Question

Case Study - Above the Knee Amputation Utilize the information in the case study, Lewis and Suanders textbooks to complete the Priority Form. This will be discussed in class and handed in for a total of 7 points. *When completing keep in mind the immediate concerns as well as discharge planning. *This assignment must be completed on your own. E.B., a 69-year-old man with type 1 diabetes mellitus (DM), is admitted to a large regional medical center complaining of severe pain in his right foot and lower leg. The right foot and lower leg are cool and without pulses (absent by Doppler). Arteriogram demonstrates severe atherosclerosis of the right popliteal artery with complete obstruction of blood flow. Despite attempts at percutaneous catheter-directed thrombolytic therapy with alteplase (tissue plasminogen activator [TPA]) over 48 hours and surgical thrombectomy, the foot and lower leg become necrotic. Finally, the decision is made to perform an above-the-knee amputation (AKA) on E.B.'s right leg. E.B. is recently widowed and has a son and daughter who live nearby. In preparation for E.B.'s surgery, the surgeons wish to spare as much viable tissue as possible. As you prepare E.B. for surgery, he is quiet and withdrawn. He follows instructions quietly and slowly without asking questions. His son and daughter are at his bedside, and they also are very quiet. Finally, E.B. tells his family, "I don't want to go like your mother did. She lingered on and had so much pain. I don't want them to bring me back." E.B. returns from surgery with the right residual limb dressed with gauze and an elastic wrap. The dressing is dry and intact, without drainage. He is drowsy and is receiving a maintenance intravenous (IV) infusion of D5NS at 125 mL/hr in his right forearm. On the evening of the first postoperative day, E.B. becomes more awake and begins to complain of pain. He states, "My right leg is really hurting; how can it hurt so bad if it's gone?"

Amputation
Priority Assessments 1. 2. 3.	Priority Labs & Diagnostics 1. 2. 3.	Priority Nursing Interventions 1. 2. 3.
Priority Medications 1. 2. 3.	Priority Potential & Actual Complications 1. 2. 3.	Priority Collaborative Goals 1. 2. 3.

Answer 1

A) priority assessment-

1.vital signs

2.pain assessment

3 .dressing

B) Priority lab and diagnostics-
1. Blood glucose level.
2.WBC count.
3. Biochemistry test

C) Priority Medications -
1 . Analgesics
2 . NSAID
3.antipyretic

D) Complications:
1.haematoma
2 . haemorrhage
3. Infection

E) Priority nursing intervention-

1.check the pain score with the pain scale and provide analgesics according to doctor's order.

2. Check the vital signs and record any abnormality.

3. Check the dressing and clean it with aseptic technique to prevent infection.

F) priority collaborative goals-

1 . Diabetic diet
2.physiotherapists
3.mental health professionals to support psychology Cally and rehab.