The nurse is providing education to a patient who will undergo an upper extremity amputation. What should the nurse emphasize as the priority nursing intervention in the immediate post-operative period?
Managing phantom limb pain
Ensuring proper prosthetic fitting
Elevating the residual limb on a pillow
Assessing the surgical incision for infection
The Correct Answer is D
The priority nursing intervention in the immediate post-operative period after an upper extremity amputation is to assess the surgical incision for infection. Early detection of signs of infection, such as redness, swelling, warmth, or drainage, is crucial to prevent complications and promote healing.
a. Managing phantom limb pain: While managing phantom limb pain is important, it may not be the priority nursing intervention immediately after the surgery. Assessing the surgical incision for infection and monitoring for any complications take precedence.
b. Ensuring proper prosthetic fitting: Prosthetic fitting is essential for functional outcomes, but it may not be the priority in the immediate post-operative period. It is addressed during the rehabilitation phase.
c. Elevating the residual limb on a pillow: Elevating the residual limb on a pillow is typically recommended for lower extremity amputations to reduce edema and promote venous return, not for upper extremity amputations.
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Correct Answer is B
Explanation
The priority nursing intervention in the immediate post-operative period for a patient who has undergone amputation is to assess the surgical incision for signs of infection. Infection is a common concern after surgery, and early detection and intervention are crucial to prevent complications and promote healing.
a. Administering pain medications as prescribed: Pain management is important for the patient's comfort and well-being, but it is not the priority nursing intervention immediately after amputation. Assessing the surgical incision for signs of infection takes precedence to prevent potential complications.
c. Applying a compression bandage to the residual limb: While compression bandages may be used as part of the post-operative care, they are not the priority intervention immediately after amputation. Ensuring the surgical site's integrity and preventing infection are more critical in the early post-operative period.
d. Providing emotional support and counseling: Emotional support and counseling are essential for the patient's overall well-being, but they are not the priority nursing intervention in the immediate post-operative period. The focus at this time is on physical assessment and early detection of any complications.
Correct Answer is C
Explanation
Acute osteomyelitis is a severe bacterial infection of the bone that can lead to tissue damage and the spread of infection if not promptly treated. In some cases, when antibiotic therapy is not effective or the infection is severe, amputation may be considered to remove the infected bone and prevent further complications.
a. Severe joint pain: Severe joint pain may be caused by various conditions, but it is not an indication for amputation. Treatment for joint pain involves identifying and managing the underlying cause.
b. Chronic osteoporosis: Osteoporosis is a condition characterized by weakened bones, but it does not typically lead to amputation. Treatment for osteoporosis focuses on preventing fractures and improving bone density through medication and lifestyle modifications.
d. Muscle strain: Muscle strains are common injuries that do not require amputation. They can usually be managed with rest, ice, compression, and elevation (RICE) and physical therapy.
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