Question

Case study

Peter is a 37 year old male transported via EHS to ER following a MVA involving a drunk driver. Peter’s leg was mangled with complete above knee amputation. Once stabilized to the extent possible, he was taken to the OR and is returning to your unit after surgery. Peter’s blood work reveals decreased Hgb, decreased PLTs, and increased WBCs. He is resting in his bed as sedation from surgery wears off
1) What are your top nursing priorities in Peter’s care?

2) Peter reports “excruciating pain” at an 8 on a pain scale from 1‐ 10. On further assessment, you find P 100bpm, R 22/min, BP 90/68 mmHg. Moving his sheets, you realize Peter’s dressing is saturated in frank, red blood that is seeping into the bed linens. What do you do?

3) Peter’s physiologic status eventually stabilizes and he progresses in rehab with his new prosthesis. On a follow‐up visit, he reports a strange and painful sensation in his amputated limb. “It’s as though my whole leg is still there only my toes are crossed over each other, and I can’t fix it. It often feels like pins and needles,” Peter reports. What complication is Peter describing? What are some interventions to relieve or decrease this sensation?

Answer 1

1.The top nursing priority care for this patient are

• Monitoring for post operative bleeding
• Monitoring vital signs ,neurological status
• Maintain intravenous fluid therapy to prevent dehydration and thus maintain fluid status
• Aseotic procedures to prevent infection
• Stopping any anticoagulants which can risk the patient to bleed ,avoiding unnecessary invasive procedures

2.Apply direct pressure on the site with a sterile gauze pad dressing

Apply pressure at the femoral point to prevent errors blood flow to the limb

Elevate the limbs to avoid gravitation and bleeding

Administer pain medication as per order

Administer intravenous fluid to elevated blood pressure

Call for the provider to inform patient status and get new orders

3.This is described to be phantom pain usually experienced in a post operative patient who has been amputated.

Some of the intervention to decrease and relieve this sensation are

• Administer medication which can block the neurinal activity at the site
• Salmon calcitonin us found to be an effective drug to relieve these discomfort
• Teaching active and passuve exercise or ROM to improve the limb functioning
• Provide diversions therapy