AMPUTATION
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 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.”
CARE SETTING
Inpatient acute surgical unit and subacute or rehabilitation unit.
RELATED CONCERNS
Cancer
Diabetes mellitus/diabetic ketoacidosis
Psychosocial aspects of care
Surgical intervention
Patient Assessment Database
Data depend on underlying reason for surgical procedure, e.g., severe trauma, peripheral vascular/arterial occlusive disease, diabetic neuropathy, osteomyelitis, cancer.
ACTIVITY/REST
May report:
Actual/anticipated limitations imposed by condition/amputation
CIRCULATION
May exhibit:
Presence of edema; absent/diminished pulses in affected limb/digits
EGO INTEGRITY
May report:
Concern about negative effects/anticipated changes in lifestyle, financial situation, reaction of others
Feelings of helplessness, powerlessness
May exhibit:
Anxiety, apprehension, irritability, anger, fearfulness, withdrawal, grief, false cheerfulness
NEUROSENSORY
May report:
Loss of sensation in affected area
SAFETY
May exhibit:
Necrotic/gangrenous area
Nonhealing wound, local infection
SEXUALITY
May report:
Concerns about intimate relationships
SOCIAL INTERACTION
May report:
Problems related to illness/condition
Concern about role function, reaction of others
TEACHING/LEARNING
Discharge plan considerations:
DRG projected mean length of inpatient stay: 5.8–12.7 days
May require assistance with wound care/supplies, adaptation to prosthesis/ambulatory devices, transportation, homemaker/maintenance tasks, possibly self-care activities and vocational retraining
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Studies depend on underlying condition necessitating amputation and are used to determine the appropriate level for amputation.
X-rays: Identify skeletal abnormalities.
CT scan: Identifies soft-tissue and bone destruction, neoplastic lesions, osteomyelitis, hematoma formation.
Angiography and blood flow studies: Evaluate circulation/tissue perfusion problems and help predict potential for tissue healing after amputation.
Doppler ultrasound, laser Doppler flowmetry: Performed to assess and measure blood flow.
Transcutaneous oxygen pressure: Maps out areas of greater and lesser perfusion in the involved extremity.
Thermography: Measures temperature differences in an ischemic limb at two sites: at the skin and center of the bone. The lower the difference between the two readings, the greater the chance for healing.
Plethysmography: Segmental systolic BP measurements evaluate arterial blood flow.
ESR: Elevation indicates inflammatory response.
Wound cultures: Identify presence of infection and causative organism.
WBC count/differential: Elevation and “shift to left” suggest infectious process.
Biopsy: Confirms diagnosis of benign/malignant mass.
NURSING PRIORITIES
1. Support psychological and physiological adjustment.
2. Alleviate pain.
3. Prevent complications.
4. Promote mobility/functional abilities.
5. Provide information about surgical procedure/prognosis and treatment needs.
DISCHARGE GOALS
1. Dealing with current situation realistically.
2. Pain relieved/controlled.
3. Complications prevented/minimized.
4. Mobility/function regained or compensated for.
5. Surgical procedure, prognosis, and therapeutic regimen understood.
6. Plan in place to meet needs after discharge.
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 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.”
CARE SETTING
Inpatient acute surgical unit and subacute or rehabilitation unit.
RELATED CONCERNS
Cancer
Diabetes mellitus/diabetic ketoacidosis
Psychosocial aspects of care
Surgical intervention
Patient Assessment Database
Data depend on underlying reason for surgical procedure, e.g., severe trauma, peripheral vascular/arterial occlusive disease, diabetic neuropathy, osteomyelitis, cancer.
ACTIVITY/REST
May report:
Actual/anticipated limitations imposed by condition/amputation
CIRCULATION
May exhibit:
Presence of edema; absent/diminished pulses in affected limb/digits
EGO INTEGRITY
May report:
Concern about negative effects/anticipated changes in lifestyle, financial situation, reaction of others
Feelings of helplessness, powerlessness
May exhibit:
Anxiety, apprehension, irritability, anger, fearfulness, withdrawal, grief, false cheerfulness
NEUROSENSORY
May report:
Loss of sensation in affected area
SAFETY
May exhibit:
Necrotic/gangrenous area
Nonhealing wound, local infection
SEXUALITY
May report:
Concerns about intimate relationships
SOCIAL INTERACTION
May report:
Problems related to illness/condition
Concern about role function, reaction of others
TEACHING/LEARNING
Discharge plan considerations:
DRG projected mean length of inpatient stay: 5.8–12.7 days
May require assistance with wound care/supplies, adaptation to prosthesis/ambulatory devices, transportation, homemaker/maintenance tasks, possibly self-care activities and vocational retraining
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Studies depend on underlying condition necessitating amputation and are used to determine the appropriate level for amputation.
X-rays: Identify skeletal abnormalities.
CT scan: Identifies soft-tissue and bone destruction, neoplastic lesions, osteomyelitis, hematoma formation.
Angiography and blood flow studies: Evaluate circulation/tissue perfusion problems and help predict potential for tissue healing after amputation.
Doppler ultrasound, laser Doppler flowmetry: Performed to assess and measure blood flow.
Transcutaneous oxygen pressure: Maps out areas of greater and lesser perfusion in the involved extremity.
Thermography: Measures temperature differences in an ischemic limb at two sites: at the skin and center of the bone. The lower the difference between the two readings, the greater the chance for healing.
Plethysmography: Segmental systolic BP measurements evaluate arterial blood flow.
ESR: Elevation indicates inflammatory response.
Wound cultures: Identify presence of infection and causative organism.
WBC count/differential: Elevation and “shift to left” suggest infectious process.
Biopsy: Confirms diagnosis of benign/malignant mass.
NURSING PRIORITIES
1. Support psychological and physiological adjustment.
2. Alleviate pain.
3. Prevent complications.
4. Promote mobility/functional abilities.
5. Provide information about surgical procedure/prognosis and treatment needs.
DISCHARGE GOALS
1. Dealing with current situation realistically.
2. Pain relieved/controlled.
3. Complications prevented/minimized.
4. Mobility/function regained or compensated for.
5. Surgical procedure, prognosis, and therapeutic regimen understood.
6. Plan in place to meet needs after discharge.
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