Knee bilateral amputation causes major alterations in the patient's overall body structure as well as bodily functioning. It obviously results in the loss of a body component, but it also has an impact on the underlying disease, in this case diabetes. As a result, it has an impact on comorbidities and synchronous injuries. To compensate for the loss of the severed body structures and function of the damaged body part, the patient could consider getting a prosthetic fitting. There is a strong likelihood that the patient may face a wide range of limits in their capacity to engage in activities on their own. It is for that reason that patient care after such a medical process is vital to the patient’s life. Some of the typical activities that the patient may be limited and participation limitations associated with limb amputation relate to mobility and self-care. The patient’s life has drastically changed since their ability to return to and maintain work, maintain social relations and participating in leisure activities end up being limited. The current condition of the patient also results in environmental restrictions such as engaging in normal social roles. Therefore, it is vital to have optimal and long-term physical therapy management approaches for the patient which requires having a comprehensive understanding of the patient and functional consequences of the amputation. Also, to provide adequate patient care it would require having a systematic and in-depth analysis consideration of the patient’s and their environment. The patient would require undergoing a rehabilitation process that would help them cope with their new body condition. Post-operatively physical therapy would play a significant role in the patient’s new condition (Kohler, 2009).
A nurse should ensure that they take a complete medical history of the patient or obtain it from the medical records to the therapist with all the information they may need to know when handling the patient. A nurse should also conduct an accurate assessment of the mental condition of the patient. The purpose of such an assessment would be to give some insight on the likely knowledge level for immediate prosthetic care. A nurse should be more apprehensive about evaluating the patient’s ability to cognitively carry out a wide range of activities such as bed positioning, skin care, and safe ambulation. In case the nurse realizes that the patient does not meet the required level of cognition, they should consider involving the patient’s relatives or friends who would be involved in the rehabilitation process to guarantee its success.
Exercise programs are essential to prevent the patient’s muscles from shortening and having joint contractures which could be achieved by increasing their flexibility. The exercises should, however, be performed in a slow and controlled manner. Some of the strengthening exercises that patient could engage in while at home may include sitting balance and bed mobility which could be initiated by the patient having a strong flexible back and abdominal flexors and hip extensors (Esquenazi & DiGiacomo 2001). During transfers and while using assistive devices the patient should consider using shoulder stabilizers and elbow extensors for supporting the upper body (Esquenazi, 2014). Cardiovascular training may also be prescribed to the patient to help improve their endurance level and functional mobility tolerance. However, the needs and abilities of the change play a significant role in determining the duration, intensity, and frequency of the cardiovascular training.
Wheelchair mobility or what is referred to as the upper-extremity could be used during the pre-prosthetic phase while administering home patient care. The patient could also take swimming activities as part of the rehabilitation process but only after the incision has healed. Swimming is considered as an excellent exercise for the patient if they need to minimize the weight-bearing impact (Robert, 2008). Balance training exercises for the patient should include activities such as sitting and standing. It could also involve static and dynamic actions according to the patient’s interests and progress with the therapy. The patient could be further tested to reach for stuff using soft or unstable surfaces and accommodating external forces.
The dressing of the amputated area is vital for the patient’s healing process. The postoperative dressing of the patients would involve edema and facilitate prosthetic fitting. After amputation, the patient is advised to soft dress by either cotton padding or using an elastic bandage. They could also use Unna paste bandage. The rigid dressing is also another type of dressing that could help in the postoperative drainage of the amputated limb while the patient is at home.
It is important to clean the socket on a daily basis as it helps promote hygiene and prevents weakening of prosthetic materials. It is a general rule that solid plastic materials should be cleaned using a damp piece of cloth and foam constituents with chafing alcohol. It is important for the patient always to remember that routine care of the prosthesis should be executed by the prosthesis to ensure that they a maximum life and maintain the safety of the prosthesis.
The patient is encouraged to engage in activities soonest possible and on a regular basis as it will help speed up their recovery process in multiple ways. It helps in offsetting the negative effects of immobility by facilitating movement through the joints and promote increased circulation. Second, by taking part in any functional activities, the patient stands a better chance of re-establishing personal independence, which could have been considered as threatened due to the amputated limbs. Consequently, functional activities are also known to have a psychological advantage to the patient in that the personal independence derived from the activities will act as a source of motivation for the patient during their rehabilitation process as well as the rest of their life.
Bed mobility if important particularly for this patient with bilateral knee amputation. To facilitate bed mobility for the patient, they could be taught how to use side rail or human assistance when learning bed mobility. However, the use of support bed mobility features should not be used for long as it might affect the patient’s future rehabilitation process while at home. The patient should be taught on the different ways through which they can roll, come to sitting or adjusting their position.
