Amputation Of Arms And Legs Health And Social Care Essay

This article is an essay about the amputation of arms and legs. Study it to learn how to write essays concerning multiple health needs and gain insights into how you can get expert essay writing help.

Amputation Of Arms And Legs Health And Social Care Essay

Multiple health need is a theoretical account to have a comprehensive view of multiple inter-webbing needs of a client which pairs health and social issues. There cannot be a common framework for the complex needs of all, but it is individual specific and needs a separate response from caregivers. (Rankin & Regan)

Client Discussion

A 37-year-old client named Mr. Shaiju came to the emergency department with an alleged history of road traffic accidents (RTA) in which a lorry ran over the tibia of his left leg. On admission, Mr. Shaiju had immense pain in the left leg and was having tachycardia and hypotension. The skin over the left tibia was degloved and the client looked apprehensive. On radiological examination, Mr. Shaiju was diagnosed with a compound fracture of the tibia and fibula.

The orthopedics advised for a Below-knee Amputation since there was popliteal artery injury along with nerve injury and bone fracture, which when associated together with inpatient is a higher risk to end up with amputation (K. Rerkasem 2006), even though the patient had a history of Type II diabetes Mellitus by considering the finding of Guo Jiong Jiong et al (2009) that immediate operation is possible in a patient with fracture.

The client was moved with traction splints to the Surgical Intensive Care Unit (SICU) after taking routine investigations like blood routines (HIV, HBsAg screening, Liver Function Test, CBC ESR, Urine Routine, Random Blood test, Urea, Creatinine) and ECG. In SICU Mr. Shaiju was prepared for surgery.

Amputation is the method of surgical removal of a limb or a portion of a limb which no longer be beneficial for the person, instead, it produces immense pain and causes threats to the life of an individual because of injury or infection.

Below the Knee, the Amputation is the process of surgical removal of the lower portion of the leg beneath from knee joint (Riley Lee Richard 2005). This can arise to many interlinking needs for the patient like economic social, and psychological demands which are not directly linked with the condition but play a crucial role in the recovery of the patient

Relevance

In order to mention the multiple health needs of the patient with below-knee amputation, the practitioner use the above-mentioned case of Mr. Shaiju who was a victim of RTA because he was drunken and driven cycle into a lorry and broke the tibia and fibula of his right leg along with injury to both nerve and artery resulted in below-knee amputation. This client is a perfect example of a case of multiple health needs of a patient undergone amputation since he is having all needs

To protect confidentiality all the persons are mentioned with pseudo names in accordance with the Nursing & Midwifery Guideline in 2008

The subject of this case study Mr. Shaiju is a 37-year-old who has been admitted to the author’s unit with severe injury to the right lower limb because of RTA. On physical examination, his height was 168 cm weight was 68kg and Body Mass Index (BMI) was. He was hypotensive with Blood Pressure and Tachycardic.

On auscultation, he was having crackles and he was having an episode of cough for one week. He was having a surgical mark on the left iliac region of the abdomen. He was having a muscular build and the rest of the system was functioning normally. He was assessed for fracture, abdominal or head injury by observation, neurological examination, and also abdominal ultrasonography, and the results of all those were negative.

System wise Examination

1. General Appearance: Muscular body built. He was apprehensive and cooperative with the author despite the severe pain he was having.

2. Skin: Good skin turgor, but skin is dry and pale over palm and lower extremity

3. Head

a) Skull is normal, round appearance with no sign of injury or bruise mark.

b) Hair is thick and some are white in color

c) No visible facial abnormalities

4. Eyes

a) Pupils are equally round and reactive to light and accommodation

b) Eyebrows are equal

c) No evidence of periorbital edema

d) Cornea is smooth

e) White sclera

5. Ears

a) No foul-smelling discharge present

b) Normal position of the pinna

c) Recoil of the pinna is present when it is folded

6. Nose: No abnormal discharge present

7. Throat & Mouth:

No obvious swelling and soreness are present, and Normal Deglutition and gagging reflex are present.

