Amputation is the surgical removal of all or part of a limb due to a chronic condition or catastrophic injury. Medical advances in preventive approaches have resulted in a drop in the overall rate of amputations in the United States.
Amputations due to chronic diseases like diabetes, on the other hand, have stayed constant or even increased. The incidence of lower extremity amputations in the United States is directly proportional to rates of peripheral arterial occlusive disease, neuropathy, and soft tissue sepsis.
This correlation is due to the increased incidence of diabetes mellitus, which is present in 82% of all vascular-related lower extremity amputations in the United States. When combined with severe wound contamination and significant soft tissue loss, trauma to the lower extremity can result in amputation in over 20% of patients.
Battle-related explosive events can result in amputation in 93% of cases, and approximately 2% of combat casualties require limb amputation. While amputations are naturally distressing to consider, they can save lives.
Signs and Symptoms of Amputation
The following are the most prevalent signs and symptoms that can lead to limb loss if not addressed promptly.
- Sensation of pain or numbness in the leg or foot
- Sores or wounds that are slow or don’t heal
- Gangrene
- Leg and foot skin that is shiny, smooth, and dry.
- Toenail and nail thickening
- Pulse in the leg is absent or feeble.
- An infection that refuses to go away.
Types of Amputation
Amputation types are commonly divided into upper and lower amputations by doctors. Fingers, wrists, and arms are all affected by upper amputations. Toes, ankles, and legs are all affected by lower amputations.
If one needs an amputation, a doctor should discuss the need for a specific place as well as prosthetic possibilities.
The following are medical words for various types of amputation.
- Upper Extremity
- Transcarpal. A finger or a part of the hand is amputated.
- Disarticulated wrist. The wrist has been amputated.
- Transradial. Amputation of the arm inferior to the elbow.
- Disarticulated elbow. Amputation at the elbow or through the elbow.
- Transhumeral. Amputation of the upper arm.
- Disarticulated shoulder. The shoulder was amputated.
- Lower Extremity
- Amputation of the toes. One or more toes are removed.
- Amputation of the midfoot. The toes and part of the foot are removed, but the heel and ankle joint remain. Amputation of the transmetatarsal bone (TMA).
- Amputation of the lower leg. Also known as amputation below the knee.
- Disarticulated knee. Amputation of the whole knee joint.
- Amputation of the femur. Amputation of the leg superior to the knee.
- Disarticulated hip. Amputation of a portion of the hip joint.
- Hemipelvectomy. The entire leg and a piece of the pelvis are amputated to the sacrum.
Risk Factors to Amputation
Some diabetics are more vulnerable than others. Amputation risk is enhanced by a number of factors, including:
- Blood sugar levels are high.
- Smoking
- Peripheral neuropathy
- Corns or calluses
- Foot malformations
- Circulation problems in the extremities (peripheral artery disease)
- Foot ulcers in the past
- A previous amputation
- Vision problems
- Kidney failure
- Blood pressure that is higher than 140/80 millimeters of mercury (mmHg)
Causes of Amputation
According to 2020 research, chronic illness that inhibits blood flow and damages bone tissue is the leading cause of amputation. There are, however, other reasons for amputation, such as:
- Amputations caused by blood flow problems. Chronic sickness and infection can disrupt blood flow, putting a limb in jeopardy. A doctor may propose amputation in this circumstance to preserve as much of the leg as feasible. Lower extremity amputations are frequently caused by chronic diseases. According to the American Academy of Physical Medicine and Rehabilitation (AAPMR), vascular disease is responsible for 93.4% of all lower extremity amputations. Diabetes and peripheral artery disease are examples of such illnesses. The following are the most common lower extremity amputations caused by blood flow problems:
- toe (33.2 percent)
- transfemoral (28.2 percent)
- transsexual (26.1 percent)
- Amputations of feet (10.6 percent)
Chronic disease-related amputations are linked to greater 5-year mortality rates than various cancer types. This is because in many cases the need for amputation indicates that a person’s medical condition or overall health is deteriorating. After amputation, improving one’s health and overall health are wonderful goals.
2. Amputations from cancer. Amputations due to cancer account for 0.8 percent of all amputations. This is frequently caused by bone cancer or cancer that has spread to the bone. Cancer, on the other hand, is the leading cause of amputation among people aged 10 to 20.
3. Traumatic amputations. Amputations can be caused by injuries or trauma. Trauma is thought to be the cause of 5.8% of lower limb amputations. This can include injuries sustained in car accidents and incidents at work. According to the Bureau of Labor Statistics, there were 6,200 work-related amputations in the US in 2018. Over 58 percent of these required the use of machinery, primarily metal and woodworking machinery.
