Amputation

What it is amputation?

Defined as the surgical removal of all or part of a limb or extremity such as an arm, leg, foot, hand, toe, or finger.

Why amputate?
Most

common reason for amputation is poor circulation because of damage or peripheral arterial disease. Other reasons include:
-

Trauma Cancer Frostbite Serious infection Congenital defects

Preoperative Care

Nursing responsibilities specific to patient undergoing amputation include:

-

Arrangements to begin construction of prosthetic device are often made before surgery

A total physical examination with particular attention to the neurologic, cardiovascular, and integumentary systems Utilizing functional assessment to determine how amputation will affect daily living Performing psychological evaluation to determine how procedure will be tolerated Administering antibiotics before surgery Tending to emotional needs of patient regarding anxiety and grieving from loss of body part

Surgery

Objective when amputating is to remove all damaged tissue while leaving as much healthy tissue as possible During procedure, surgeon will:
-

Remove the diseased tissue and any crushed bone Smooth uneven areas of bone Seal off blood vessels and nerves Cut and shape muscles so that the ends of the limb, or stump, will be able to have a prosthesis

Possible Complications
Problems
-

that often occur include:

Hematoma and hemorrhage Necrosis Wound dehiscence Gangrene Edema Contracture Pain Infection

Postoperative Care

Typically require hospital stay of 5 to 14 days or more Generally the same as most surgeries: take vital signs, monitor for complications, wound assessment, pain assessment, etc. Physical therapy often begins soon after surgery with gentle stretching exercises. Practice with the prosthesis may begin as soon as 10 to 14 days after surgery

Discharge Teaching

Discharge teachings include:

-

What to expect at home: use of walker, wheelchair, and prosthesis Self care: compliance with medications and food regimen, emotional counseling, and assistance measures to take at home

Discharge Teaching (contd)

-

Wound Care:
Refraining

from using limb, putting weight on it, or rubbing it Not driving Keeping wound clean and dry Frequently checking for redness or presence of dirt Keeping amputation site inside prosthetic stocking

Discharge Teaching (contd)

-

Contact physician if:

Wound looks redder and is warm to the touch Swelling or bulging around wound New drainage New openings in wound Temperature above 101.4 more than once Skin around wound is turning dark Pain keeps getting worse and medications not effective Wound has gotten larger A foul smell coming from the wound

Conclusion
Patients

with amputation may go through grieving process for long periods of time Pain MUST be acknowledged Hope has to be kept alive

Bibilography
A.D.A.M. (2012, November 11). Amputation - traumatic. Retrieved on December 3, 2012 from http://www.nlm.nih.gov/medlineplus/ency/article/000006.htm
Chatterjee, R. (2010, March 05). Definition of amputation. Retrieved on December 3, 2012 from http://www.webmd.com/a-to-z-guides/definition-amputation

Clements, I. (2011). How Amputation Works. Retrieved on December 3, 2012 from http://science.howstuffworks.com/life/human-biology/amputation6.htm

Linton, A. (2012). Introduction to Medical-Surgical Nursing. (5th ed.). Chapter 43: pgs. 979993. St. Louis: Elsevier Inc. NHS Choices. (2010, Novemeber 08). How amputation is performed. Retrieved on December 3, 2012 from http://www.nhs.uk/Conditions/ Amputation/Pages/How-it-is-performed.aspx