8. Neck

a) No visible enlargement of the thyroid gland and jugular vein distension

9. Chest: Normal appearance, no gynecomastia present

10. Cardiovascular: No cardiac murmurs, the normal rhythm of the pulse

11. Respiratory: Crackles on both lungs with frequent coughing

12. Gastrointestinal: No organomegaly present and normal bowel sound present.

13. Extremities: No abnormality found other than crush injury over right lower limb

14) Urogenital System: Normal urine output present, no haematuria or pyuria present

15) Neurological System: Normal reflexes present

Past Medical History

The past medical history was not good when the operation while considering the possible complication associated with it. Shaiju had severe medical histories like Type II Diabetic Mellitus (DM), hypertension, and also chronic alcoholism He was diagnosed of having diabetes in 2006 and was on regular oral hypoglycaemic.

In the year 2007 he was diagnosed as a victim of chronic renal failure as hypertension is a main predisposing factor for the disease ( ). He was on regular hemodialysis as this is the best treatment option available for chronic alcoholism ( ) besides the supportive medication.

Past Surgical History

He had undergone appendicectomy one year before and the operative and post-operative history were uneventful. He had developed a heterogeneous mass in the hilum of the liver and on later examination it was found to be a cyst Endoscopic retrograde cholangiopancreatography (ERCP) was performed. On ERCP gallstones and stones on the hepatic duct were found and removed and a drain was put in to remove pus collection from the cyst.

Living Standard

Family History

He is having a nuclear family with a wife and three children and he is the only breadwinner of the family. His parents died because of old age and the cause of death according to him was because of Cardiac Arrest. His uncle and mother was having DM and hypertension. He had four siblings in which three of them died because of cancer and another one recently died because of RTA, so he was very stressed since he also encountered an accident.

Financial Status

He is a coli worker and belongs to a socially deprived group of society. He did not have support from any other family members since he is the only earning member and his other relatives belong to low socio-economic strata . The subject was living in a rented house. The roof was tiled and had access to safe water.

Nutritional Status

He was well-nourished and is a nonvegetarian. He was taking food four times a day and had at least 8 glasses of water per day.

MANAGEMENT AND TREATMENT

Crush Injury of Lower Extremity

Physiological Function

¿½ To bear the weight of the body.

¿½ To enable locomotion.

The main focus of orthopedics is to manage the condition by below-knee amputation, even though that may be considered the failure of the surgeon to perform amputation due to the advancement of surgery in microvascular technique, revascularisation, and internal fixation of fracture (Ertl Jan 2005). But in this case, the bone was fragmented due to crush injury by RTA. A transtibial procedure was used. Informed consent was taken from the patient and the risk for above-knee amputation was explained.

The patient was given a supine position and a tourniquet was applied. An anterior-posterior incision was used. The muscle layer was dissected first and followed by the neurovascular structures. After the soft tissues are dissected the osseous tissue is approached using a chisel. After the dissection is performed anterior flap is attached to the posterior flap.

Drains are placed to prevent the formation of hematoma and the extremity is wrapped in sterile dressing and a plaster cast is applied with a leg in extension. The splint was removed on the 7th day, as the normal duration will be between 2-7 days (Ertl Jan 2005). The patient was on broad-spectrum antibiotics since he was a high-risk candidate for infection due to diabetes mellitus ( ) and NSAIDs.

ALCOHOLISM & ALCOHOL WITHDRAWAL SYNDROME

Alcoholism is a condition that arises because of either psychological or physical strive alcohol is consumed which is manifested by behavioral responses of other kinds and is associated with a temptation to consume alcohol to get its physiological effect or to nullify the effects caused if you do not take alcohol. (World Health Organisation 1992).

Alcohol Withdrawal Syndrome is a group of clinical manifestations that arises due to the reduced concentration of alcohol in the blood, which is essential for the normal functioning of that individual since the body developed a dependency on alcohol ( Winnington J et al 1998 )

Pathophysiology

The reduced intake of alcohol because of the long post-operative period caused a decrease in alcohol levels in patients¿½ blood so the body cannot perform the normal function, since his body developed a dependency. The withdrawal symptoms were sweating at night, tremors, increase in heartbeat and respiration, reduced amount of sleep, agitation, and irritability. He was aggressive and also had auditory hallucinations.

Treatment.

