2.

Mr X a 20 years old gentleman, diagnosed to have distal femur osteosarcoma and

was planned for wide resection and endoprosthesis surgery.

a) Define wide resection (4 marks)

Wide resection is defined as removal of the gross tumor with at least 3 cm of normal
surrounding soft tissue and 5 cm of normal surrounding bone tissue. Wide resection
also define as bone excision

b) i. Explain the post operative care for Mr X. (10marks)

1. vital sign (bp, pulse rate, spo2)
2. NBM until patient can tolerate to diet
3. Nutrition (hight protein diet for faster healing)
4. Neurovascular assessment (to evaluate sensory, motor function and peripheral
circulation)
5. Medication: Pain control (iv morphine PRN), ask patient if he/she can tolerate
with the pain. Antibiotic
6. Wound care –wound inspection Day3 & dressing
7. Ambulate – encourage get out of bed and sit in a chair
8. Psychological support – advice relative to give moral support to patient
9. Document all the procedures that have been done to the patient
10. TCA as adviced

ii. state the post operative complication for Mr X. (4 marks)

1. Infection and can be wound necrosis.
2. Mechanical complication such as breakage/fracture of the implant and instability
due to wear.
3. Aseptic loosening - failure of joint prostheses without the presence of mechanical
cause or infection
4. Nerve or vascular injury cause by operation
5. Length leg discrepancy which is one leg is shorter than other.

c) Describe the therapy for PTSD for Mr X (7 marks)

Psycotherapy
1. Cognitive therapy helps patient recognize the ways of thinking (cognitive
patterns) that are keeping them stuck. For example, negative beliefs about
themself and the risk of traumatic things happening again.
2. Exposure therapy helps patient safely face both situations and memories that
find frightening so that patient can learn to cope with them effectively.
3. Eye movement desensitization and reprocessing (EMDR). combines exposure
therapy with a series of guided eye movements that help patient process
traumatic memories and change how they react to them.
 Medication
1. Antidepressants help symptoms of depression and anxiety. They can also help
improve sleep problems and concentration
2. Anti-anxiety medications can relieve severe anxiety and related problems
3. Prazosin may reduce or suppress nightmares

Patient coping and support

1. Follow your treatment plan will help move you forward
2. Learn about PTSD knowledge can help you understand what you're feeling
3. Take care of yourself (get enough rest, eat a healthy diet, exercise and take time
to relax)
4. Don't self-medicate Turning to alcohol or drugs to numbs feelings isn't healthy
5. Consider a support group