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Nursing Care of Patient with an Amputation

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Nursing Care of Patient with an Amputation

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If the patient has had an amputation, the nurse promotes tissue healing, uses compression dressings to promote residual limb shaping, and minimizes contracture formation. A permanent prosthetic limb cannot be fitted until the tissue has healed completely and the residual limb shape is stable and free from edema. The nurse also helps the patient cope with the emotional issues surrounding loss of a limb and encourages acceptance of the prosthesis. The prosthetist, nurse, and primary provider collaborate to provide instructions related to skin care and care of the prosthesis. (Hinkle & Cheever)
Interventions

Pain relief

Nutrition

Dressing changes using aseptic technique

Build a trusting relationship

Vitals

Monitor for hemorrhage

Monitor for infection

Enhance patient body image

Positioning

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Several doctors and a nurse perform a very quick amputation of a man's leg.  Film 11109

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Tricyclic Antidepressants- alleviate phantom limb pain while also improving mood and coping ability

sympathetic blocks

TENS

Performed with a portable battery-powered device that transmits a painless electrical current to peripheral nerves or directly to a painful area over relatively large nerve fibers

Changes the patient's perception of pain by blocking painful stimuli traveling over smaller fibers

relaxation training

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Definition- pain perceived in an amputated section

Cause- severing of the peripheral nerves

occurs intermittently and unpredictably, lasting seconds to hours

pain is described as if the amputated limb is crushed, cramped, or being twisted

reported in 51%-89% of patients who have amputations

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explain phantom limb sensation

acknowledge that the pain experienced is real

encourage the patient to verbalize when pain is experienced so that effective treatment may be given

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What are scenarios that might call for amputation? 

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What are scenarios that might call for amputation? 

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Fulminating gas gangrene
Crushing injuries
Burns
Frostbite
Electrical burns
Explosions
Ballistic injuries
Congenital deformities
Chronic osteomyelitis

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In an emergent accidental amputation (one that occurs outside of an OR), what should be done?

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In an emergent accidental amputation (one that occurs outside of an OR), what should be done?

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CALL 911
Stop the Bleeding- elevate the affected extremity, apply pressure with cleanest possible towel, gauze, absorbent material. Be as clean as possible- hand-washing.
Check for and treat SHOCK- with person still lying flat elevated legs- do not do this if you suspect a head, neck, back, or leg injury involved.
Keep warm- cover with coat or blanket.
Calm person as much as possible until help arrives.
Save amputated Part- place amputated body part in a clean plastic bag, place in container with ice. Avoid water or ice directly on the body part. Give to medical persons or hospital staff.

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Elevate the affected limb, as ordered.

Provide an analgesic, as ordered, and comfort measures for pain.

Keep the residual limb wrapped properly with elastic compression bandages or an elastic shrinker, as ordered.

Inspect the wound and incisional area daily for signs and symptoms of infection.

Perform a fall-risk assessment, and put the patient on fall precautions as needed.

Maintain the patient in proper body alignment to prevent contractures.

Reinforce physical therapy instructions and activities.

Encourage frequent ambulation, as appropriate.

Encourage active or passive range-of-motion exercises.

Monitor the patient's vital signs and intake and output; report changes.

Observe the surgical wound and reinforce or change dressings, as ordered.

Monitor and record the amount of bleeding, patency of drains, and amount and type of drainage.

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Explain the treatment and preparation to the patient and family.

Verify that the patient has signed an appropriate informed consent form.

Explain preoperative and postoperative procedures.

Confirm the patient's nothing-by-mouth status before the procedure.

Perform a complete preoperative assessment, noting any allergies; obtain vital signs.

Verify that ordered laboratory and imaging studies have been completed.

Initiate I.V. therapy, as prescribed.

Allow the patient to verbalize feelings related to the loss of a body part. Provide emotional support.

Arrange for counseling, if necessary.

If possible, arrange for the patient to meet with someone else who has undergone amputation and has adjusted well to the life changes that it brings.

Administer a broad-spectrum antibiotic, deep vein thrombosis prophylaxis, or both, as ordered.

Ensure that the appropriate limb or area to be amputated is clearly marked.

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Review prescribed medication dosages, frequency and duration of administration, rationales for use, expected results, and possible adverse reactions with the patient.

Review postoperative care  and rehabilitation, emphasizing the need for increasing independence.

Review the use and care of the ordered prosthesis.

Explain phantom limb sensation.

Reiterate the importance of daily examination of the distal limb. Describe postoperative daily limb and dressing care as well as daily care after healing is complete.

Review the signs and symptoms of potential complications, including infection and skin breakdown. Instruct the patient to notify the practitioner if any of these signs or symptoms occurs.

Review the use of elastic bandages or a limb shrinker.

Teach the proper use of crutches, a walker, or other assistive devices, as appropriate.

Emphasize the importance of follow-up care with the practitioner and rehabilitation services.

Assist the patient and family in finding a local support group or obtaining a referral for psychological counseling.