Amputation Types and Indications

• Amputation involves the removal of a limb or part of a limb

Types of Amputation

• Amputations are categorized by the level of the limb that is removed
• Above-the-knee amputation (AKA) means amputation through the femur
• Below-the-knee amputation (BKA) means amputation through the tibia and fibula
• Above-the-elbow amputation (AEA) means amputation through the humerus
• Below-the-elbow amputation (BEA) means amputation through the radius and ulna
• Syme's amputation is ankle disarticulation
• You can have a Toe or partial foot amputation which is the removal of one or more toes or part of the foot
• You can have a Finger or partial hand amputation which is removal of one or more fingers or part of the hand

Indications for Amputation

• Peripheral vascular disease (PVD), often associated with diabetes, is a common cause for lower extremity amputations because of poor circulation and tissue necrosis
• Trauma can result in amputation if a limb is crushed, severely damaged, or cannot be adequately reconstructed
• Infection, such as osteomyelitis or sepsis, may necessitate amputation to prevent the spread of infection
• Tumors, both benign and malignant, in the bone or soft tissues of a limb may require amputation
• Congenital deformities may be corrected with amputation and prosthetics

Pre-operative Nursing Care

• Assessment includes evaluating the patient's overall health, including cardiovascular status, nutritional status, and the presence of infection
• Psychological preparation involves addressing the patient's fears, anxieties, and concerns about the surgery, body image, and future mobility
• Patient education includes explaining the surgical procedure, the expected outcome, post-operative care, pain management, and rehabilitation
• The affected limb should be assessed for skin integrity, circulation, and sensation
• Baseline vital signs, including blood pressure, heart rate, and respiratory rate, are recorded

Post-operative Nursing Care

• Vital signs should be monitored frequently to detect any signs of instability, such as hypotension or tachycardia
• The surgical site should be assessed for bleeding, edema, redness, drainage, and odor
• Pain should be managed with prescribed analgesics, and the patient's pain level is regularly assessed using a pain scale
• Proper positioning helps prevent contractures, especially hip and knee flexion contractures after lower extremity amputation
• Wound care involves keeping the surgical site clean and dry, changing dressings as ordered, and monitoring for signs of infection
• Compression bandages are applied to the residual limb to reduce edema, support the soft tissues, and promote shaping of the limb for prosthetic fitting
• Early ambulation, as tolerated, helps improve circulation, prevent complications such as pneumonia and deep vein thrombosis (DVT), and promote independence
• The patient should be encouraged to express their feelings about the amputation, and be provided with emotional support and counseling if needed
• Assess the patient's nutritional status and provide a diet that is high in protein, vitamins, and calories to promote wound healing

Potential Complications

• Infection at the surgical site can occur, leading to delayed healing, further tissue damage, or systemic infection
• Hemorrhage can occur post-operatively, requiring intervention to control bleeding
• Phantom limb pain is the sensation of pain in the amputated limb; it is a common complication that can be difficult to treat
• Neuroma: A tumor formed of nerve tissue
• Contractures, especially hip and knee flexion contractures, can develop if the patient is not properly positioned and does not perform range-of-motion exercises
• Skin breakdown can occur due to pressure from the cast or prosthetic; regular skin assessment is crucial
• Deep vein thrombosis (DVT) and pulmonary embolism (PE) are risks in post-operative patients, especially those with limited mobility

Phantom Limb Pain

• Phantom limb pain is a common condition experienced by individuals after amputation characterized by the sensation of pain originating from the removed limb
• Symptoms can vary widely, including shooting, stabbing, burning, cramping, or aching sensations
• The exact cause of phantom limb pain is not fully understood but it is believed to involve a combination of peripheral and central nervous system factors
• Treatment options include medications (such as analgesics, antidepressants, and anticonvulsants), nerve blocks, TENS, and complementary therapies such as acupuncture and massage
• Psychological support and counseling are important in helping patients cope with chronic pain

Stump Care

• Residual limb care is essential to promote healing, prevent complications, and prepare the limb for prosthetic fitting
• Wash the residual limb daily with mild soap and water, and dry thoroughly
• Inspect the skin for signs of breakdown, irritation, or infection
• Apply a clean compression bandage to reduce edema and promote shaping of the limb
• Perform range-of-motion exercises to prevent contractures and maintain joint mobility
• Encourage the patient to participate in activities of daily living to promote independence
• Avoid prolonged sitting or immobility, which can impair circulation and increase the risk of complications

Prosthetic Rehabilitation

• Prosthetic fitting usually begins several weeks or months after amputation, once the residual limb has healed and edema has subsided
• A prosthetist will assess the patient's needs and goals and fabricate a custom-made prosthesis
• Physical therapy is crucial to teach the patient how to use the prosthesis effectively, improve balance and coordination, and increase strength and endurance
• Occupational therapy may be helpful in teaching the patient how to perform activities of daily living with the prosthesis
• Regular follow-up appointments are important to monitor the fit and function of the prosthesis and make adjustments as needed

Psychological Support

• Amputation can have a profound psychological impact on patients, leading to feelings of grief, loss, anxiety, depression, and body image disturbances
• Encourage the patient to express their feelings and concerns
• Provide emotional support and counseling, and refer the patient to a mental health professional if needed
• Support groups can provide a sense of community and shared experience
• Encourage the patient to focus on their strengths and abilities and to set realistic goals for recovery and rehabilitation

Key Nursing Interventions

• Pain Management: Administer prescribed analgesics, assess pain levels, and use non-pharmacological pain management techniques
• Wound Care: Monitor the surgical site for signs of infection, change dressings, and promote wound healing
• Positioning: Prevent contractures by positioning the patient properly and encouraging range-of-motion exercises
• Edema Control: Apply compression bandages to reduce edema and promote shaping of the residual limb
• Psychological Support: Provide emotional support and counseling to help the patient cope with the psychological impact of amputation
• Education: Educate the patient and family about post-operative care, prosthetic rehabilitation, and potential complications
• Mobility: Encourage early ambulation and participation in physical therapy to improve strength, balance, and coordination

NCLEX-Style Questions Considerations

• Focus on prioritizing interventions based on patient assessments and potential complications
• Knowledge of expected post-operative findings versus signs of complications is essential
• Understanding of the psychological aspects of amputation and appropriate support strategies is important
• Be familiar with proper stump care techniques and the role of the nurse in prosthetic fitting and rehabilitation
• Safety is a key consideration, especially in preventing falls and ensuring proper use of assistive devices