Complications of Amputation
Amputations are surgical operations that have a number of dangers. One may also need to recover from additional medical issues if the amputation was caused by trauma or infection. This can make amputation healing more difficult.
Some of the most common amputation problems, according to the AAPMR, are:
- infection
- pinched nerve
- phantom limb sensation and discomfort (the sensation of having a limb that isn’t actually there)
- limb discomfort that persists
- Joint contracture is another consequence. This occurs when the remaining muscles, tendons, and other tissues become so tight that the remaining joint becomes immobile.
- Phantom Limb Syndrome
Phantom limb pain is the most common consequence of amputation surgery. When nerves in the stump send pain signals to the brain even though the limb is no longer there, this is known as phantom pain. Phantom limb pain is usually temporary. People who have their limbs amputated frequently experience phantom limb experiences and discomfort. Though the exact origin is unknown, it’s possible that following amputation, the residual nerve connections in the spinal cord and brain “remember” the body part, causing phantom limb syndrome or intense agony (phantom pain syndrome). These signs and symptoms can be extremely distressing.
During amputation surgery, the surgeon might take efforts to address the nerves that convey feelings back to the brain, which affect pain and phantom sensations. These procedures will not eradicate the problems, but they will lessen the overall risk of them occurring and the magnitude of their impact. Patients who have already had an amputation and are still enduring significant nerve pain may benefit from the nerve operations.
- Risk of Falls After Amputation
Patients who have lost a foot or limb are at danger of falling in the early stages of their recovery. This is especially common if they try to get out of bed in the middle of the night and forget about the amputation. These falls can be dangerous and cause more damage to the surgical site, necessitating additional care and possibly more surgery. Placing a walker or wheelchair next to the bed can serve as a reminder not to try to stand and walk without help.
Rehabilitative therapy and exercises performed in front of a mirror can assist the patient in adjusting to the loss of a limb and preventing falls.
Diagnosis of Amputation
Unless the patient requires an emergency amputation, the doctor will do a thorough examination before proceeding with the surgery. The evaluation determines the best method for amputating all or part of the leg and takes into account any factors that may impair the patient’s rehabilitation. Typically, the evaluation entails:
- Comprehensive Medical Examination
Doctors will examine the patient’s physical condition, bladder or bowel function, nutritional state, and cardiovascular system, which includes the blood vessels, blood, and heart. The lungs and airways of the respiratory system will also be examined by the doctor.
- Assessment of Limb Function and Condition
Amputating one leg normally creates a major pressure or weight on the remaining working limb, which might lead to issues and problems in the future.
- Psychological Evaluation
Coping with an amputation can have a significant emotional and psychological impact on the patient, who will almost certainly require further support for many years.
- Assessment of Patient’s Environments
Provisions will most likely be needed to assist the individual in coping with the modifications that must be made in living with an amputated limb in their professional, social, and home environments.
A physiotherapist who will assist the patient with postoperative care will normally provide information and recommendations prior to the amputation. Prior to the surgery, the surgeon will usually go over everything with the patient, including the necessity to stay in the hospital and whether the treatment will be done awake or under spinal or general anesthetic.
Treatment of Amputation
Every person who has an amputation requires postoperative wound care, which commonly includes a “drain in situ” that is removed a day or two after the procedure. Because the drainage was never sutured in place, it was frequently removed without disrupting the dressing or bandages.
The treatment is expected to heal successfully and without complications, according to the surgeons. Wound infections, on the other hand, occur at an alarmingly high incidence, leading to consequences such as dehiscence, which occurs when a biological release divides tissue and skin due to a spontaneous burst of a surgically closed wound, and skin blistering.
Antibiotics and pain medications will most likely be administered as needed, and the dressings will be changed in the hospital while the wound is continuously monitored. Physical therapy is usually started immediately after the surgery is completed.
Rehabilitation takes into account the patient’s individual needs, although it almost usually includes particular exercises, moderate stretching, and transferring in and out of a wheelchair or bed. People who have had a leg amputated must learn how to carry their body weight on the remaining limb in the most effective way possible.
The doctor will consider all of the patient’s emotional issues, such as the sadness associated with losing a limb or any physical condition generating phantom discomfort or pain in the leg that is no longer present. To address the patient’s physical, emotional, and mental needs, the doctor may prescribe drugs or suggest other nonsurgical options.
Amputation Pain Management
Any surgery can result in uncontrolled pain, and the amputation team works hard to keep pain to a minimum. If possible, pain management can begin prior to surgery. To control discomfort and phantom limb symptoms, a peripheral nerve block may be required.
