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Below the Knee Amputationon CKD V Sec to DM NephPatient
A Case Study of
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Nephropathy Patient
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Nephropathy Patient
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What is BKA?
BKAstands for belo!the!knee
amputation"
!anstibial amputation is the preferred
term for BKA# as the tibia is the largerbone belo the knee"
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Nephropathy Patient
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What a!e the !is" #acto!s?
$isk %actors that may lead to Amputationon DM Patients&'
Decreased perfusion (Diabetic )europathy*
' +n,ury or Trauma
' Severe infection on affected limb
' -ncontrolled .yperglycemia
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Nephropathy Patient
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Clinical Mane#estations
Signs and Symptoms& Decreased sensation on e/tremeties )on 0
healing ound +mmobility
+ncreased Pre .D and Post .D $BS +ncreased 1BC count on CBC
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Nephropathy Patient
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Mana$ement
%oot care# including regular follo!up#
patient education# and referral asappropriate
Tight# stable glycemic control (most
important for sloing progression ofneuropathy*Pain
management
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7/25/2019 A Case Study of BKA on CKD V Secondary to DM
Nephropathy Patient
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Below the Knee Amputationon CKD V Sec to DM Neph
PatientPatient Case
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Nephropathy Patient
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Nephropathy Patient
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PA('N BACK)&O*ND
$2# 34yo#$ale ,atient with *ia(nosis o-
.D 0 secon*ary to D 'e,hro,athy isun*er(oin( he$o*ialysis
treat$ent -or 2x a
week
General Information:
+ei(ht: 38k(
ei(ht: %5 355
6: 24%3k(/$5
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7/25/2019 A Case Study of BKA on CKD V Secondary to DM
Nephropathy Patient
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PA('N %(SO&+
.istory of Present +llness&
Patient complained of severe headache for 6daysand episodes of
increased blood pressure athome# pain medications ere ordered
andad,ustment on anti!hypertensive medicationsas done" Also to
alleviate the pain# the patient
opted to use arm compress and placed it onthe soles of his feet
causing 5nddegree burn"
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Nephropathy Patient
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PA('N %(SO&+
Past Medical .istory' .epatitis B infection
' Type 5 Diabetes Mellitus ($outine Dialysis*
Social .istory' 79 to&acco use alcohol an* elicit *ru(s
Surgical .istory' Debridement of $ight %oot (diabetic ulcer*
December# 5787
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Nephropathy Patient
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Dia$nostic ests
Complete Blood Count%BS Monitoring9ray of both foot AP:
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Nephropathy Patient
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COMP,'' B,OOD CO*N
-*N' ./ 0123
(&: ;ct: #21!.:4#"+.: "2
$ Of %u P&C'ero(enem 1g ) 12*rse,of-oxa.in 500mg O"
x#d
-*N' 04/ 0123
(&: ;8ct: #2"!.:2%"+.: 8#PL=: 28+CA= MA)A>?M?)T'
D?B$+D?M?)T
' B?=:1 K)?? AMP-TAT+:)
P.A$MAC:=:>+CA= MA)A>?M?)T
.?M:D+A=@S+S
)-$S+)> MA)A>?M?)T
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P%A&MACO,O)(C MANA)'M'N
A)T+!DM M?DSA)T+! .P) M?DSA)T+B+:T+CSA)?M+A MA)A>?M?)TPA+)
M?D+CAT+:)S
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Nephropathy Patient
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N*&S(N) CA&' P,AN
ASS'SSM'N' Sub,ective&
2erbal report of pain and discomfort Pain scale of 3 out of 87
(87 being the highest*
' :b,ective&(* post op BKA mild pain (* eakness Behavioral
change
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Nephropathy Patient
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N*&S(N) MANA)'M'N
D(A)NOS(S' +mpaired physical mobility due to
surgicalinterruption and musculoskeletal impairment
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N*&S(N) MANA)'M'N
P,ANN(N)LONG TERM:
>-ter 12 weeks o- nursin( inter?ention the client will &e
a&leto ,artici,ate in >DL an* *esire* acti?ities
SHORT TERM:
>-ter 1%2# $inutes o- nursin( inter?ention the client will
&e
a&le to:0er&alize un*erstan*in( a&out the $etho*s
that ,ro?i*e relie-
De$onstrate use o- relaxation skills an* *i?ersional
acti?ities a,,ro,riate to situation
State the i$,ortance o- co$,liance to -- check u, an*
$e*ication co$,liance
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N*&S(N) MANA)'M'N
+)T?$2?)T+:)' 8">ssess si(ns o- ,ain ?er&al an*
non?er&al location an*
intensity shoul* &e note* to &e a&le
Rationale: to determine appropriate therapeutic
intervention.
' 2 Su,,ort a--ecte* &o*y ,arts/@oints usin(
,illows/rollsRationale: to maintain position of function and reduce
risk
of pressure ulcers.' " Ancoura(e ,artici,ation in
sel-careoccu,ational/*i?ersional/recreational acti?ities
Rationale: This enhances self-concept and sense of
independence.
' 4 Bi?e anal(esics ,rescri&e* an* e?aluation o-
e--ecti?enessRationale:analgesics in severe pain may need to
block
pain
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Nephropathy Patient
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N*&S(N) MANA)'M'N
?2A=-TA+:)
LONG TERM:
>-ter 12 weeks o- nursin( inter?ention the client was
a&le to
,artici,ate in >DL an* *esire* acti?ities
SHORT TERM:
>-ter 1%2# $inutes o- nursin( inter?ention the client was
a&le
to: 0er&alize* un*erstan*in( a&out the $etho*s that
,ro?i*e
relie-
De$onstrate* use o- relaxation skills an* *i?ersional
acti?ities
a,,ro,riate to situation
State* the i$,ortance o- co$,liance to -- check u, an*$e*ication
co$,liance
