Prepared by: Germany De Guzman

DEFINTION:
Refers to the removal of a body part as a result of trauma or surgical intervention Necessitated by: a. Malignant tumor b. Congenital malformation c. Trauma (e.g. vehicular accident) d. Acute arterial insufficiency (e.g. diabetic client)

SIGNS AND SYMPTOMS:

SUBJECTIVE:
a. Pain b. Limited motion c. Malaise

OBJECTIVE:

a. b. c. d. e.

Local swelling Weight loss Anemia Elevated serum alkaline phosphatase Fever

THERAPEUTIC INTERVENTION:

1. Below-the-knee amputation (BKA) is commonly done to patient with severe peripheral vascular disease; facilitates successful adaptation of prosthesis because of retained knee function.

2. Above-the-knee amputation necessitated by trauma or extensive disease. 3. Upper extremity amputation usually necessitated by severe trauma, malignant tumors or congenital malformations.

CARE FOR CLIENTS WITH AMPUTATION

ASSESSMENT:
1. Assess neurological status of the involved extremity 2. History: Causative factors Health problems that might compromise recovery 3. Clients understanding of the extent of the surgery 4. Coping mechanism 5. Client support system

NURSING DIAGNOSES: body image disturbance Constipation Diversion activity deficit Altered family processes Fear Risk for injury Impaired physical mobility Self-care deficit Risk for impaired skin integrity Situational low self-esteem

NURSING INTERVEVTIONS:

1. Provide care preoperatively Initiation of exercises to strengthen muscles of extremities in preparation for crutch walking Coughing and deep breathing exercise Emotional support for anticipated alteration in body image 2. Monitor vital signs and stump dressing for signs hemorrhage

3. Elevate stump for 12-24 hours to decrease edema; remove pillow after this time to promote functional alignment and prevent contracture

4. Provide stump care Maintain elastic bandage to shrink and shape stump in preparation for prosthesis When wound is healed, wash stump daily, avoiding the use of oils, which may cause maceration Apply pressure to end stump with progressively firmer surfaces to toughen stump Encourage client to move stump Place client with lower extremity amputation in prone position in a prone position twice daily to stretch the flexor muscles and prevent hip flexion contractures

5. Teach client about phantom limb sensation Phantom limb: physiologic reaction of the nerves in the stump causing an unpleasant feeling that the limb is still there; this response may or may not be precipitated by a physiologic overlay. Phantom pain: when the unpleasant feelings become painful or disagreeable Characteristics of phantom limb: sensations may be constant or intermittent and of varying severity Institute care that may help relieve phantom limb phenomenon

6. Consider the special needs related to an upper extremity amputation Mastery of an upper extremity prosthesis is more complex than that of a lower extremity prosthesis The client must do bilateral shoulder exercise to prepare fitting the prosthesis The artificial arm cannot be used above the head or behind the back because of harnessing No artificial hands can duplicate all the fine movements of the fingers and thumb of the normal hand There is a loss of sensory feedback

7. Support client through fitting, application and utilization of prosthesis 8. Encourage family to participate in care 9. Allow client to express emotional reactions