Below The Knee Amputation (BKA) Case Study Example

This paper outlines a clinical experience that involved below the knee amputation of a 64-year-old male patient.

Medical History of the Patient, Assessment, Medication list and Recommendations
The clinical condition of the patient in question was right foot osteomyelitis with ascending cellulitis. The procedures performed during that exercise involved right below the knee amputation with wound vacuum placement. There were a number of past factors that precipitated the BKA procedure. The 64-year-old male patient had different co-morbidities, and he had undergone right fifth toe amputation for gangrene. Later, it was found that the patient had osteomyelitis of the forefoot that was accompanied by swelling and cellulitis of the lower extremity. There are different medications that could be used, but their role would be temporal. The underlying condition would prevail. Pain relievers, antibiotics, anti-oxidants, and nerve regeneration medications could be used as alternative therapy. However, following the patient’s medical history and the diagnosis of osteomyelitis of the forefoot that was accompanied by swelling and cellulitis of the lower extremity, a resolution (recommendation) to conduct amputating was made by the medical team to conduct BKA. The patient’s consent on the same matter was sought; he agreed. An amputation was the best option for the patient in question.

Medical History:

64 years, Male.

Previous: Fifth toe amputation Rx Gangrene;

Current: osteomyelitis of the fore-foot and cellulitis;
Lab report: diagnosis; osteomyelitis of the fore-foot and cellulitis;
Medication list: Pain relievers, antibiotics, anti-oxidants, and nerve regeneration medications.
Physical assessment; cellulitis, swelling of the forefoot. Patient appears to be in pain.

Recommendation: Right, below the knee amputation.

Lower-extremity amputations are some of the oldest surgical procedures in medicine (Medscape 1). In fact, the original surgical procedures outlined by Hippocrates have not changed until today. Only a few refinements have been made such as the use of anesthesia, improved perioperative conditions, and minor technical improvements. Although it is a medical procedure, some view it as a failure in medical practice. Medicine would have failed when it did not provide a solution other than amputation. However, it should be noted that this surgical process could be inevitable especially when clinical condition of the patient may involve trauma, tumors or vascular disease. In this case, trauma was the underlying condition. Therefore, amputation should not be viewed as a failure of medicine or treatment. It is but just one of the available treatment alternatives in medicine today (Medscape 1).
Amputation is one of the oldest medical practices (Medscape 1). In pre-historic times, the main risks that would be associated with amputations included excessive bleeding, shock, as well as sepsis. In the past, prior to the discovery of anesthesia, the entire process was difficult. The patient would be awake and aware of the entire proceedings because there was no anesthesia. Currently, the problem with lack of anesthesia has been solved, and patients do not feel extreme pain during the process. However, challenges involving sepsis are still present (Medscape 1).
Nowadays, after the amputation of the limb, the patient can lead a normal life following the application of an appropriate prosthesis (Medscape 1). However, it should be noted that the removal of the diseased limb is not the end of the process. Important steps must be taken to avoid after surgery complications. First, the surgical process must be conducted by an expert and should allow for the use of as prosthesis after surgery. Care must be taken with respect to the immediate knee to avoid exhaustion. The patients must be taught how to put on or remove a prosthesis, how to take care of it and monitor the skin or other associated pressure points. In order to register convincing results, the process should be led by a surgeon and a physician, prosthetist, physical therapist, and a social care worker (nurse). The nurse plays a crucial role in preparing the patient emotionally and psychologically for the process. The nurse ensures that the patient is comfortable as possible before, during and after the exercise. The nurse and the prothetist train the patient on how to manage their own while at home and how to put on or remove a prosthesis. The physician, on the other hand, has the task of explaining to the patient why the decision to conduct an amputation has been taken. The physical therapist should train the patient on how to manage their amputated limb (Medscape 1).
Prior to undertaking this life defining procedure the patient and his or her closest family members ought to be informed about the decision. The patient must be made to understand why the decision has been taken. Amputation is associated with extreme stigma. The patient may be traumatized to learn that one of his limbs would be amputated. It is hard to stomach such a situation, and that is why the patient must be prepared psychologically for this process prior to executing it.
The execution of this task calls for coordinated organization within the organizational setting. In this case, decent organization ensures that all the professionals needed to undertake the task are present in time and have all the necessary equipment. Poor organization and management can be a hindrance to the entire process.
As a final year nursing student, this clinical study has helped me understand the importance of teamwork when conducting complex tasks such as amputations. It has helped me come face to face with real life experiences, and this has gone a long way in boosting me psychologically and my morale.

