Professional Documents
Culture Documents
• Amputations are a last resort treatment used to relieve symptoms, improve function,
save or improve quality of life
• Performed at most distal part will heal successfully
• Site is determines by two factors:
o Circulation in the part (Doppler, physical exam)
o Functional usefulness – change requirement prosthesis (leave joint)
• Preservation of knee and elbow joint are desired
COMPLICATIONS
• Hemorrhage
• Infection
• Skin Breakdown
• Phantom limb pain
o Treat as real pain
o Talk with patient that it is a normal occurrence and to keep active because that
will decrease the pain
o Takes about 2 weeks for suture to heal
TYPES OF AMPUTATIONS
• Open
o Infection remove part most infected and leave open 3-7 day with aggressive
treatment. Drain with soft dressing
• Closed or Flap
o Use bottom portion for flap with no evidence of infection with no drain if small
PROMOTING WOUND HEALING
• Handle residual limb gently
• Dressing changes with aseptic techniques – Soft dressing – Open kelix with ace wrap
monitor any changes
• Residual limb shaping is important for prosthesis formation – wrap with elastic dressing
to decrease edema
• Pre Operative
o Teaching what will happen after surgery (dsg chgs, exercises)
• Age Consideration
o Young Age:
o Young children have to deal with trauma (sudden or quick) or tumors as reason
for amputation
o Is a traumatic situation
o Make sure they have interaction with others who have gone through before
o Young age is better due to fact they are healthier and heal faster
o Difficulty with loss of limb
o A lot of rehab involved and lifestyle changes
o Elderly:
o More time to adjust
o Other health problems along with amputation
o May not be candidate for prosthesis
o Relieved to have procedure (eg. PVD, relieve pain)
o Must work through adjustment
• Physchological Assessment
o Important to discuss with client give time to express feeling / fears
o Report extreme depression and fears
o Address family feelings
o Patient response to social workers and rehab
• Post Operative
o Increased R/F Hemorrhage – most serious /threatening problem
Frequent VS – Q30-1o – chk dressing, assess drain, monitor, stability with
pressure
Turn at bedside
Notify MD if potential for hemorrhage
o Neurovascualr assessment: monitor stump, pulses
o Contractors: reinforce exercise – has been taught preop
o Pain: Expected outcome (PCA) – Client may find ways to deal with phantom pain
Hematoma may develop with C/O increased pain with no relief
o Infection: Increased R/F, Monitor VS, S/S
o Grieving: Dealing emotionally with therapeutic communication
o Body Image:
o General Post Op Complication: Resp, F/E. Nutrition, Emboli
o General Self Care: Limited to what do after surgery with time encourage
independence
o Home Management: A lot of teaching with correct information
Stump Care: washing, dressing
• Wash area with gently massage dry thorough (avoid lotions and
skin creams)
• DO not soak stump
• Dressing or ACE wrap
• Stump Sock – Clean and dry – increased risk for breakdown
• Teach assessment for infection
• Wear prosthesis amount of time told to build up to all day
Prosthesis Care: taught by company reinforce
Pt work with transfer, crutch walking or need
Wt bearing 2 weeks post op to toughen skin
Never adjust or mechanically alter – exercise all extremities
Include family in all of teaching
AMPUTATION These must have been from class; they seemed a
little more organized than the others.
COMPLICATIONS
MEDICAL MANAGEMENT
• Soft Dressing:
o With or without compression may be used when frequent inspection of residual
limb (stump) is desired
o Immobilizing splint incorporated in dressing
o Stump (wound) hematomas controlled with wound drainage devices to minimize
infection
REHABILITATION THERAPY
• Severe Trauma
o Generally, NOT always, young and healthy, heal rapidly and participate vigorous
rehab program
o Psychological support in accepting sudden change in body image and dealing
with stresses of hospitalization and long-tem rehab, and modification of lifestyle
o Need time to work through feelings about permanent loss and change in body
image
o Unpredictable and can include anger, bitterness, hostility
• Multidisciplinary rehab team helps client achieve highest possible level of function and
participation in life activities
• Prosthetic clinics and amputee support groups facilitate rehab process
• Vocational counseling and job retraining may be necessary to help client return to work
• NOT fully rehabbed until prosthesis fitted and client learned how to use it
o Best accomplished in specialized rehab unit or center
PREOPERATIVE
• Assess neurovascular and functional status of extremity
o History and Physical Exam
• Assess Circulatory status and function of unaffected extremity
• With Infection or gangrene have enlarged lymph nodes, fever, purulent drainage; culture
taken to determine appropriate antibiotic therapy
• Evaluate clients nutritional status and create plan
o Wound healing balanced diet with adequate protein and essential vitamins
• Concurrent problems (dehydration, anemia, cardiac insufficiency, chronic respiratory
problems, DM) be identified and treated so client best condition to withstand trauma of
surgery
o Use Of:
Corticosteriods
Anticoagulants
Vasoconstrictors
Vasodilators
o These may influence management of wound healing
• Assess clients psychological status
o Determination of clients emotional reaction to amputation essential for nursing
care
o Grief response to alteration of body image is normal
POST OPERATIVE
• Efforts made to reestablish homeostasis and prevent problems related to surgery
anesthesia, and immobility
• Assess body Systems: Problems Associated with Immobility
Pneumonia
Respiratory Constipation
GI Anorexia
GU Urinary Stasis