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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 nursing care plans and nursing diagnosis for amputation:
- Impaired Physical Mobility
- Risk for Infection
- Risk for Ineffective Tissue Perfusion
- Situational Low Self-Esteem
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Impaired Physical Mobility
Nursing Diagnosis
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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:
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- 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. |
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Recommended Resources
Recommended nursing diagnosis and nursing care plan books and resources.
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- Nursing Care Plans: Nursing Diagnosis and Intervention (10th Edition)
An awesome book to help you create and customize effective nursing care plans. We highly recommend this book for its completeness and ease of use. - Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions and Rationales
A quick-reference tool to easily select the appropriate nursing diagnosis to plan your patient’s care effectively. - NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023 (12th Edition)
The official and definitive guide to nursing diagnoses as reviewed and approved by the NANDA-I. This book focuses on the nursing diagnostic labels, their defining characteristics, and risk factors – this does not include nursing interventions and rationales. - Nursing Diagnosis Handbook, 12th Edition Revised Reprint with 2021-2023 NANDA-I® Updates
Another great nursing care plan resource that is updated to include the recent NANDA-I updates. - Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5(TM))
Useful for creating nursing care plans related to mental health and psychiatric nursing. - Ulrich & Canale’s Nursing Care Planning Guides, 8th Edition
Claims to have the most in-depth care plans of any nursing care planning book. Includes 31 detailed nursing diagnosis care plans and 63 disease/disorder care plans. - Maternal Newborn Nursing Care Plans (3rd Edition)
If you’re looking for specific care plans related to maternal and newborn nursing care, this book is for you. - Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care (7th Edition)
An easy-to-use nursing care plan book that is updated with the latest diagnosis from NANDA-I 2021-2023. - All-in-One Nursing Care Planning Resource: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health (5th Edition)
Definitely an all-in-one resources for nursing care planning. It has over 100 care plans for different nursing topics.
See also
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch. - Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans for musculoskeletal disorders and conditions:
- Amputation | 4 Care Plans
- Congenital Hip Dysplasia | 4 Care Plans
- Fracture | 11 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
- Spinal Cord Injury | 12 Care Plans
- Total Joint (Knee, Hip) Replacement | 5 Care Plans
this page is so helpful. most nurses are so poor in writing care plans
It is most important part for caring amputated clients M.Ghosh
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.