The patient developed alcohol withdrawal syndrome on the 3rd post-operative day, the common complication of alcohol abstinence after a long history of drinking. The patient was referred to a psychiatrist and was advised to give Polybion an Intravenous drug of multivitamin and a Serenenace tablet in order to make the patient calm.

Diabetes Mellitus

Diabetic Mellitus (DM) is a metabolic disorder in which there may be the absolute or relative absence of insulin hormone or resistance of insulin or a combination of both which deter the proper carbohydrate, fat, and protein metabolism.

DM is of two types

1. Noninsulin-dependent diabetes mellitus or NIDDM or Type II DM

2. Insulin-dependent diabetes mellitus

Anatomy & Physiology

The pancreas is an endocrine gland situated behind the stomach and it is in the left upper quadrant of the abdomen. It is an exocrine as well as an endocrine gland. . The two important hormones are Glucagon and Insulin. The former convert glycogen stored in body tissues to glucose for meeting energy requirement and the latter do vice versa which is glucose to glycogen. The pancreas is having three pats head neck and tail. It is supplied by the pancreaticoduodenal and splenic artery and pancreaticoduodenal vein.

Pathophysiology

The risk factors for DM can be grouped as nonmodifiable ( age, family history, ethnic origin) and modifiable risk factors (Obesity, hypertension, polycystic ovarian disease, viral infection, drugs, stress, and gestational diabetics Mellitus ). Mr. Shaiju had a family history and hypertension. These caused hyperglycemia. The hyperglycemia causes increased glucose uptake which penultimately leads to cellular starvation and ultimately polyphagia since the satiety center is stimulated because of the starvation.

Hyperglycemia causes increased glucose elimination from the kidney since it exceeds the renal threshold. This result in polyuria since more water will be gone out since glucose will attract the water. Hyperglycemia increases blood osmolarity which in turn result in Polynesia since intracellular dehydration occurs as fluid shifts from intracellular to extracellular space and also it results in reduced blood flow which causes complication for diabetics like dry itchy skin, nephropathy, neuropathy, retinopathy, and confusion. Mr. Shaiju was devoid of complications and had polydipsia, polyphagia, and polyuria.

Treatment

Throughout the days the blood sugar level of the patient was very much raised due to underlying history of diabetics and stress due to hospitalization. The patient was advised to start insulin injection subcutaneously on the 2nd postoperative day since the oral hypoglycaemic agents were found ineffective, with the advice of a doctor specialized in diabetics.

Chronic Renal Failure (CRF)

Anatomy & Physiology

The kidney is a retroperitoneal bean-shaped organ situated between the T12 and L3 vertebrae and is guarded by the 11th and 12th ribs. The basic functional unit of the kidney is Nephron. The physiological functions are excretion, controlling the fluids in the blood, and maintaining ionic regulation of pH of the body fluids, it shares the function of synthesizing vitamin D along with skin and maintaining red blood cell concentration.

CRF is a disease condition in which the kidney cannot maintain the body’s normal internal environment since there occurs gradual progressive deterioration in the number of functioning renal tissues.

Pathophysiology

There are predisposing factors (Age above 55 & Family history of DM and Hypertension) and precipitating factors (Lifestyle like smoking and alcoholism, certain diseases like hypertension and DM, recurrent infections). Mr. Shaiju had a family history of DM and hypertension and also had both diseases and he was a chronic alcoholic.

These factors caused thickening of small vessels and deposition of collagen in them resulting in decreased blood flow. This causes glomerulosclerosis and thereby reducing the glomerular filtration rate (GFR).This result in gradual progression through 5 stages according to the Kidney Disease Outcome Initiative Classification.

Stage I: GFR will be normal (>90ml/min/1.73meter square)

Stage II: GFR will be mildly reduced (60-89ml/min/1.73meter square)

Stage III: GFR is moderately reduced (30-59 ml/min/meter square)

Stage IV: There occurs a severe reduction in GFR(15-29ml/min/meter square)

Stage V: There occurs failure of the kidney (<15ml/min/meter square)

Mr. Shaiju was in the 4th stage of CRF and had pruritis, anorexia, and decreased libido.

