Master Amputation with Picmonic for Nursing RN

Amputations secondary to trauma are more common among young individuals. Examples of trauma include motor vehicle accidents, landmines, and farm-related injuries

Amputations affecting the lower limbs secondary to peripheral vascular disease are more common among older patients. Decreased blood flow to the extremities reduces perfusion (oxygen delivery to tissues), white blood cells proliferation, and nutrients delivery to the limbs.

Diabetes mellitus is the most common cause of peripheral vascular disease requiring amputation. Patients with diabetic neuropathy lose protective neurosensory information and this can increase the incidence of injury or trauma to the affected limb. Severe injury or infection of the foot can go unnoticed by a patient with diabetic neuropathy, and this can result in poor outcomes or a higher incidence of amputation.

Gentle handling of the residual limb is critical in promoting the healing process and preventing traumatic damage.

During the immediate postoperative period, a surgical tourniquet must be kept available at the bedside at all times for emergency use. The tourniquet is used to stop excessive bleeding that may occur in the residual limb.

Physical therapy is an important early modality to implement following an amputation. Important aspects of physical therapy include a comprehensive exercise program aiming to prevent the development of contractures. It is important to educate the patient about postoperative positioning and maintaining proper body alignment. Prolonged stasis or immobility in one position can increase the risk of developing contractures, as well as other unintended outcomes like DVT development.

Frequent inspection, especially within the first 24 hours, of the stump and incision site is critical for monitoring for signs of complication. Assess for signs of tissue breakdown, bleeding, early infection, tenderness, and neurovascular status. To avoid skin irritation: do not apply lotions, powders, or oils directly to the surgical site.

Compression bandaging is indicated to shrink the residual limb to shape the stump for eventual prosthesis fitting. Compression bandages are used immediately after surgery to support soft tissues of the residual limb. Residual limb bandaging is indicated to decrease edema and minimize pain. The residual limb should be exposed to air for 20 minutes each day. For amputations above the knee or below the elbow, delayed prosthetic fitting is the optimal choice.

A significant percentage of amputees experience phantom limb pain after surgery. The patient still perceives pain in the missing portion of the limb and may also experience feelings of coldness, heaviness, and cramping. It can be exacerbated by underlying anxiety or depression and may develop into a chronic problem for the patient. Proper rehabilitation, including mental healthcare and pain management, can help the patient improve and cope with the problem of phantom limb pain.

Mirror therapy is indicated to help decrease phantom limb sensation and pain. By using a mirror, visual information is sent to the brain and replaces sensory feedback expected from the missing limb.