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 osteomyelitis (infection and inflammation of the bone) If a cast or elastic dressing inadvertently comes off, the nurse must immediately wrap the residual limb with an elastic compression bandage to prevent excessive edema from developing in a short time, resulting in delay rehabilitation.
Enhancing body image Identifying patient’s strengths and resources to facilitate rehab Helping the patient to resolve grieving (Nurses creates an accepting and supportive atmosphere to encourage expression of feelings by the patient and family) Helping to achieve physical mobility Proper body positioning to prevent: hip or knee joint contractures in patients w/ lower limb amputation Encourage patients to use assistive devices Nursing Interventions cont. Monitoring and Managing Potential Complication Monitor for infection, massive hemorrhage due to loosened sutures, skin breakdown from immobilization and prosthesis usage. EVALUATE.