Amputation

Types:
 Complete
 Incomplete

ASSESSMENT
a. Extent and location of the injury
 Some amputation will require the patient to go immediately to the OR
b. What is the missing and how much, if any, of the appendage is left intact?
o Determine the amount and color of the blood
 Dark blood- venous
 Bright red blood- arterial
c. Palpate pulse to the injury
o If pulse is not palpable, immediate intervention is warranted
d. Capillary refill should be < 2 seconds
o To indicate adequate perfusion
e. Pain maybe present depending on the extent of the nerve involvement and damage
f. Determine the underlying physiologic or psychological pathology prompting the injury.
o Is it suicidal?
o Is it accident?

DIAGNOSIS
1. Xray
2. Vascular studies
a. Arteriogram
b. Determine the extent of vascular compromise caused by the injury
3. CBC
4. Chemistry
5. INR level
6. Urinalysis
7. Urine drug sreen
TREATMENT
1. Surgival replantation
2. Antibiotics – pre and post op

NURSING INTERVENTIONS
1. ABC assessment and include cervical spine
2. Manage life threatening concerns
3. Oxygenation
4. Control bleeding
o Current evidence indicate efficacy of the tourniquet, used to control life and limb
threatening hemorrage
 5. 2 large bore – IV cannula
6. Clean site using normal saline for irrigation only
o Do not scrub or use cleaning solution on the stump!
7. Administer tetanus prophylaxis
8. Administer analgesic and antibiotic
9. Apply sterile dressing
10. Prepare the patient for transfer to an appointment facility - OR
11. Psychological report for the patient and family
12. Immobilize the limb in its correct anatomical position
13. Take care to pressure the amputated part for possible reimplantation by wrapping it in
saline-moistened gauze and placing it in sealed plastic bag
i. Wrap with saline- moistened gauze
ii. Placing it in a sealed plastic bag
iii. Bag should then be placed in a bath of ice water
iv. Make sure that the part does not freeze
v. Don’t allow the part to be submerged directly in the ice

BKA amputation
 Surgical removal of the limvb or part of the limb

Post operative interventions:

 Monitor vs
 Monitor infection and hemorrage
 Mark bleeding and drainage on the dressing if it occurs
 Keep a tourniquet at the edside if prescribed
 Observe for and prevent contractures, which can result to prolonged residual limb
elevation
 Monitor for signs of infection, necrosis and neuroma
 Evaluate for phantom limb sensation and pain; explain sensation and pain to the client
and medicate the client as prescribed
 First 24 hours: elevate the foot of the bed to reduce edema; then keep the bed flat to
prevent hip flexion contractures; if prescribed by the physician
 After 24 to 48 hours post op: position the client prone to stretch the muscles and preent
hip flexion contractures, if prescribed.
 To prevent hip flexion contractures, do not elevate the residual limb on a pillow
 Maintain surgical application of dressing, elastic compression wrap, or elastc stump
(residual lim) shrinker as prescribed to rduce swelling, minimize pain and mold the
residual limb in preparation for prosthesis
 As prescribed, wash th residual limb with mild soap and water and dry completely.
 Massage the skin toward the sutureline to mobilize scar and prevent its adherence to
underlying bone.
 Prepare for the prosthesis and instruct the client in progressive resistive techniques by
gently pushing the residual limb against pillows and progressing to firmer surfaces.
 Encourage verbalization regarding loss of the body part, assist the client to identify
coping mechanism to deal with the loss.

INTERVENTIONS for BKA

 Prevent edema
 Do not allow the residual limb to hang over the edge of the bed
 Discourage long periods of sitting to lessen complicatins of knee flexion

INTERVENTIONS for AKA

 Prevent internal or external rotation of the limb
 Place a sandbag, rolled towel, or trochanter roll along the outside of the thigh or
prevent external rotation
REHABILITATION
 Instruct the client in the use of a mobility aid such as crutches or a walker
 Prepare residual limb for a prosthesis
 Prepare the client for fitting of the residual limb for a prosthesis
 Instruct the client in exercises to maintain range of motion and upper body
strengthening
 Provide psychosocial support to the client