After the patient has mastered bed mobility, it is important for them to learn how to transfer from the bed to the wheelchair while at home, as the setting is quite different from that of the hospital. Since the patient has a bilateral amputation if they are not built-in with any preliminary prosthesis transfer is initiated in a head-on approach. For this case, the wheelchair draws near the mat of the chair, with the front of the chair adjacent to the relocating surface. The patient then swiftly slides onward onto the preferred surface by elating their body and pushing forward with both hands. Up until sufficient strength of the triceps and latissimus is realized for the relocation to happen, a lateral sliding-board transfer will be vital in minimizing resistance and closing the gap between the chair and wanted a surface.
The patient should safely ascend and descend stairs. It should be performed comfortably one step at a time. The stairs at home are quite different from those they trained with during the rehabilitation process while in hospital. The patient should consider living in a house where they will not have the struggle to get to their rooms. They could consider houses with lifts to ease movement up the story building.
The patient should have had a mastery of uneven surfaces during the rehabilitation process while at the hospital. The patient should understand that it is significant to detect the terrain ahead while at home to evade any slippery surfaces or potholes that might cause them to fall or loss stability resulting in further injuries. Ascending inclines for the patient might be a problem due to the lack of dorsiflexion.
The identified hazards within the home environment were in the kitchen, bedroom and bathroom. The identified location were considered as the primary locations where most injuries occur at home health assistants (Czuba, Sommerich, & Lavender, 2012). Other identified safety concerns within the home environment included trip, slip and lift hazards in each room, with the exclusion of throw rugs which was identified as risky in every room. In the kitchen, water and grease spills were pronounced to being frequent on the floor. In the bathroom, the problem was with tight spaces and missing equipment while in the bedroom the identified problem was lifting hazards. While in the living room the safety cues was with the electrical cords and oxygen tubing, and cutter within the hallway. There were similar differences that were identified in the types of biohazards recorded in each room of the patient’s house.
It is important to balance other priorities and fall prevention for the patient. The patient is not in need of proper home care or hospital care because of falls. Therefore, attention is vital and naturally directed to elsewhere. Yet, a fall by the patient could be disastrous and could prolong their recovery process. The need to mobilize the patient must be balanced with fall prevention. One could be tempted to leave the patient in bed to prevent them from falling. However, the patient needs to transfer and ambulate for them to maintain their strength and avoid developing complication due to bed rest. Fall prevention is interdisciplinary activity as it involves the patient, family, nurses and therapists. All these individuals should cooperate to prevent falls. Therefore, a proper and effective channel should be developed through which information about the patient fall can reach the right member of the team without delays.
Fall prevention alone cannot be the only objective of a fall prevention program. For instance theoretically, patient falls could be prevented by restraining them, preventing them from leaving the bed. However, restraining the patient is considered an unethical and is a form of poor care administration to the patient. Such a practice conflicts with the principles of patient autonomy and may result in the complications of bed rest such as pressure ulcers. Which could lead in prolonging the patient’s stay at the hospital and making it hard for them to recover.
One of the most effective ways through which I could prevent error in the patient would be staying informed about the patient’s condition and progress. In case of any internal errors, they should be discussed by the technicians and pharmacists. There as a way of preventing errors proactive learning is important as well as sharing the errors that other nurses might have experienced in their line of work. It includes errors and prevention strategies that are reported on an annual basis, for instance, those published in the ISMP Medication Safety Alert Community/ Ambulatory Care Edition, which could be a beneficial source in understanding some of the areas that I might experience any error. Another role in error prevention for the patient would be through prescription drop-off. Creating a checklist of the patient's critical information is important. Example of such information could include their date of birth which should be written on a hard copy prescription so that the pharmacist has a second identifier easily accessible during verification. The patient’s diabetic condition, as well as any allergy condition, should be regularly updated in the patient’s profile at each meeting with the patient. Once the information has been updated, it should be communicated to the verification pharmacist immediately. Knowing the patient’s medical condition would help the pharmacist decide whether prescriptions are appropriately administered or whether there is a need for further assessment.
References
Czuba, L. R., Sommerich, C. M., & Lavender, S. A. (2012). Ergonomic and safety risk factors in home health care: Exploration and assessment of alternative interventions. Work, 42(3), 341-353.
Esquenazi, A., & DiGiacomo, R. (2001). Rehabilitation after amputation. Journal of the American Podiatric Medical Association, 91(1), 13-22.
Esquenazi, A. (2014). Gait analysis in lower-limb amputation and prosthetic rehabilitation. Physical Medicine and Rehabilitation Clinics, 25(1), 153-167.
Kohler, F., Cieza, A., Stucki, G., Geertzen, J., Burger, H., Dillon, M. P., ... & Kostanjsek, N. (2009). Developing Core Sets for persons following amputation based on the International Classification of Functioning, Disability and Health as a way to specify functioning. Prosthetics and orthotics international, 33(2), 117-129.
Robert Gailey PhD, P. T. (2008). Review of secondary physical conditions associated with lower-limb amputation and long-term prosthesis use. Journal of rehabilitation research and development, 45(1), 15.
