In general, the amputation of limbs is the result of trauma, peripheral vascular disease, tumors, and congenital disorders. For the purpose of this plan of care, amputation refers to the surgical/traumatic removal of a limb. Upper extremity amputations are generally due to trauma from industrial accidents. Reattachment surgery may be possible for fingers, hands, and arms. Lower-extremity amputations are performed much more frequently than upper-extremity amputations. Five levels are currently used in lower-extremity amputation: foot and ankle, below the knee (BKA), knee disarticulation and above (thigh), knee-hip disarticulation; and hemipelvectomy and translumbar amputation. There are two types of amputations: (1) open (provisional), which requires strict aseptic techniques and later revisions, and (2) closed, or “flap.”
Nursing Care Plans
Nursing care planning for patients who had an amputation includes: support psychological and physiological adjustment, alleviate pain, prevent complications, promote mobility and functional abilities, provide information about surgical procedure/prognosis and treatment needs.
- Impaired Physical Mobility
- Risk for Infection
- Risk for Ineffective Tissue Perfusion
- Situational Low Self-Esteem
Impaired Physical Mobility
- Loss of a limb (particularly a lower extremity); pain/discomfort; perceptual impairment (altered sense of
Possibly evidenced by
- Reluctance to attempt movement
- Impaired coordination; decreased muscle strength, control, and mass
- Client will verbalize understanding of the individual situation, treatment regimen, and safety measures.
- Client will maintain a position of function as evidenced by the absence of contractures.
- Client will demonstrate techniques/behaviors that enable resumption of activities.
- Client will display willingness to participate in activities.
|Encourage patient to perform prescribes exercises.||To prevent stump trauma.|
|Provide stump care on a routine basis: inspect the area, cleanse and dry thoroughly, and rewrap stump with an elastic bandage or air splint, or apply a stump shrinker (heavy stockinette sock), for “delayed” prosthesis.||Provides an opportunity to evaluate healing and note complications (unless covered by immediate prosthesis). Wrapping stump controls edema and helps form stump into a conical shape to facilitate the fitting of the prosthesis.|
|Measure circumference periodically||Measurement is done to estimate shrinkage to ensure proper fit of sock and prosthesis.|
|Rewrap stump immediately with an elastic bandage, elevate if “immediate or early” cast is accidentally dislodged. Prepare for reapplication of the cast.||Edema will occur rapidly, and rehabilitation can be delayed|
|Assist with specified ROM exercises for both the affected and unaffected limbs beginning early in the postoperative stage.||Prevents contracture deformities, which can develop rapidly and could delay prosthesis usage.|
|Encourage active and isometric exercises for the upper torso and unaffected limbs.||Increases muscle strength to facilitate transfers and ambulation and promote mobility and more normal lifestyle.|
|Maintain knee extension.||To prevent hamstring muscle contractures.|
|Provide trochanter rolls as indicated.||Prevents external rotation of lower-limb stump|
|Instruct patient to lie in the prone position as tolerated at least twice a day with a pillow under the abdomen and lower-extremity stump.||Strengthens extensor muscles and prevents flexion contracture of the hip, which can begin to develop within 24 hr of sustained malpositioning.|
|Caution against keeping the pillow under a lower-extremity stump or allowing BKA limb to hang dependently over the side of bed or chair.||Use of pillows can cause permanent flexion contracture of the hip; a dependent position of stump impairs venous return and may increase edema formation.|
|Demonstrate and assist with transfer techniques and use of mobility aids like trapeze, crutches, or walker.||Facilitates self-care and patient’s independence. Proper transfer techniques prevent shearing abrasions and dermal injury related to “scooting.”|
|Assist with ambulation.||Reduces the potential for injury. Ambulation after lower-limb amputation depends on the timing of prosthesis placement.|
|Instruct patient in stump-conditioning exercises.||Hardens the stump by toughening the skin and altering feedback of resected nerves to facilitate the use of the prosthesis.|
|Refer to the rehabilitation team.||Provides for the creation of exercise and activity program to meet individual needs and strengths, and identifies mobility functional aids to promote independence. Early use of a temporary prosthesis promotes activity and enhances general well-being and positive outlook.|
|Provide foam or flotation mattress.||Reduces pressure on skin and tissues that can impair circulation, potentiating the risk of tissue ischemia and breakdown.|
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Musculoskeletal Care Plans
Care plans related to the musculoskeletal system:
- Amputation | 4 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Fracture | 8 Care Plans
- Juvenile Rheumatoid Arthritis | 4 Care Plans
- Laminectomy (Disc Surgery) | 8 Care Plans
- Osteoarthritis | 4 Care Plans
- Osteoporosis | 4 Care Plans
- Rheumatoid Arthritis | 6 Care Plans
- Scoliosis | 4 Care Plans
- Total Joint (Knee, Hip) Replacement | 5 Care Plans