Amputation

Topics: Amputation, Phantom limb, Surgery Pages: 5 (687 words) Published: July 25, 2015
Nursing Management
Patient With An Amputation
Aries Nubla

Amputation

Is the removal of a body part, and most commonly a limb
(Cheever & Hinkle, 2013).
Used to relieve symptoms, improve functions and to save or
improve the patient’s quality of life (Cheever & Hinkle, 2013). Can be elective due to complications of the vascular disease often of diabetes. ex. Gangrene, trauma (burns, crushing
injury, electrical burns, frostbite, explosions)
Vascular disease accounts for 82% of all amputations with
97% results in lower limb amputations. This is called
dysvascular amputation.
Men and African-Americans are at a higher risk for dysvascular amputations and the risk increases with age

Amputation Cont.
Upper limb amputations occurs less frequently compared to lower limb amputation and happens due to trauma or malignant tumors
Objective of the surgery is to conserve as much limb length as possible to function with or without prosthesis and preservation of knee and elbow joints are always desirable, if possible.
Two key components of the body that is significant in healing are muscle and tissue perfusion. Caregivers assess this by physical examination and diagnostic tools such as: Doppler flow studies with duplex ultrasound, segmental blood pressure determinations, and transcutaneous partial pressure of arterial oxygen.

It is also performed at the distal point of a limb that will heal successfully.

Levels of Amputation
The site of amputation is determined by two factors:
adequate blood supply for healing and functional
usefulness for prosthesis compatibility.
Amputations are described in regards to the extremity
and its location.
AE- above elbow BE- below elbow
AK/A- above knee BK/A- below knee
Syme- ankle disarticulation (amputation through the
ankle joint)
Disarticulation- amputation through a joint

Complications
Hemorrhage or massive bleeding
Infection (always a risk with any surgical
procedure)
Skin breakdown (irritation with prosthesis
use)
Phantom limb pain due to severed
peripheral nerve
Joint contractures (cause by positioning
and protective flexion withdrawal pattern)

Nursing Assessments
and Actions
History and physical assessment
Assess the function & condition of the residual
limb if pt experienced a traumatic amputation
(ex. Motorcycle crash that resulted in
amputation)
Assess the circulatory and function of the
unaffected limb.
Collection of culture and sensitivity samples to
determine the choice of antibiotic to use in case
if an infection occurs

Nursing Assessments and Actions cont.
Identification and treatment of any
concurrent health problems (ex. Anemia,
dehydration, diabetes) –for patient to
withstand surgical procedure.
Psychological and emotional assessment of
patient (if patient is aware and ready for the
surgery)
Assess patient’s nutritional status (high
protein diet is essential for recovery and
healing)

Diagnosis
Acute pain r/t amputation
Impaired skin integrity r/t surgical amputation
Distributed body image r/t amputation
Grieving and/or risk for complicated grieving
r/t loss of body part and resulting disability
Self-care deficit: feeding, bathing, dressing,
toileting, r/t amputation
Impaired physical mobility r/t amputation

Planning and Goals
Pain relief
Wound healing
Altered body image acceptance
Grieving process resolution
Self-care independence
Physical mobility restoration
Absence of complications

Nursing Interventions
Relieving pain (ex. Phantom pain)
Surgical pain can be effectively controlled by
opioid analgesics
Position change can improve client’s comfort
level
Medications: Opioid analgesics, beta blocker (for
dull & burning discomfort), anti-seizure
medications (for controlling stabbing and
cramping pain), Tricyclic antidepressants (for
phantom pain)

Nursing Interventions
cont.

Promoting Wound Healing

Residual limb must be handled gently to prevent infection and...
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