Wound Care, Limb Preservation and Amputation service€¦ · (Above, Through and Below Knee)...

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Wound Care, Limb Preservation and Amputation service MARK GOETCHEUS, BSN, RN, CWON, CFCN, CDE WOUND, OSTOMY, LIMB PRESERVATION, & AMPUTEE SERVICES HARBORVIEW MEDICAL CENTER May 25 th , 2019 CONFIDENTIAL – DO NOT DISTRIBUTE

Transcript of Wound Care, Limb Preservation and Amputation service€¦ · (Above, Through and Below Knee)...

Page 1: Wound Care, Limb Preservation and Amputation service€¦ · (Above, Through and Below Knee) •standardize treatment • pre-op clinic visit to 10 weeks post-operation •includes

Wound Care, Limb Preservation and Amputation

service

MARK GOETCHEUS, BSN, RN, CWON, CFCN, CDE

WOUND, OSTOMY, LIMB PRESERVATION, & AMPUTEE SERVICES

HARBORVIEW MEDICAL CENTER

May 25th, 2019

CONFIDENTIAL – DO NOT DISTRIBUTE

Page 2: Wound Care, Limb Preservation and Amputation service€¦ · (Above, Through and Below Knee) •standardize treatment • pre-op clinic visit to 10 weeks post-operation •includes

DISCLOSUREMark Goetcheus, BSN, RN

• No relevant financial relationship reported

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Wound, Ostomy, Limb Preservation, & Amputation Services

Mark Goetcheus Holly VanceNikki OertingBrandon Ibarra

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Limb Preservation & Amputation Services

Surgical Consolation

• Salvage vs amputation

• Coordination: LP surgical service

• Vascular interventions

• Wound care plan

Amputee Education:

• Physical Therapy/ Occupational Therapy

• Prosthetics & Orthotics

• Rehab Psychology

• Rehab Medicine

• Amputee Support Group

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Limb Preservation Surgical Services

• Multidiscipline

• Vascular, Podiatry, Rehab medicine , Plastics, Nursing, Wound Care

• Continuum of care

• Inpt to outpt

• 65% reduction in major amputations versus previous 5 years

• Responsive vascular interventions

• Minor amputations

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Limb Preservation & Amputation Services

Physical Therapy & Occupational Therapy • Exercises

• ADL’s

• Equipment

• Home, wheel chair

• Diabetes/ LE Neuropathy: foot care education

• Fall prevention

• Phantom Pain

• Guided imagery, mirror box

• Goal is to start pre-op

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Limb Preservation & Amputation Services

Prosthetics & Orthotics

• Dressing plan

• Serial casting, suture removal, retention/shrinker socks

• Purpose of a knee immobilizer( BKA)

• Recovery timelines

• When will my get prosthetic?

• Amputation prevention

• Offloading shoe or boot• Education: daily foot exam

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Limb Preservation & Amputation Services

Rehabilitation Psychology

Coping adjustment

• Anxiety, depression, SUD

• Pain relief strategies : Acute, Chronic, phantom

• Mirror box tx

• Resources

• Where do you go when you get stuck?

• Early intervention

• Critical Limb Ischemia

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Limb Preservation & Amputation Services

Rehabilitation Medicine

• Goal setting

• Realistic

• Discuss:

• Recovery plan• What to expect

• When do I walk?

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Limb Preservation & Amputation Services Outpatient Rehab Clinic

Salvage vs amputation Consultation

• Should I get an amputation?

• Patients Goals

• Multidiscipline approach:• Rehab, Podiatrist, Ortho,

Vascular, nursing

• Offloading, dynamic braces, wound care

Post amputation treatment

• Multidiscipline approach:• Rehab

• Prosthetist

• surgeon

• wound care

• Physical Therapy

• Psych Rehab

• Pain Relief Services

• Vocational Rehab

Page 11: Wound Care, Limb Preservation and Amputation service€¦ · (Above, Through and Below Knee) •standardize treatment • pre-op clinic visit to 10 weeks post-operation •includes

Lower Extremity Amputation Clinical Pathway (Above, Through and Below Knee)

• standardize treatment

• pre-op clinic visit to 10 weeks post-

operation

• includes trauma related procedure

• Multidiscipline approach

• Patient education

Page 12: Wound Care, Limb Preservation and Amputation service€¦ · (Above, Through and Below Knee) •standardize treatment • pre-op clinic visit to 10 weeks post-operation •includes
Page 13: Wound Care, Limb Preservation and Amputation service€¦ · (Above, Through and Below Knee) •standardize treatment • pre-op clinic visit to 10 weeks post-operation •includes

Thank [email protected]

mailto:[email protected]

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