Amputation

  • amputation Is the total or partial surgical removal of an extremity or digit.
  • It is done in cases of inadequate tissue perfusion not responsive to other treatments, such as with diabetes mellitus or other peripheral vascular diseases.
  • The extent of amputation is based on the level of maximal viable tissue available for wound healing.

Etiology and Pathophysiology

  1. Refers to the removal of a body part as a result of a trauma or surgical intervention.
  2. Necessitated by: malignant tumor, trauma, and acute arterial insufficiency.

Signs and Symptoms

Subjective

  • Pain
  • Limited motion
  • Malaise

Objective

  • Local swelling
  • Weight loss
  • Anemia
  • Elevated serum alkaline phosphatase
  • Fever

Surgical Interventions

  1. Below the knee amputation (BKA)
    • Common in peripheral vascular disease.
    • Facilitates successful adaptation to prosthesis because of retained knee function.
  2. Above the knee amputation (AKA)
    • Necessitated by trauma or extensive disease.
  3. Upper extremity amputation
    • Usually necessitated by severe trauma, malignant tumors, or congenital malformation.

Assessment

  1. Neurovascular status of involved extremity.
  2. History to determine causative factors and health problems that can compromise recovery.
  3. Client’s understanding of the extent of the surgery.
  4. Client’s coping status.
  5. Client’s support system.

Nursing Diagnosis

  • Body image disturbance
  • Constipation
  • Diversional activity deficit
  • Fear
  • Risk for injury
  • Impaired physical mobility
  • Self-care deficit
  • Risk for skin integrity
  • Situation low self-esteem

Nursing Interventions

  1. Provide care preoperatively by initiating exercise to strengthen muscles of extremities in preparation for crutch walking.
  2. Encourage coughing and deep breathing exercises.
  3. Monitor vital signs and stump dressing for signs of hemorrhage.
  4. Elevate stump for 12 to 24 hours to decrease edema.
  5. Maintain elastic bandage to shrink and shape stump in preparation for prosthesis.
  6. When wound is healed, wash stump daily, avoiding the use of oils which may cause maceration.
  7. Apply pressure to the end of the stump with progressively firmer surfaces to toughen stump.
  8. Encourage the client to move the stump.
  9. Place the client with a lower extremity amputation in a prone position twice daily to stretch the flexor muscles and prevent hip flexion contractures.
  10. Teach the client about phantom limb sensation.
  11. Support the client through fitting, application, and utilization of prosthesis.
  12. Encourage family to participate in care.
  13. Allow the client to express emotional reactions.

Daisy Jane Antipuesto RN MN

Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing. Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse. Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.

What Do You Think?