Amputations

Definitions Levels of Amputations

*Goal = circulation, extremity length & function

Diagnostic Studies

Amputation answers

Types of amputations Open of Guillotine

– Required if infection present

– Late closure Closed or Flap

– Produce weight bearing stump

Nursing diagnosis– Pre-op– Post-op

• Complications: hemorrhage, infections

• Pain• Impaired

mobility

•Interventions

Pre-op – physical and mental preparations – prepare for phantom pain

Post-op– Hemorrhage – Pain and phantom pain– Elevate first 24-48 hours– Prevent infections– Prevent contraction, prone position– Delayed or immediate fitting

Post-op Care: Immediate and Delayed Prosthesis Fitting

Delayed– Ace wrap– Potential

hemorrhage, swelling

– Stitches out at 2-3 wks

– Temporary prosthesis with full wt at 6 wks

Immediate– Total contact, rigid

dressing– Compression dec.

edema– Early wt. bearing– inc. chance for

Infection

Test Yourself!

Which crutch-walking gait should the B-K amputee with a prosthesis use?– a. swing-through

gait– b. 3 point– c. 4 point– d. swing-to gait

Amputation home page

Teaching Stump bandaging

– Wrap distal to proximal

– Produce cone shape Stump care

– Stump sock, stump shrinker

– Keep clean

The Goal: cone-shaped, well-healed stump!

Teaching

Weight Control Temperature control Muscle

strengthening Positioning

Hydraulic prosthesis

Replanation

Criteria Interventions

– Keep body part– Plastic bag, /ice– Elevate stump– No tourniquet– Saline dressing

Post-op Care– Adequate

circulation: arterial/venous

– Use of leeches– Prevent infection– Prevent platelet

agglutination– Psychological

support

What initial action should be taken with traumatic amputation?

What criteria determine the viability of the severed part with amputation?

replantation

Indications for Use of Leeches

Useful on tissue with impaired circulation– dusky, blue skin color

– brisk capillary return

– rapid, dark pinprick response

Contraindicated with impaired arterial circulation