This chapter discusses about how many people are being affected with this condition, framework of the acute needs of the patients, and the two most important acute needs of the patient.
INTRODUCTION
Total knee amputation is removing or cutting both lower parts by a surgery, with the induction of the regional anesthesia or general anesthesia. Mostly these surgical interventions performed because of gangrenous limbs and to those who have been infected damaged limbs. I choose a case of total knee amputation in which I have to know how many patients are being affected in this particular problem. From the result of the national survey in United Kingdom, that it come up to an average of 34.3 that the surgeon performed total knee amputation per year. As there are many cases in the hospital, I get to know how is this being manage and handle so that the patients needs are fulfill. Total knee amputation really needs attention and care to the nurses or to the health care providers who handle it. And as I have been exposed in orthopedic ward I come to choose this case based on the knowledge that I have learn and practiced. It is very much advantage on my part in studying this problem knowing that I am practicing in orthopaedic ward. Moreover I’ve come to realize that choosing this problem would greatly help me also to be more aware and be knowledgeable that by time that I may encounter this again in the field, I may have the confidence to handle the patient and know what are going to do.
Roper, Logan and Tierney 12 activities of daily living model
The Roper-Logan-Tierney model for nursing was initially created as an education tool for ‘beginning nursing students and their teachers’ (Ropert et al 2000, p. 1).
I choose this model the Roper, Logan and Tierney 12 activities of daily living model of nursing because this model emphasize the needs of the patients. It is primarily used for those students who are being practiced in variety of settings. This model had helped the student nurses to get related on to their needs on their different levels of education. Thus this model has also to do something with the nursing process and the medical practice. This model is not only used by registered nurses for planning but it also help to teach the families and aides on how to individualize the nursing care. With this model of Roper, Logan and Tierney helps the nursing to focus from an ill patients to a well patients. In a such it also facilitating the health promotion nursing practice. Further more it is being used extensively within the United Kingdom and to all other countries as a framework for nursing care. This model enable us the students and also to the health care practitioners to apply. This model views and guide the students nurses and as well as the instructor to apply in various settings. It is easy to understand, and the concepts are broad. In caring with patient having being a case of total knee amputation based on the model of Roper, Logan and Tierny that shows concepts on how to deal and care with the patient. Since this model really for the beginning student nurses we must study this model before jumping into a harder concept.
The Model of Living
Five components of the model; Activities of daily Living, Lifespan, Dependence/ Independence, Factors influencing the activities of daily living, Individuality of living. First, Activities of Daily Living, this focuses on what are the things we do usually, normally what we do in daily living. There are twelve activities that are identified as a core of the model of living namely (Roper et al 2000); maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, mobilizing, working and playing, expressing sexuality, sleeping, dying. Each activity has different impact on our lives, although some of these don’t exist yet but some of it may have an important part. Second the Lifespan, “ As a person moves along the lifespan there is continuous change and every aspect of living is influenced by the biological, psychological, socio-cultural, environmental and politico-economic circumstances encountered throughout the life. ( Roper et al, 1996, p. 23). Third is the, Factors Influencing the Activity of Living, there are five factors; biological, psychological, socio-cultural, environmental and politico-economic. Fourth, Individuality of living , each person has its own way of living and has its own way means of living. Different styles and approaches in every day living.
Needs of the patient
The needs of the patient when he came in the ward is having or maintaining having a safe environment in which it is the most important aspect to care for the patient. To help the patients achieve it optimum health, to be more alive and so that in order he/she can perform the daily activities one of it must maintain a safe environment. Like preventing a patient from fall always put the side rails up to prevent falls, then washing hands before and after handling patients to prevent further diseases. Personal cleansing and dressing, since the wound of a total knee amputation is not totally heal, it needs a total care, standard precaution in handling the wound so that it may not contaminate. Position the patient in a comfortable way, and put some pillows on the affected side to elevate the leg. Keep the wound dry and clean, don’t let the bandages contaminated, wet or moist is the source of contamination. Check the floor if there is some objects that might the patient cause an injury. And also clean environment helps the patient to be more relax and comfortable. In maslow’s hierarchy of needs in which eating, drinking, breathing, shelter belongs in the physiological needs. These needs are eating and drinking as well as breathing, are essentials in life in order to sustain and maintain a body’s homeostasis. We need to eat foods and drink to have a good health and to correct balance. A lot of people are dying because of starvation they cant afford to buy foods. To function our body well we must also comply the needs of our body. Controlling the body temperature is also important, if a patient cannot able to control his/her temperature it may lead to serious condition that may lead to trauma or death. Mobilizing is one great aspect in helping client with total knee amputation, with this we have to be empathy that it is hard on the patient side that he cannot move easily hence he/she needs some assistance to get move. Mobility is very important in doing our daily living, unable to move may add some serious problem like bed sores, spinal injury, inflammatory disease. Daily exercise greatly demands on our body to be physically fit and active. With those condition this can affect on individuals lifestyles and social activities. Eliminating , since we are eating and drinking we need also to excrete some waste products in our body. Sleep help as to be relax and get out of stress. It helps to grow and repair the cells.
