Adult Medical-Surgical Adult Medical-Surgical NursingNursing

Musculo-skeletal Module: Musculo-skeletal Module: AmputationAmputation

Amputation: DescriptionAmputation: Description

Amputation is removal of a body part Amputation is removal of a body part usually part or whole of an extremity usually part or whole of an extremity (limb)(limb)

Amputation: CausesAmputation: Causes

Progressive peripheral vascular Progressive peripheral vascular disease (often a complication of disease (often a complication of Diabetes Mellitus: “Diabetic foot”)Diabetes Mellitus: “Diabetic foot”)

Trauma: crush injury, burn injury Trauma: crush injury, burn injury including electrical, frostbiteincluding electrical, frostbite

Chronic osteomyelitisChronic osteomyelitis Gas gangreneGas gangrene Malignant tumourMalignant tumour Congenital deformityCongenital deformity

Aim of Amputation Aim of Amputation

To save life where gangrene To save life where gangrene (inadequate circulation) infection or (inadequate circulation) infection or malignancy will spreadmalignancy will spread

To preserve as much viable healthy To preserve as much viable healthy limb as possiblelimb as possible

To relieve symptomsTo relieve symptoms To improve function To improve function To improve quality of life To improve quality of life

Levels of AmputationLevels of Amputation

Aim to conserve as much limb as Aim to conserve as much limb as possible and to preserve jointspossible and to preserve joints

Surgery at the most distal point of Surgery at the most distal point of limb which will heal successfully limb which will heal successfully

Depends on:Depends on: Circulatory status of extremityCirculatory status of extremity Appropriate level for fitting Appropriate level for fitting

prosthesisprosthesis

Pre-operative AssessmentPre-operative Assessment

Age of patient and general healthAge of patient and general health Current medicationsCurrent medications Psychological impact of proposed surgery Psychological impact of proposed surgery Circulatory status of affected limb:Circulatory status of affected limb: Doppler flowmetryDoppler flowmetry Segmental BPSegmental BP Transcutaneous partial pressure O2 Transcutaneous partial pressure O2

(PaO2)(PaO2) Related muscle and joint functionRelated muscle and joint function

Amputation: ComplicationsAmputation: Complications

HaemorrhageHaemorrhage InfectionInfection Skin breakdown/ delayed healingSkin breakdown/ delayed healing Phantom limb pain (tingling pain as if Phantom limb pain (tingling pain as if

limb still present)limb still present) Joint contractureJoint contracture Severe depression and grief over Severe depression and grief over

permanent loss of limb, altered body permanent loss of limb, altered body image and modification of lifestyleimage and modification of lifestyle

Amputation: Amputation: Post-operative Nursing CarePost-operative Nursing Care

Adequate hydration/ nutritional statusAdequate hydration/ nutritional status Aseptic techniqueAseptic technique Monitor wound healing, presence of Monitor wound healing, presence of

oedema/ infection/ skin breakdownoedema/ infection/ skin breakdown Monitor for onset of complicationsMonitor for onset of complications Tourniquet available in case of severe Tourniquet available in case of severe

haemorrhagehaemorrhage Assess moodAssess mood

Amputation: Care of LimbAmputation: Care of Limb

Reduce oedema (delays healing):Reduce oedema (delays healing): Elevate limb (avoid placing lower limb Elevate limb (avoid placing lower limb

on pillow. Risks flexion contracture of on pillow. Risks flexion contracture of hip joint. Rather raise foot of bed)hip joint. Rather raise foot of bed)

Constant pressure bandage: (molds Constant pressure bandage: (molds stump for prosthesis)stump for prosthesis)

Range of motion exercises/ change of Range of motion exercises/ change of position:position:

Strengthens and molds muscles of Strengthens and molds muscles of stumpstump

Prevents flexion contracture of jointPrevents flexion contracture of joint

Amputation: Phantom Pains Amputation: Phantom Pains

Monitor for phantom pains Monitor for phantom pains Address by: Address by:

Massage of stump to mold for Massage of stump to mold for prosthesis and desensitisation with: prosthesis and desensitisation with:

Transcutaneous electrical nerve Transcutaneous electrical nerve stimulation (TENS)stimulation (TENS)

Local anaestheticLocal anaesthetic ββ-blocker medication -blocker medication

Amputation: RehabilitationAmputation: Rehabilitation

Multi-disciplinary rehabilitation team Multi-disciplinary rehabilitation team (patient, physician, nurse, physiotherapist, (patient, physician, nurse, physiotherapist, psychologist, occupational therapist)psychologist, occupational therapist)

Early application of prosthesis as soon as Early application of prosthesis as soon as stump formedstump formed

Early usage/ ambulation (↑ muscle tone)Early usage/ ambulation (↑ muscle tone) Counselling, encouragement, support for Counselling, encouragement, support for

grieving process, lifestyle changesgrieving process, lifestyle changes