4 Amputation Nursing Care Plans

July 13, 2013

In general, 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

Impaired Physical Mobility: Limitation in independent, purposeful physical movement of the body or of one or more extremities.

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 him 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. Note: Vocational counseling and retraining also may be indicated.
Provide foam or flotation mattress.	Reduces pressure on skin and tissues that can impair circulation, potentiating the risk of tissue ischemia and breakdown.