care of clients with an amputation

8/2/2019 Care of Clients With an Amputation

1/23

Care of Clients with an

Amputation

Reported by:

Cabiltes, Claitte

Canonce, Pearl Myka

Corregidor, Maria Leofe

Cotiangco, Kenneth John


2/23

OBJECTIVES

At the end of 8-hour group reporting andclass discussion, the Level III nursing studentswill be able to:

1. Define amputation2. Explain the purpose of amputation

3. Describe the various types of amputations

4. Discuss the nursing responsibilities in thefollowing situations:

4.1 before amputation

4.2 taking care of clients who underwent anamputation


3/23

Amputation

- the removal of a limb or a part of the

body

- may occur as a result of trauma(traumatic amputation) or in an effort to

control disease or disability (therapeutic

amputation)


4/23

Etiology:

malignant tumors

long standing infections of bone and tissues

that prohibit restoration of function extensive trauma to an extremity

death of tissue from peripheral vascular

insufficiency or peripheral vasospasticdisease such as Buergers and Reynauds

disease


5/23

Etiology:

thermal injuries

deformity of a limb rendering it a useless

hindrance life threating disorders, such as arterial

thrombosis and gas bacillus infections


6/23

Complications:

1. Hemorrhage

- When a person loses part or all of an

extremity either by surgery or by trauma,major blood vessels are severed , which

causes bleeding


7/23

Complications:

2. Infection

- As with any surgical procedures of

trauma, infection can occur in the woundof the bone


8/23

Complications:

3. Phantom limb pain

- A normal, frequently occurring

physiologic response after amputation. It isthe feeling of the patient that the

amputated portion of the limb still

remains.


9/23

Complications:

4. Problem associated with immobility

- Because the client experience reduced

mobility as a result of surgery, thecomplication of immobility can readily

occur.


10/23

Complications:

5. Neuroma

- A sensitive tumor consisting of nerve cells

found at the severed nerve endings form often

in amputation of the upper extremity but can

occur anywhere.


11/23

Complications:

6. Flexion contractures

- Flexion contractures of the hip or knees

are seen in clients with amputation of thelower extremity. These complications must

be avoided so that the client can ambulate

with prosthesis.


12/23

Purpose of Amputation

Relieve symptoms

To improve function

To save or improve the patients qualityof life

Prevent complication

Control pain or disease process


13/23

Types of Amputation

1. Open (Guillotine) Amputation

- Indicated to patients with infection

- The surgeon does not close the stumpwith a skin flap immediately but leaves it

open, allowing the wound to drain freely.


14/23

Types of Amputation

2. Closed (Flap) Amputation

- There is no evidence of infection

- No need for open drainage- The surgeon covers or closes the stump

with a flap of skin sutured over the end of

the stump


15/23

Levels of Amputation

Lower Amputation

Partial foot

Total foot Ankle (Symes Amputation)

Below-the-knee

Above-the-knee Hip disarticulation

Hemipelvictomy


16/23

Levels of Amputation

Upper Limb Amputation

Fingers

Wrist disarticulation Below-the-knee

Elbow disarticulation

Above-the-knee


17/23

Nursing responsibilities

Before Amputation

If time permits, review the doctors

explanation of the scheduledamputation, answering any questions the

patient may have.

Provide emotional support.

Discuss postoperative care and

rehabilitation measures.


18/23


Point out the possibility of phantom limb

sensation

As ordered, administer broad-spectrum

antibiotics to minimize the risk of infection

Explain to the patient that the duration

between amputation and fitting of the

prosthesis varies, depending on wound

healing, muscle tone, and overall stump

condition.


19/23


Taking care of clients who underwent an

amputation

Monitor the vital sings every hour for the first

4 hours, every 2 hours for the next 4 hours,

and then every 4 hours until stable.

If ordered, elevate the limb on a pillow or

other support for 24-48 hours.

Assess for pain and provide analgesics and

other pain control measures a s needed.


20/23


Keep the stump properly wrapped with elastic

compression bandages.

If a rigid plaster has been applied, care

For it as you would a plaster cast for a fracture

or severe pain.

Emphasize the need for proper body

alignment and regular physical therapy to

condition the limb and prevent contractures

and deformity.


21/23


If the patient is bedridden, encouragehim to turn form side to side and toassume an alternate position, usually

prone from time to time throughout theday.

If the patient has had a leg amputation,

instruct him not to prop the limb on apillow.

Teach proper crutch use for walking.


22/23


Teach activities to toughen the residual

limb.

If the patient has had a below-the-kneeamputation, tell him to keep the knee

extended.

Instruct the patient with a partial armamputation to keep his elbow extended

and shoulder abducted.


23/23


If possible, give the patient information about

available prostheses.

Throughout recovery and rehabilitation,

encourage the patient to adopt a positive

outlook toward resuming an independent

lifestyle.

care of clients with an amputation

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