Amputation

The client with an above-the-knee amputation is to use crutches while the prosthesis is being adjusted. Which exercises will best prepare the client for using crutches? abdominal exercises isometric shoulder exercises quadriceps setting exercises triceps strengthening exercises

Correct answer triceps strengthening exercises Feedback Use of crutches requires significant strength from the triceps muscles. Therefore, efforts are focused on strengthening these muscles in anticipation of crutch walking. Bed and wheelchair push-ups are excellent exercises targeted at the triceps muscles. Abdominal exercises, range-of-motion and isometric exercises of the shoulders, and quadriceps and gluteal setting exercises are not helpful in preparing for crutch walking.

Which action is most helpful to promote circulation for the client with peripheral arterial disease? resting with the legs elevated above the level of the heart walking slowly but steadily for 30 minutes twice a day minimizing activity as much and as often as possible wearing antiembolism stockings at all times when out of bed

Correct answer walking slowly but steadily for 30 minutes twice a day Feedback Slow, steady walking is a recommended activity for the client with peripheral arterial disease because it stimulates the development of collateral circulation needed to ensure adequate tissue oxygenation. The client with peripheral arterial disease should not minimize activity. Activity is necessary to foster the development of collateral circulation. Elevating the legs above the heart is an appropriate strategy for reducing venous congestion. Wearing antiembolism stockings promotes the return of venous circulation, which is important for clients with venous insufficiency. However, their use in clients with peripheral arterial disease may cause the disease to worsen. Score: 1 / 1

The nurse teaches a client about using crutches, instructing the client to support the weight primarily on which part of the upper body? axillae Elbows Upper arms hands

Correct answer hands Feedback When using crutches, the client is taught to support weight primarily on the hands. Supporting body weight on the axillae, elbows, or upper arms must be avoided to prevent nerve damage from excessive pressure.

A client who has had an above-the-knee amputation develops a dime-sized bright red spot on the dressing after 45 minutes in the postanesthesia recovery unit. What should the nurse do first? Elevate the stump. Reinforce the dressing. Call the surgeon. Draw a mark around the site.

Correct answer Draw a mark around the site. Feedback The priority action is to draw a mark around the site of bleeding to determine the rate of bleeding. Once the area is marked, the nurse can determine whether the bleeding is increasing or decreasing by the size of the area marked. Because the spot is bright red, the bleeding is most likely arterial in origin. Once the rate and source of bleeding are identified, the surgeon should be notified. The stump is not elevated because adhesions may occur, interfering with the ability to fit a prosthesis. The dressing would be reinforced if the bleeding is determined to be of venous origin, characterized by slow oozing of darker blood that ceases with the application of a pressure dressing. Typically, operative dressings are not changed for 24 hours. Therefore, the dressing is reinforced to prevent organisms from penetrating through the blood-soaked areas of the initial postoperative dressing.

A client in the postanesthesia care unit with a left below- the-knee amputation has pain in the left big toe. What should the nurse do first? Tell the client it is impossible to feel the pain. Show the client that the toes are not there. Explain to the client that the pain is real. Give the client the prescribed opioid analgesic.

Correct answer Give the client the prescribed opioid analgesic. Feedback The nurse's first action should be to administer the prescribed opioid analgesic to the client because this phenomenon is phantom sensation and interventions should be provided to relieve it. Pain relief is the priority. Phantom sensation is a real sensation. It is incorrect and inappropriate to tell a client that it is impossible to feel the pain. Although it does relieve the client's apprehensions to be told that phantom sensations are a real phenomenon, the client needs prompt treatment to relieve the pain sensation. Usually, phantom sensation will go away. However, showing the client that the toes are not there does nothing to provide the client with relief.

A client with absent peripheral pulses and pain at rest is scheduled for an arterial Doppler study of the affected extremity. When preparing the client for this test, what should the nurse do? Have the client sign an informed consent form for the procedure. Administer a pretest sedative as appropriate. Keep the client tobacco free for 30 minutes before the test. Wrap the client's affected foot with a blanket.

Correct answer Keep the client tobacco free for 30 minutes before the test. Feedback The client should be tobacco free for 30 minutes before the test to avoid false readings related to the vasoconstrictive effects of smoking on the arteries. Because this test is noninvasive, the client does not need to sign an informed consent form. The client should receive an opioid analgesic, not a sedative, to control the pain as the blood pressure cuffs are inflated during the Doppler studies to determine the ankle-to-brachial pressure index. The client's ankle should not be covered with a blanket because the weight of the blanket on the ischemic foot will cause pain. A bed cradle should be used to keep even the weight of a sheet off the affected foot.

What information should the nurse include in the teaching plan for a client with arterial insufficiency to the feet that is being managed conservatively? Lubricate the feet daily. Soak the feet in warm water. Apply antiembolism stockings. Wear firm, supportive leather shoes.

Correct answer Lubricate the feet daily. Feedback Daily lubrication, inspection, cleaning, and patting dry of the feet should be performed to prevent cracking of the skin and possible infection. Soaking the feet in warm water should be avoided because soaking can lead to maceration and subsequent skin breakdown. Additionally, the client with arterial insufficiency typically experiences sensory changes, so the client may be unable to detect water that is too warm, thus placing the client at risk for burns. Antiembolism stockings, appropriate for clients with venous insufficiency, are inappropriate for clients with arterial insufficiency and could lead to a worsening of the condition. Footwear should be roomy, soft, and protective and allow air to circulate. Therefore, firm, supportive leather shoes would be inappropriate.

A client has severe arterial occlusive disease and gangrene of the left great toe. Which finding is expected? edema around the ankle loss of hair on the lower leg thin, soft toenails warmth in the foot

Correct answer loss of hair on the lower leg Feedback The client with severe arterial occlusive disease and gangrene of the left great toe would have lost the hair on the leg due to decreased circulation to the skin. Edema around the ankle and lower leg would indicate venous insufficiency of the lower extremity. Thin, soft toenails (i.e., not thickened and brittle) are a normal finding. Warmth in the foot indicates adequate circulation to the extremity. Typically, the foot would be cool to cold if a severe arterial occlusion were present.

The client asks the nurse, "Why won't the health care provider tell me exactly how much of my leg he is going to take off? Don't you think I should know that?" On which information should the nurse base the response? the need to remove as much of the leg as possible the adequacy of the blood supply to the tissues the ease with which a prosthesis can be fitted the client's ability to walk with a prosthesis

Correct answer the adequacy of the blood supply to the tissues Feedback The level of amputation often cannot be accurately determined until during surgery, when the surgeon can directly assess the adequacy of the circulation of the residual limb. From a moral, ethical, and legal viewpoint, the surgeon attempts to remove as little of the leg as possible. Although a longer residual limb facilitates prosthesis fitting, unless the stump is receiving a good blood supply, the prosthesis will not function properly because tissue necrosis will occur. Although the client's ability to walk with a prosthesis is important, it is not a determining factor in the decision about the level of amputation required. Blood supply to the tissue is the primary determinant.