AMPUTATION

AMPUTATION

DEFINITION:-

The removal of a limb, part of a limb, or any other portion of the body (such as breast or rectum) is called Amputation. It is a surgical reconstructive procedure.

INDICATIONS:-

Peripheral vascular disease in D.M.

Severe trauma

Congenital deformity

Malignant tumour

Osteomyelitis/infection

To relieve symptoms, improve function and save or improve patients quality of life


TYPES OF AMPUTATION:-

Open (Guillotine)

Used with infection and for patients who are poor surgical risks.

Wounds heals by granulation over time or secondary closure 1 week later.


Closed (Myoblastic or Flap)

Residual limb is covered by a flap of skin

Flap of skin is sutured posteriorly.


TYPES OF DRESSING:-

Soft Dressing: Secure with elastic bandage.

Closed Rigid Plaster Dressing: Secure with plaster.


PREOPERATIVE MANAGEMENT:-

To relieve anxiety.

To reduce pain.

To increase mobility.

To maintain good nutrition.

Provide Preoperative teaching.

To give general preoperative care.

Evaluation of cardiovascular, respiratory, renal systems.


POSTOPERATIVE MANAGEMENT:-

Complications are monitored: haemorrhage, infections, non healing wound.

Acceptance of body image change should be promoted.

To monitor fluid balance.

Maintaining adequate tissue perfusion.

Give psychological support.

To control pain.

To promote physical activities.

To give general post-operative care.


LEVEL OF AMPUTATION:-

Amputation is performed at the most distal point that will heal successfully. The site of amputation is determined by two factors:


*Circulation in the part.

*Functional usefulness, i.e., meet the requirement for the use of the prosthesis.


There are two levels of Amputation:

1)Level of amputation of upper extremity.

2)Levels of amputation of lower extremity.


COMPLICATIONS:-

Haemorrhage.

Infection.

Skin breakdown.

Phantom limb pain (a sensable pain in arm or leg).

Joint contracture.


NURSING DIAGNOSIS:-

Acute pain related to Amputation

Nursing Intervention

Provide opioid analgesics (morphine) to relieve pain.

Change the patients position or placing a light sand bag on residual limb to counteract the muscle spasm may improve patient's level of comfort.



Risk for Disturbed sensory perception (phantom limb pain) related to amputation

Nursing Intervention

Early intensive rehabilitation and stump desensitisation with kneading massage brings relief.

Transcutaneous electrical nerve stimulation and local anesthetics may provide relief to some patients.

Beta-blockers may relieve dull, burning discomfort.

Antiseizure medications control stabbing and cramping pain.

Also antidepressants are used to improve mood and coping ability.



Disturbedrbed Body Image related to Amputation

Nursing Intervention

Nurse has to establish a trust relationship with the patient to communicate acceptance of patient who has experienced an amputation.

The nurse encourages the patient to look at, feel, and then care for residual limb.

Provide psychological support to patient.



Ineffective coping related to failure to accept loss of body part

Nursing Intervention

Nurse creates an accepting and support atmosphere in which the patient and family are encouraged to express and share their feelings and work through the grief process.

Provide psychological support also.


Self care deficit feeding, bathing, hygiene, dressing, grooming, or toileting related to loss of extremity

Nursing Intervention


Patient is encouraged to be an active participant in self care.

Nurse should do works with the physical therapist an occupational therapist to teach and supervise the patient in these self-care activities.

PREVIOUS YEAR QUESTIONS KUHS

Essays:

1. Define amputation. List the complications following amputation. Explain the post- operative management of below knee amputation. (2+4+4=10)  

2. 2. Define amputation. List the complications following amputation. Explain the rehabilitative measures for this patient. (1+4+5=10) 

Short essay

1. Define amputation. Enlist the complications of amputation. Explain the postoperative management of a patient after below knee amputation. (7)


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