PICOT Question

What measures can be taken to minimize amputations among elderly patients with osteomyelitis of the forefoot?
Population: The elderly
Intervention: prevention of amputations
Comparison: benefits of prevention vs. conduction of amputation
Outcome: Improved prognosis
Article Critique
Mohammed and Shebl conducted a study to assess the quality of life of Egyptians who had undergone upper and lower-extremity amputations. Most importantly, the researchers sought to evaluate the factors that shape the quality of life among Egyptian patients who had undergone an amputation of the lower o upper extremity. The study was in the form of a descriptive exploratory research design. The researchers chose surgical and orthopedic departments of Mansoura University Hospitals. The study recruited a sample size of 100 males and females. Health status and short form questionnaires were used to gather information. That study found that the majority of patients experienced change in the quality of life following the conduction of an amputation (Mohammed and Shebl 1). Place of amputation, social status, marital status, age, gender, type of work, and educational level play a crucial role in defining the quality of life of the patients who have undergone an amputation (Mohammed and Shebl 1). In summary, these researchers contend that limb amputation is associated with some degree of disability (Mohammed and Shebl 1).
The study conducted by Mohammed and Shebl has important findings. It highlights some of the important factors that clinicians ought to take into consideration while preparing a patient for an amputation process. In essence, factors such as place of amputation, social status, marital status, age, gender, type of work, and educational level must be understood. They will help in understanding the patient better as they prepare him or her for the procedure. In essence, the study conducted by Mohammed and Shebl provides wealthy information that will help clinicians in their management of lower-extremity amputation cases.
The second article had a similar objective. In their study, Sinha, Heuvel, and Arokiasamy recruited 605 participants aged 18 years and above. All of them had undergone an amputation in the lower extremity. The objective of that study was shaped by the realization that most rehabilitation programs are emphasizing on improving the quality of life of their patients. A number of factors were found to influence amputees’ quality of life. They include the age and time when the amputation was conducted, socioeconomic status, comorbidities, the use of a prosthesis, and the use of an assistive device. These researchers conclude by indicating that the factors mentioned above must be taken into consideration when planning for the rehabilitation of amputees.
Again, this article highlights some of the major factors that clinicians must take into consideration when planning for the management of an amputee. Having these factors in mind helps in the prognosis process, as well as, the establishment of a decent treatment protocol that meets the needs of the patient.
In summary, this paper has analyzed a case study in which an elderly patient with osteomyelitis of the forefoot underwent an amputation. As a final year nursing student, this case study has played a crucial role in boosting my morale as a nurse. Secondly, this research has analyzed two scholarly sources that researched factors that shape amputees’ quality of life. When the highlighted factors are taken into consideration, clinicians plan for the prognosis process, as well as, the establishment of a custom-made treatment protocol that meets the needs of the patient. Besides, this research proposes the PICOT question: What measures can be taken to minimize amputations among elderly patients with osteomyelitis of the forefoot? The provision of answers to this question will help in the improvement of the management of elderly patients with osteomyelitis of the forefoot.

Works Cited

Janos, P. Amputations of the Lower Extremity. Emedicine.medscape.com April 2014. Web. Feb. 10 2015.  
Mohammed, Salwa and Shebl Amany. Quality of Life among Egyptian Patients with Upper and Lower Limb Amputation: Sex Differences. Advances in Medicine, (2014): 1-8. Web.
Sinha, R. Heuvel, V. and Arokiasamy, P. Factors affecting quality of life in lower limb amputees. Prosthet Orthot Int.35.1(2011):90-6. Web.