.
Question: What is acute compartment syndrome?
Rationale:
Acute compartment syndrome is a medical emergency, requiring fasciotomy to prevent permanent nerve and muscle damage.
After a fracture, this assessment is essential to monitor for compartment syndrome, which can lead to permanent muscle and nerve damage.
What is neurovascular assessment (pain, pallor, pulse, paresthesia, paralysis)?
Rationale:
Early recognition of compartment syndrome is vital. Pain out of proportion to injury, paresthesia, pallor, weak pulses, and paralysis are warning signs requiring immediate intervention
After a spinal cord injury, this type of shock is characterized by hypotension, bradycardia, and flaccid paralysis below the injury level.
What is neurogenic shock?
Children with CP often exhibit persistence of this reflex past 4 months of age, which can indicate neuromotor dysfunction.
What is the Moro reflex?
This painful sensation occurs in the missing limb, where the client feels tingling, itching, or burning.
What is phantom limb pain?
Rationale:
Phantom pain is real and neurologically based. Management may include opioids, adjuvant meds (gabapentin), mirror therapy, or TENS. Reassurance alone is insufficient.
This set of assessments is vital for early detection and includes pain, pallor, pulselessness, paresthesia, and paralysis.
Question: What is neurovascular assessment (“5 Ps”)?
Rationale:
The “5 Ps” help nurses recognize circulatory and nerve compromise in the affected limb. Pulse may remain normal early, so monitoring pain and sensation is key.
A patient with a femur fracture complains of sudden shortness of breath and chest pain. This life-threatening complication should be suspected.
What is a fat embolism syndrome (FES)?
Rationale:
Long bone fractures can release fat into circulation → fat emboli. Classic signs: respiratory distress, altered mental status, petechial rash. Immediate oxygen and supportive care are required.
For clients with SCI, this intervention is first-line when orthostatic hypotension occurs during position changes.
What is gradual elevation of the head of the bed and use of abdominal binders?
These medications, such as baclofen or diazepam, are used to reduce muscle spasticity in children with CP.
What are muscle relaxants?
After amputation, the nurse should elevate this part of the body for the first 24 hours to reduce swelling but avoid prolonged elevation to prevent contractures.
What is the residual limb (stump)?
Rationale:
Elevating the residual limb reduces edema and promotes healing. Avoid prolonged elevation or improper positioning to prevent hip/knee flexion contractures.
This action is contraindicated in suspected compartment syndrome, as it may worsen pressure and tissue damage.
What is elevating the limb above heart level or applying tight dressing/cast?
Rationale:
Elevation above heart level can reduce arterial perfusion in early compartment syndrome. Casts may need to be bivalved or loosened to relieve pressure.
This type of traction is commonly used in femur fractures to maintain alignment before surgery.
What is Buck’s traction?
Rationale:
Buck’s traction provides skin traction, reduces muscle spasms, and maintains fracture alignment temporarily. Weights must hang freely; skin integrity must be monitored.
Clients with injuries at this cervical level often require ventilator support due to impaired diaphragmatic function.
What is C1–C4?
This is a non-pharmacologic therapy involving stretching, positioning, and mobility aids to prevent contractures and improve function in CP.
What is physical therapy?
A major psychosocial concern after amputation includes difficulty adjusting to body image changes, loss of independence, and fear of mobility limitations.
What is coping/adaptation to body image and functional changes?
Rationale:
Successful adaptation involves emotional support, rehabilitation, and prosthetic training. Nurses play a key role in psychosocial support and teaching about mobility and self-care.
The definitive treatment for acute compartment syndrome to prevent permanent damage is this surgical procedure.
What is fasciotomy?
Rationale:
Fasciotomy involves surgical incision to release pressure in the affected compartment, restoring circulation and preventing necrosis or amputation.
After a fracture, a nurse teaches the patient that elevation, ice, and neurovascular checks are essential for the first 24–48 hours.
This is part of:
What is initial fracture management / RICE (Rest, Ice, Compression, Elevation)?
Rationale:
Early management focuses on reducing swelling and pain, preventing further injury, and monitoring circulation and nerve function.
What nursing action is a priority when a client with SCI develops sudden diaphoresis, severe headache, and flushed face.
What is sit the client upright and identify/remove noxious stimuli (e.g., full bladder, fecal impaction)?
Children with CP are at high risk for aspiration and feeding difficulties, so nurses often recommend this positioning technique during meals.
What is upright positioning with chin tuck?