ADULT HEALTH NURSING 2

TOPIC : AMPUTATION
Presented to : MAM CAROL

Presented BY : RIMSHA SHAHZAD

KHADIJA MEHMOOD
SUMAIRA GHAFFAR
MAJID HUSSAIN
 OBJECTIVES
Define amputation
Purpose of amputation
Risk factors
Prevention of amputation
Levels of amputation
List indications of Amputation
Surgical amputation techniques
 Medical management
Complications of amputation
Nursing management of patient with amputation
 NANDA Nursing diagnosis
 Amputation
Amputation is removal of a body part often a digit or limb.
 The sites of amputation is determined by two factors :
 Circulation in parts
 Functional usefulness.
Causes of Amputation :-

Amputation of lower extremity is often due to peripheral vascular

diseases i.e.
> Diabetic foot and gangrene/ Infection
> Burns and electrical burns
> Malignant tumor
> Trauma
> Chronic osteomyelitis
> Congenital deformities
 PURPOSE OF AMPUTATION

The purpose of amputation are :-

> To relieve symptoms
> To improve functions
> To save and improve patient quality of life
> To control the infection
Clinical Manifestations

 Severe pain
 Numbness
 low blood pressure
 Rapid heart rate
 Skin changes
 Shortness of breath
 Confusion
RISK FACTORS
Older age
Impair vision
Trauma
Charcot foot
Ethnicity
Infection
Male
Peripheral arterial diseases
Diabetes mellitus
 LEVELS OF AMPUTATION

Upper Extremity Amputation Lower Extremity Amputation

It includes: It includes:

i. Above the elbow amputation i. Above the knee amputation(AKA)

ii. Below the knee amputation (BKA)
ii. Below the elbow amputation
iii. knee disarticulation
iii. Wrist disarticulation
iv. Hip disarticulation
iv. Shoulder disarticulation
v. Hemipelvectomy
v. Finger Amputation
 Upper extremity Amputation
Hand and partial hand amputation:-
Fingers , Thumb and portion of hand below wrist

Wrist Disarticulation :-
Limb is Amputated at level of wrist.

Transradial( below elbow amputations )

Amputation occurring in forearm, from elbow to wrist .
 FOOT AMPUTATIONS
• Amputation of greater toes and other toes
• Amputation through metatarsal bone
• Lisfrance operation ( at level of tarsometatarsal joints )
• Chopart operation ( through midtarsal joints )
• Transtibial Amputation ( Below the knee )
• Amputation occurs at any level from knee to ankle .
Prevention:
Many lower limb amputation are prevented by :
Inspect your feet daily
Going to regular visits to your doctor
Wearing proper footwear.
Improved foot care of diabetic patients reduced rate of lower limb
amputation
Regular exercise such as walking to keep blood flowing
Quit smoking.
Safe driving.
 Indications of Amputation
Acute disease process:
i. Traumatic injury: Common types of accidents and injuries leading to
amputation include those involving motorcycles and automobiles, farm
machinery.
ii. Thermal injury (frostbite, electrocution, burns)
iii. Malignancy
 Chronic disease process :
i. Peripheral vascular disease resulting in ischemia/gangrene(a condition
of the blood vessels that leads to narrowing and hardening of the
arteries that supply blood to the extremities).
ii. Diabetes mellitus resulting in peripheral neuropathy leading to pressure
Ulcers
iii. Infection (osteomyelitis)
 Surgical Amputation Techniques
 Closed amputation :–
the most common technique, allowing the
skin flap to close the site. Create a weight-bearing residual limb,
important for lower extremity amputations .
 Open amputation :–

Used with active infection, allowing the skin to be

closed at a later. The severed bone or joint is left uncovered by a
skin flap .
 Reconstructive/plastic surgery.
Closed amputation Open Amputation
 Medical Management
 Healing is enhanced by gentle handling of residual limb ,
control of residual limb edema through soft or rigid
compression dressings and use of aseptic techniques to avoid
infection .
 A closed rigid cast dressing is frequently used to provide
uniform compression , to support soft tissues , to control pain
and to prevent joint contractures.
 Immediately after surgery, a sterilize residual limb sock is
applied to the residual limb.
 Felt pads are placed over pressure sensitive areas.
 The residual limb is wrapped with elastic plaster-of-paris
bandages while firm, even pressure is maintained.
 The objective of treatment is to achieve the healing of
amputation of wound.
 Complications with Amputation

Hemorrhage (because major blood vessels has been severed)

Phantom limb pain( caused by severing of peripheral nerves )
Skin irritation / breakdown (cause by prosthesis )
Infection(risk of infection increases with contaminated wound after traumatic amputation)
Joint contracture(caused by positioning and protective flexion withdrawal pattern
associated with pain and muscle imbalance)
 Nursing Management
Before surgery
Assess patient :
 Circulatory status of the limb.
 In case of infection or gangrene assess enlarged lymph nodes, fever
and purulent discharge.
 Nutritional assessment for wound healing
 Any concurrent health problems like dehydration, anemia, respiratory
problems, Diabetes mellitus need to be identified and treated before
surgery.
  After surgery
 Assess the patient Tissue perfusion, Pain, Mobility ,Signs of
infection( edema, fever, discharge etc.),Client’s perception and
feelings regarding amputation of body part, Coping, Prosthesis fit.
 Monitor vital signs.
 Monitor for infection and hemorrhage.
 Mark bleeding and drainage on the dressing if it occurs.
 Keep a tourniquet at the bedside if prescribed.
 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.
 Administrate analgesics
 Consult a certified prosthetic orthotic for assessment and planning for
prosthetic training.
 Promote wound healing
 Psychological support
 Rehabilitation(support from physical therapist, Prosthetist , Vocational
rehabilitation workers ) to achieve highest possible level of functioning &
participation in life activities.
Nursing diagnosis :
Acute pain related to surgical Amputation.
Impaired physical mobility related to loss of extremity.
Ineffective tissue perfusion related to reduced blood flow, tissue
edema ,hematoma formation
Impaired skin integrity related to surgical amputation.
Disturbed body image related to loss of body part.
Risk for disturbed sensory perception/phantom limb related to
surgical amputation
Risk of infection related to wound contamination .