Assess pain by using the pain scale, 0- 10 as 0 with no pain and 10 as the rating for very painful.
Three important needs of the patient
PERSONAL CLEANSING AND DRESSING. In dealing with patient being amputated we as the health care provider must provide a cleanliness on the patient’s body especially on the wounds. since talking about amputation and that the skin is not intact and its open to environment we need to monitor on its skin. We need to teach also the client on how to care and handle his wounds and to maintain its skin integrity. Keeping the bandages or plaster in a dry , a wet or moist bandages may have some bacteria, moist is a good source of bacteria. So to prevent further complication in order not to get infected, we must learn to clean the wounds and know how to do proper dressing. I can say that it is one of the important needs of the patient knowing that we are preventing further complications. After surgery we are checking if there are some complications that might have to the patient like checking his vital signs especially the temperature, for example we get confused why he has a fever even though we can’t find any reason but the point is that his wound are being infected and was not properly cleaned and dressed. As a nurse we must do the sterile way in cleaning the wound with sterile gloves and correct way of putting the medication into the patient’s skin. Patient need to learn to clean his wound not just the patient but the relatives as well.
EATING AND DRINKING. Vitamins and minerals are from the food we eat like fruits and vegetables. It is one great factor in helping the patient to be more alive and active. We became healthy through the food we eat, our body really needs some food, and liquids to help the body more function. Especially the vitamin A.D.E.K for the skin integrity and for the bones. Drinking helps the body to eliminate waste products which are harmful in the body. It is the food that we eat that initiate energy to perform our activities in daily living. Water in the body is really important , if the skin wound gets dry in which the body lacks water, it add minor problem to the case.
MOBILIZING. I choose this as one of the important needs of the patient because mobilization is very important aspect. Gradual movement or passive exercises may have to perform this case, the post operation total knee amputation really need this. It doesn’t mean that we teach the patient to walk of course the patient cannot walk but we think of the remaining parts on the body. Applying passive motion of exercise to have the blood circulate. Elevating the lower part I every 2 hours or as doctors required, turn to sides every hours or as desired. With the help of the therapist they are also aware on the mechanics of the body parts, but nurses have to do with the patients by assisting him to move. Providing trapeze for the patient to hold on, in case that he likes to move.
Discussion on the medications
Pain Reliever- since the case of knee amputation is really painful and other major surgery it really needs a pain reliever to get relieve the pain. Pain reliever work on the body to manage the moderate, severely acute and chronic pain, it inhibit the cyclooxygenase, which decreases the prostaglandin production resulting to reduce pain. The patient need to take a pain reliever hence, after the surgery in an hours ago the anesthesia wear off and since it is amputation it is really in great demand to take pain reliever, it is very painful on the patients part.
Antibiotic- this medication is really needed to discourage infection. In cleaning the wound the nurse must observe proper way of cleaning it or observe sterility. The stump must remove and changed, in order to facilitate the flow of the blood there should a good blood circulation. Infection is really the concerns of the amputees, if the stump gets infected it may lead to a worse thing, thus necessary to remove the prosthesis and maybe it may lead to second time amputation at a higher level. This medication act as killing the bacteria in the area thus or preventing any problems. Antibiotics may come in a topical preparation, or in a tablet form or parenteral form.
Summary of the discussion
Based on the chosen problem, total knee amputation is not a simple problem but it is a serious problem. It should be treated very well and have to take care very well, patient also need to counsel since their body parts have been lost or being removed and that they may think they will not have will to survive, mostly these patients have a low self esteem so encourage verbalization in order to know the side of the patient and let go of the worries. With this problem I come up to choose the Roper-Logan-Tierney model of nursing because it is mostly used by the student nurses, the approach were good enough to support the needs of the amputees. It has a great impact on a student nurses profession since we are dealing with different patients, we get rotated to the different settings in a hospital, total knee amputation is seen mostly in the hospital. Since this case is very common we must be knowledgeable enough if ever we handle this certain kind of case.
Reference:
Baly, M 1995, Nursing and social change, 3rd ed., Routledge, London
Roper, N et al, 1996,The elements of nursing, Churchill Livingstone, Edinburgh.
Credit:ivythesis.typepad.com
0 comments:
Post a Comment