Nursing Considerations for Patients with Amputation
- Protocols of Care. According to the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) assessment, fewer than half of trusts had a written policy in place for the care of patients who required Lower Limb Amputation (LLA). This or similar protocols of care should be in place in all hospitals and must include the following:
- Routes of referral
- Creation of dedicated interdisciplinary groups
- Care planning that incorporates the recommendations of Vascular Surgical Society Great Britain and Ireland (VSGBI) and NCEPOD
- Review of Amputation Care. In 2012, NCEPOD assessed the care of 628 individuals over the age of 16 who had significant limb amputations owing to vascular disease or diabetes. According to the audit, less than half of LLA patients received adequate care. The study includes 20 suggestions as well as information on who is accountable for putting them into action. The specified nursing suggestions are the following:
- All patients should have a named person in charge of their rehabilitation and discharge plans.
- Within 48 hours of admission, all patients should receive a nutritional assessment.
- A falls risk assessment should be performed, and steps taken to limit the chance of falling while in the hospital.
- MRSA should be checked on patients prior to surgery.
- Both before and after surgery, a referral to a pain specialist should be established.
- Lower limb amputation policy/protocol should be designed with input from all specialties involved in the patient pathway.
Nursing Diagnosis for Amputation
Nursing Care Plan for Amputation 1
Nursing Diagnosis: Situational Low Self-Esteem related to changes in functional abilities/loss of a body portion secondary to amputation as evidenced by fear of rejection/reaction from others, anticipated lifestyle changes, negative bodily sensations, an emphasis on previous strength, function or appearance, feelings of impotence and helplessness, not looking at or touching the stump due to preoccupation with a missing body component, and changes in expected patterns of responsibility/physical ability to resume the role.
Desired Outcomes:
- The patient will begin to adapt and express acceptance of himself in the situation (amputee).
- The patient will accurately notice and incorporate changes in self-concept without jeopardizing self-esteem.
- The patient will create realistic plans for adapting to new roles and role changes.
| Amputation Nursing Interventions | Rationale |
| Examine the patient’s readiness for and attitude toward amputation. | According to research, amputation puts the patient’s psychological and emotional well-being at risk. Patients who see amputation as a life-saving or reconstructive procedure may have an easier time accepting their new self. Patients who have had a sudden traumatic amputation or who believe their amputation was the result of a failure of previous therapies are more likely to have self-concept issues. |
| Assist the amputee in adjusting to his new body image. | To more easily accept the new self. |
| Encourage fear, negative sentiments, and grief at the loss of a body part to be expressed. | Venting feelings assists the patient in coming to terms with the fact that he or she is living without a limb. |
| Remind patients about the type and location of amputation, the type of prosthetic fitting (immediate or delayed), and the expected postoperative course, which includes pain management and rehabilitation. | Allows the patient to ask questions and process information, as well as begin to deal with changes in body image and function, which can help with postoperative recovery. |
| Assess the patient’s level of assistance. | The rehabilitation process might be aided with adequate support from SO and friends. |
| Determine the patient’s personal strengths and prior positive coping behaviors. | It is beneficial to build on the patient’s existing strengths in order to help them cope with the current predicament. |
| Encourage people to participate in ADLs. Allow people to see and care for the stump, taking advantage of the opportunity to point out evidence of healing. | Increases sense of self-worth and promotes independence. Although the integration of the stump into the patient’s body image can take months or even years, looking at the stump and hearing pleasant comments (given in a normal, matter-of-fact manner) can aid acceptance. |
| Encourage and arrange for a visit from another amputee, particularly one who is recuperating well. | A friend who has gone through a comparable ordeal might act as a role model, validating comments and providing hope for rehabilitation and a normal future. |
| Take note of withdrawn conduct, negative self-talk, denial, or excessive worry about actual or perceived changes. | The stage of mourning and the need for interventions are identified. |
| Allow the patient to express his or her sexual issues in a safe atmosphere. | Promotes the sharing of opinions and values regarding the sensitive subject, as well as the identification of myths and misconceptions that may obstruct adjustment to the circumstance. |
| Discuss the availability of different resources, such as psychiatric and sexual counseling, as well as occupational therapy. | These concerns may necessitate support in order to promote effective adaptation and recuperation. |
Nursing Care Plan for Amputation 2
Nursing Diagnosis: Impaired Physical Mobility related to limb loss (especially one of the lower extremities), pain/discomfort, and perceptual impairment (altered sense of balance) secondary to amputation as evidenced by fear of attempting movement
Reduced muscle strength, control, and bulk; impaired coordination
Desired Outcomes:
- The patient will express verbally his or her awareness of the issue, treatment plan, and safety precautions.
