Amputation: Lesson Plan On ON

LESSON PLAN ON
ON
AMPUTATION
Presented by
Mrs. Dhanasundari. G
Lecturer in Nursing (MSN)
AMPUTATION
Introduction:
Amputation:- Surgical removal of limb or part of the limb through a bone or multiple
bones Amputation is the removal of a body extremity by trauma or surgery. As a surgical
measure, it is used to control pain or a disease process in the affected limb, such as malignancy
or gangrene. In some cases, it is carried out on individuals as a preventative surgery for such
problems.
Removal of part or all of a body part enclosed by skin Removal of the peripheral part of
the limb or any other organ.
Amputation refers to the surgical or traumatic removal of the terminal portion of the
upper or lower extremity. Hemicorporectomy (trans lumbar amputation or "halfectomy") is a
radical surgery in which the body caudal to the waist is amputated, transecting the lumbar spine
Incidence
Age;- common in 50-75 yrs of age traumatic- common in young age
Sex;- approx.. 75% male, 25% female
Limb;- approx.. 85% - lower limb, 15% -- upper limb
Indication
Common causes
Lesscommon
Infection(fulminating gas gangrene),
Malignancy, Nerve injury, congenital anomalies

Peripheral vascular disease
Trauma
Trauma is the leading indication for amputation in younger age group. The only absolute
indication for primary amputation is an irreparable vascular injury in an ischemic limb.
Peripheral vascular disease
lower extremity 60-70% of amputations
upper extremity 6%
 Arteriosclerosis
 Thromboembolism
 Most significant predictor of amputation in diabetes:- peripheral neuropathy
 Prior stroke
 Decrease ankle-brachial blood pressure index
 Vascular surgery consultation
Congenital limb deficiency

 L/E <3% of all amputations, U/E 9%
 failure of partial or complet formation of a portion of the limb.
 Congenital extremity deficiencies have been classified as longitudinal,
transverse, or intercalary.
 Radial or tibial deficiencies are referred to as preaxial, and
 ulnar and fibular deficiencies are referred to as postaxial
Tumor
Amputation is performed less frequently with the advent of advanced limb-
salvage techniques
Burns and frostbite:
Burns : -
 delayed amputation – local infection
 - systemic infection
 - myoglobin induced renal failure
 - death
Frostbite :-
Typically occurs when one is trapped in extreme cold conditions for
extended periods
 direct tissue injury- ice crystals in ECF
 Ischaemic injury- vascular endothelium
 clot formation
 inc sympathetic tone
 limb kept at 40-44 degree C
 wait 2-6 month demarcation
 Triple phase technetium bone scan
Signs and Symptoms

Subjective
 Pain
 Limited motion
 Malaise
Objective
 Local swelling
 Weight loss
 Anemia
 Elevated serum alkaline phosphatase
 Fever
Pre op assessment
 Hematocrit
 Creatinine levels should be monitored. In individuals with muscle
injury and necrosis, myoglobin enters the systemic circulation and
can lead to renal insufficiency and failure. especially in individuals
with thermal and electrical burns.
 Potassium and calcium levels should be monitored. Elevated levels of

these electrolytes may lead to cardiac arrhythmias and seizures.
 White blood cell count, C-reactive protein , and ESR Expect the C-reactive
protein to be the first laboratory value to respond to treatment,
 Platelets
Goal of postoperative management

 Prompt, uncomplicated wound healing
 Control of edema
 Control of Postoperative pain
 Prevention of joint contractures
Rapid rehabilitation
Care of stump
 keep the stump clean, dry, and free from infection at all times.
 If fitted with a prosthesis, you should remove it before going to
sleep.
 Inspect and wash the stump with mild soap and warm water every
night, then dry thoroughly and apply talcum powder.
 do not use the prosthesis until the skin has healed.
 The stump sock should be changed daily, and the inside of the socket
may be cleaned with mild soap.
Rehabilitation
 1. Residual Limb Shrinkage and Shaping
 2. Limb Desensitization
 3. Maintain joint range of motion
 4. Strengthen residual limb
 5. Maximize Self reliance
 6. Patient education: Future goals and prosthetic options
Surgical Interventions
1. Below the knee amputation (BKA)
 Common in peripheral vascular disease.
 Facilitates successful adaptation to prosthesis because of retained knee function.
. Above the knee amputation (AKA)
 Necessitated by trauma or extensive disease.
. Upper extremity amputation
 Usually necessitated by severe trauma, malignant tumors, or congenital
malformation.
Assessment
1. Neurovascular status of involved extremity.
2. History to determine causative factors and health problems that can compromise
recovery.
3. Client’s understanding of the extent of the surgery.
4. Client’s coping status.
5. Client’s support system.
Nursing Diagnosis
 Body image disturbance
 Constipation
 Diversional activity deficit
 Fear
 Risk for injury
 Impaired physical mobility
 Self-care deficit
 Risk for skin integrity
 Situation low self-esteem
Nursing Interventions
1. Provide care preoperatively by initiating exercise to strengthen muscles of extremities
in preparation for crutch walking.
2. Encourage coughing and deep breathing exercises.
3. Monitor vital signs and stump dressing for signs of hemorrhage.
4. Elevate stump for 12 to 24 hours to decrease edema.
5. Maintain elastic bandage to shrink and shape stump in preparation for prosthesis.
6. When wound is healed, wash stump daily, avoiding the use of oils which may cause
maceration.
7. Apply pressure to the end of the stump with progressively firmer surfaces to toughen
stump.
8. Encourage the client to move the stump.
9. Place the client with a lower extremity amputation in a prone position twice daily to
stretch the flexor muscles and prevent hip flexion contractures.
10. Teach the client about phantom limb sensation.
11. Support the client through fitting, application, and utilization of prosthesis.
12. Encourage family to participate in care.
13. Allow the client to express emotional reactions.
Complication
Risk factors for complications includes
 Blood clotting disorder

 Diabetes
 Anemia
 Certain medication, such as steroids
 Infection
 Obesity
References
 Lewis et al, Medical Surgical Nursing, Mosby Elsevier,7th edition. Wolters
 kliwer,Lippincott nursing procedure, seventh edition published bylippincott wilians and
wikins
 Sandhya ghai, clinical nursing procedure,published by CBS publishers and distributors
pvt.Ltd, new delhi,
 Joyce.M.Black et al, Medical Surgical Nursing, Saunders publication.
Brunner and Siddhartha, Medical Surgical Nursing, Lippincott Williams and Wilkins

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LESSON PLAN ON

Malignancy, Nerve injury, congenital anomalies

Congenital limb deficiency

Signs and Symptoms

 Potassium and calcium levels should be monitored. Elevated levels of

Goal of postoperative management

 Blood clotting disorder

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