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Friday, 5 July 2013

Self-Esteem, situational low, Amputation NCPs

Nursing Diagnosis
  • Self-Esteem, situational low
May be related to
  • Loss of body part/change in functional abilities
Possibly evidenced by
  • Anticipated changes in lifestyle; fear of rejection/reaction by others
  • Negative feelings about body, focus on past strength, function, or appearance
  • Feelings of helplessness, powerlessness
  • Preoccupation with missing body part, not looking at or touching stump
  • Perceived change in usual patterns of responsibility/physical capacity to resume role

Amputation Nursing Care Plans

In general, amputation of limbs is the result of trauma, peripheral vascular disease, tumors, and congenital disorders. For the purpose of this plan of care, amputation refers to the surgical/traumatic removal of a limb. Upper-extremity amputations are generally due to trauma from industrial accidents. Reattachment surgery may be possible for fingers, hands, and arms. Lower-extremity amputations are performed much more frequently than upper-extremity amputations. Five levels are currently used in lower-extremity amputation: foot and ankle, below knee (BKA), knee disarticulation and above (thigh), knee-hip disarticulation; and hemipelvectomy and translumbar amputation. There are two types of amputations: (1) open (provisional), which requires strict aseptic techniques and later revisions, and (2) closed, or “flap.”

Amputation Diagnostic Studies

Studies depend on underlying condition necessitating amputation and are used to determine the appropriate level for amputation.
  • X-rays: Identify skeletal abnormalities.
  • CT scan: Identifies soft-tissue and bone destruction, neoplastic lesions, osteomyelitis, hematoma formation.
  • Angiography and blood flow studies: Evaluate circulation/tissue perfusion problems and help predict potential for tissue healing after amputation.
  • Doppler ultrasound, laser Doppler flowmetry: Performed to assess and measure blood flow.
  • Transcutaneous oxygen pressure: Maps out areas of greater and lesser perfusion in the involved extremity.
  • Thermography: Measures temperature differences in an ischemic limb at two sites: at the skin and center of the bone. The lower the difference between the two readings, the greater the chance for healing.
  • Plethysmography: Segmental systolic BP measurements evaluate arterial blood flow.
  • ESR: Elevation indicates inflammatory response.
  • Wound cultures: Identify presence of infection and causative organism.
  • WBC count/differential: Elevation and “shift to left” suggest infectious process.
  • Biopsy: Confirms diagnosis of benign/malignant mass.

Nursing Priorities - Amputation Nursing Care Plans

  1. Support psychological and physiological adjustment.
  2. Alleviate pain.
  3. Prevent complications.
  4. Promote mobility/functional abilities.
  5. Provide information about surgical procedure/prognosis and treatment needs.

Discharge Goals - Amputation Nursing Care Plans

  1. Dealing with current situation realistically.
  2. Pain relieved/controlled.
  3. Complications prevented/minimized.