Care of Clients with an Amputation

Reported by: Cabiltes, Claitte Canonce, Pearl Myka Corregidor, Maria Leofe Cotiangco, Kenneth John

OBJECTIVES
At the end of 8-hour group reporting and class discussion, the Level III nursing students will be able to: 1. Define amputation 2. Explain the purpose of amputation 3. Describe the various types of amputations 4. Discuss the nursing responsibilities in the following situations:
4.1 before amputation 4.2 taking care of clients who underwent an amputation

Amputation
- the removal of a limb or a part of the

body - may occur as a result of trauma (traumatic amputation) or in an effort to control disease or disability (therapeutic amputation)

Etiology:
malignant tumors long standing infections of bone and tissues that prohibit restoration of function extensive trauma to an extremity death of tissue from peripheral vascular insufficiency or peripheral vasospastic disease such as Buergers and Reynauds disease

Etiology:
thermal injuries deformity of a limb rendering it a useless hindrance life threating disorders, such as arterial thrombosis and gas bacillus infections

Complications:
1. Hemorrhage - When a person loses part or all of an extremity either by surgery or by trauma, major blood vessels are severed , which causes bleeding

Complications:
2. Infection - As with any surgical procedures of trauma, infection can occur in the wound of the bone

Complications:
3. Phantom limb pain - A normal, frequently occurring physiologic response after amputation. It is the feeling of the patient that the amputated portion of the limb still remains.

Complications:
4. Problem associated with immobility - Because the client experience reduced mobility as a result of surgery, the complication of immobility can readily occur.

Complications:
5. Neuroma - A sensitive tumor consisting of nerve cells found at the severed nerve endings form often in amputation of the upper extremity but can occur anywhere.

Complications:
6. Flexion contractures - Flexion contractures of the hip or knees are seen in clients with amputation of the lower extremity. These complications must be avoided so that the client can ambulate with prosthesis.

Purpose of Amputation
Relieve symptoms To improve function To save or improve the patients quality of life Prevent complication Control pain or disease process

Types of Amputation
1. Open (Guillotine) Amputation - Indicated to patients with infection - The surgeon does not close the stump with a skin flap immediately but leaves it open, allowing the wound to drain freely.

Types of Amputation
2. Closed (Flap) Amputation - There is no evidence of infection - No need for open drainage - The surgeon covers or closes the stump with a flap of skin sutured over the end of the stump

Levels of Amputation
Lower Amputation Partial foot Total foot Ankle (Symes Amputation) Below-the-knee Above-the-knee Hip disarticulation Hemipelvictomy

Levels of Amputation
Upper Limb Amputation Fingers Wrist disarticulation Below-the-knee Elbow disarticulation Above-the-knee

Nursing responsibilities
Before Amputation If time permits, review the doctors explanation of the scheduled amputation, answering any questions the patient may have. Provide emotional support. Discuss postoperative care and rehabilitation measures.

Nursing responsibilities
Point out the possibility of phantom limb sensation As ordered, administer broad-spectrum antibiotics to minimize the risk of infection Explain to the patient that the duration between amputation and fitting of the prosthesis varies, depending on wound healing, muscle tone, and overall stump condition.

Nursing responsibilities
Taking care of clients who underwent an amputation Monitor the vital sings every hour for the first 4 hours, every 2 hours for the next 4 hours, and then every 4 hours until stable. If ordered, elevate the limb on a pillow or other support for 24-48 hours. Assess for pain and provide analgesics and other pain control measures a s needed.

Nursing responsibilities
Keep the stump properly wrapped with elastic compression bandages. If a rigid plaster has been applied, care For it as you would a plaster cast for a fracture or severe pain. Emphasize the need for proper body alignment and regular physical therapy to condition the limb and prevent contractures and deformity.

Nursing responsibilities
If the patient is bedridden, encourage him to turn form side to side and to assume an alternate position, usually prone from time to time throughout the day. If the patient has had a leg amputation, instruct him not to prop the limb on a pillow. Teach proper crutch use for walking.

Nursing responsibilities
Teach activities to toughen the residual limb. If the patient has had a below-the-knee amputation, tell him to keep the knee extended. Instruct the patient with a partial arm amputation to keep his elbow extended and shoulder abducted.

Nursing responsibilities
If possible, give the patient information about available prostheses. Throughout recovery and rehabilitation, encourage the patient to adopt a positive outlook toward resuming an independent lifestyle.