Adult Medical-Surgical Nursing Musculo-skeletal Module: Amputation

Amputation: Description Amputation is removal of a body part usually part or whole of an extremity (limb)

Amputation: Causes Progressive peripheral vascular disease (often a complication of Diabetes Mellitus: “Diabetic foot”) Trauma: crush injury, burn injury including electrical, frostbite Chronic osteomyelitis Gas gangrene Malignant tumour Congenital deformity

Aim of Amputation To save life where gangrene (inadequate circulation) infection or malignancy will spread To preserve as much viable healthy limb as possible To relieve symptoms To improve function To improve quality of life

Levels of Amputation Aim to conserve as much limb as possible and to preserve joints Surgery at the most distal point of limb which will heal successfully Depends on: Circulatory status of extremity Appropriate level for fitting prosthesis

Pre-operative Assessment Age of patient and general health Current medications Psychological impact of proposed surgery Circulatory status of affected limb: Doppler flowmetry Segmental BP Transcutaneous partial pressure O2 (PaO2) Related muscle and joint function

Amputation: Complications Haemorrhage Infection Skin breakdown/ delayed healing Phantom limb pain (tingling pain as if limb still present) Joint contracture Severe depression and grief over permanent loss of limb, altered body image and modification of lifestyle

Amputation: Post-operative Nursing Care Adequate hydration/ nutritional status Aseptic technique Monitor wound healing, presence of oedema/ infection/ skin breakdown Monitor for onset of complications Tourniquet available in case of severe haemorrhage Assess mood

Amputation: Care of Limb Reduce oedema (delays healing): Elevate limb (avoid placing lower limb on pillow. Risks flexion contracture of hip joint. Rather raise foot of bed) Constant pressure bandage: (molds stump for prosthesis) Range of motion exercises/ change of position: Strengthens and molds muscles of stump Prevents flexion contracture of joint

Amputation: Phantom Pains Monitor for phantom pains Address by: Massage of stump to mold for prosthesis and desensitisation with: Transcutaneous electrical nerve stimulation (TENS) Local anaesthetic β-blocker medication

Amputation: Rehabilitation Multi-disciplinary rehabilitation team (patient, physician, nurse, physiotherapist, psychologist, occupational therapist) Early application of prosthesis as soon as stump formed Early usage/ ambulation (↑ muscle tone) Counselling, encouragement, support for grieving process, lifestyle changes