U Assessment

HISTORY. Seek information in such areas as control of diabetes and hypertension, diet, smoking, and any other activities that may affect the condition and rehabilitation of the patient.

PHYSICAL EXAMINATION. Inspection of the limb prior to surgery should focus on the area close to the expected site of amputation. Because of limited circulation, the limb often feels cool to the touch. Any lacerations, abrasions, or contusions may indicate additional problems with healing and should be made known to the surgeon.

PSYCHOSOCIAL. The young patient with a traumatic amputation may be in the denial phase of grief. The older patient with a long history of peripheral vascular problems, culminating in loss of a limb, may fear the loss of independence. Patients may show hostility or make demands of the nurse that seem unreasonable. Incomplete grieving, along with depression and false cheerfulness, can indicate psychological problems that predispose to phantom limb pain and prolong rehabilitation.

Those patients who are reluctant to have visitors while they are hospitalized following an amputation may have problems with depression later.

Diagnostic Highlights

Abnormality with Test Normal Result Condition

Explanation

Ankle arm index AAI > 1.0 AAI < 0.6 (AAI)

Ratio of the blood pressure in the leg to that in the arm; identifies people with severe aortoiliac occlusive disease

Other Tests: Limb blood pressure; Doppler ultrasonography; ultrasonic duplex scanning; plethysmography; computed tomography

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