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.
Here are four (4) nursing care plans and nursing diagnosis for amputation:
- Impaired Physical Mobility
- Risk for Infection
- Risk for Ineffective Tissue Perfusion
- Situational Low Self-Esteem
Impaired Physical Mobility
Nursing Diagnosis
Related to:
- Loss of a limb (particularly a lower extremity); pain/discomfort; perceptual impairment (altered sense of
- balance)
Possibly evidenced by
- Reluctance to attempt movement
- Impaired coordination; decreased muscle strength, control, and mass
Desired Outcomes:
- 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.
| Nursing Interventions | Rationale |
|---|---|
| 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. |
Additional Resources
You may also like the following posts and care plans:
- Nursing Care Plan: The Ultimate Guide and Database – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- Nursing Diagnosis: The Complete Guide and List – archive of different nursing, nursing assessment, and nursing interventions with rationale.
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
this page is so helpful. most nurses are so poor in writing care plans
So satisfied with the write up seeing is what I experience everyday at work
I really appreciated your efforts.
A great work there. The simplicity of the language used is what I could compare with that of the Merck Manual; easy to read and comprehend.
Thank you.