Treatment

The patient was having a history of chronic renal failure and hypertension so he was given antihypertensive (ACE inhibitors), a loop diuretic, vitamin and mineral supplements, and especially Vitamin D supplements. There was a high concern for the worsening of the disease because of the high course of antibiotics science kidney is the organ meant for excretion of waste products of drug metabolism ( ). He was on a protein-restricted diet.

The author as a nurse practitioner looked at the patient holistically like physical, psychosocial, and economic dynamics rather than particular disease.

PHYSICAL DYNAMICS

Alcoholism is associated with many medical problems which are harmful to the normal functioning of the body. It also is the causative factor of RTA as in the case of him ( in the United Kingdom one in seven RTA is due to alcoholism) and problems with coordination ( Ritson Bruce 2000). There will be a great expectation of the patient for health care professionals to ask about their drinking habits of the patients (Kaariainen et al 2001).

The hospital is the best site for prevention since the admitted patient in the hospitals demonstrate a high willingness to change (Emmon et al 1992). The nurse practitioner used this opportunity to identify the dangerous alcohol consumption habit of the patient and given counseling as stated by Lock et al in 2002.

The nurse practitioner identified the risk of developing contractors as a major concern after the amputation (Christian Adrian 2006) and also the physical movement act as the stimuli in mechanical form for the skeleton in maintaining normal homeostasis of bones (Lundon Katie 2000). The immobilization causes a sudden loss of bone mass (Krolner et al 1983).

So the patient was given range of motion exercises along with physiotherapists. The residual limb was covered with an elastic bandage so that the residual limb attains proper shape and is devoid of swelling (Christian Adrian 2006). Mr. Shaiju had muscle pain skin pain and bone pain and he was given health education regarding that the former two will diminish quickly and the latter will last longer as quoted by Erhl Jan in 2005.

The patient was given special care for phantom limb sensation and given a massage from mild to severe patterns and also a towel used, both for desensitization so that the nerve reflex is reduced (Riley Lee Richard 2005). The patient was given health education that residual limbs should be kept covered and elevated in order to enhance blood supply and wound healing.

From the physical examination, the nurse practitioner identified the crackles in the lungs and cough. The patient was given chest physiotherapy and steam inhalation so that the present condition was relieved.

The stress of operation results in increased circulatory adrenaline, adrenocorticotrophic hormone, cortisol, and growth hormone which result in deficiency of insulin in the body and also develop resistance to insulin (Heller 2002). The nurse practitioner identifies the tough job to find out hypoglycemia in a sedated patient after surgery since the diabetic patient. The patient’s blood glucose was checked half-hourly to relieve the risk of hypoglycemia and its complication.

The nurse practitioner identified the risk of decline in physique and functional capability in hemodialysis patients (Johansen L Kirsten 2003). Adequate attention was given to this aspect and the patient was approached with that mindset and was referred to a dietician for preventing malnutrition.

PSYCHOSOCIAL DYNAMICS

The nurse practitioner gave information regarding the temporary problem with verbal, visual, and spatial learning, which would be regained within a few weeks if the chronic alcoholics abstain from alcohol (Ellenberg Leah 1980).

Amputation Of Arms And Legs
Amputation Of Arms And Legs Health And Social Care Essay

The point about the alcohol hinders the performance of suitable form of behavior and self-interpretation regarding events that happened in past (Hull G Jay 1981) was informed to the patient. The patient was also informed regarding the loss of functioning in which alcoholics deter better processing of information and physical activity and also the increased chance of aggression after consumption of alcohol (Hull g Jay1986).

ECONOMIC DYNAMICS

The term diabetes mellitus denote a severe issue to health care because of the increasing cost and the hindering nature of the disease on the individuals affected to live a better quality of life. The complications of DM can be prevented by proper primary care which reduces two-thirds of the cost. Physical activity and weight regulation promote a reduction in the expenditure for mortality and morbidity (G John 2009).

REHABILITATION

The nurse practitioner coordinated the rehabilitation team which consists of a dietician, social worker, and occupational therapist by proper referrals, informing the proper condition and improvement of patient and helping them in the rehabilitation process.

Read More On

Amputation Of Arms And Legs Health And Social Care Essay

 

Similar Posts