- The patient will exhibit and maintain a position of function as evidenced by the absence of contractures.
- The patient will exhibit skills and behaviors that allow tasks to be resumed.
- The patient will show an interest in participating in activities.
| Amputation Nursing Interventions | Rationale |
| Encourage the patient to complete the exercises prescribed. | To avoid injury to the stump. |
| Regularly examine the region, clean and dry thoroughly, and rewrap the stump with an elastic bandage or air splint, or use a stump shrinker (thick stockinette sock) for “delayed” prosthesis. | Allows the assessment of healing and identification of any difficulties (unless covered by an immediate prosthesis). Wrapping the stump helps mold it into a conical shape, which makes it easier to fit the prosthesis. |
| Measure circumference on a regular basis. | This is to determine shrinkage and maintain optimal sock and prosthesis fit. |
| If the “immediate or early” cast is accidently dislodged, rewrap the stump with an elastic bandage and elevate it. Prepare the cast for reapplication. | Edema will develop quickly, delaying rehabilitation. |
| Beginning early in the postoperative stage, assist with specific ROM exercises for both the affected and unaffected limbs. | Prevents contracture deformities, which can occur quickly and cause prosthesis use to be delayed. |
| Encourage upper-body and unaffected-limbs vigorous and isometric activities. | Improves muscle strength to make transfers and ambulation easier, as well as improve mobility and a more normal lifestyle. |
| Keep the patient’s knees extended. | To avoid contractures in the hamstring muscles. |
| As directed, provide trochanter rolls. | External rotation of the lower-limb stump is prevented. |
| Instruct the patient to lie in the prone position as tolerated with a pillow under the abdomen and lower-extremity stump at least twice a day. | Extensor muscles are strengthened, and flexion contracture of the hip is avoided, which can develop within 24 hours of persistent malpositioning. |
| Avoid putting the pillow under a lower-extremity stump or letting a BKA limb hang over the side of the bed or chair. | Pillow use can result in persistent hip flexion contracture; a stump in a dependent position reduces venous return and can lead to edema accumulation. |
Nursing Care Plan for Amputation 3
Nursing Diagnosis: Risk for Infection related to primary defenses are insufficient (broken skin, traumatized tissue), invasive procedures, exposure to the environment, changed dietary status, and chronic disease secondary to amputation
Desired Outcome: The patient will exhibit wound healing in a timely manner as evidenced by absence of fever, purulent discharge or erythema.
| Amputation Nursing Interventions | Rationale |
| Monitor vital signs (particularly in hypovolemic shock), clean the wound, and administer tetanus prophylaxis and antibiotics as directed during emergency therapy. | In order to avoid skin infection. |
| Wrap the severed area in a damp dressing soaked in regular saline solution after a full amputation. Label the component, place it in a plastic bag, and place it in ice water. | So that it isn’t thrown away by accident. |
| Apply a sterile pressure dressing after flushing the wound with sterile saline solution. | Prevent the spread of germs. |
| Practice aseptic methods during wound dressing change and wound care. | Reduces the chance of bacteria being introduced. |
| Examine the incision and dressings for any signs of drainage. | Early diagnosis of an illness in progress allows for prompt action and prevention. potentially dire consequences |
| Maintain patency and empty drainage device on a regular basis. | Hemovac and Jackson-Pratt drains make drainage clearance easier, increasing wound healing and lowering infection risk. |
| When using the bedpan or if incontinent, cover the dressing with plastic. | Lower-limb amputation contamination is avoided. |
| After the dressings have been removed, expose the stump to the air and bathe it with mild soap and water. | Maintains skin cleanliness, reduces skin pollutants, and aids in the healing of sensitive and delicate skin. |
| Observe vital signs. | Temperature increase and tachycardia could indicate the onset of sepsis. |
| As needed, get wound and drainage cultures as well as sensitivities. | Detects illness and specific pathogens, as well as the relevant treatment. |
| Antibiotics should be given as directed. | Antibiotics with a broad spectrum of action can be administered prophylactically, or antibiotic therapy can be tailored to specific species. |
Nursing Care Plan for Amputation 4
Risk for Ineffective Tissue Perfusion
Nursing Diagnosis: Risk for Ineffective Tissue Perfusion related to tissue edema, hematoma development, reduced arterial/venous blood flow, and hypovolemia secondary to amputation.
Desired Outcome: The patient will maintain adequate tissue perfusion as evidenced by palpable peripheral pulses, warm/dry skin, and prompt wound healing.
| Amputation Nursing Interventions | Rationale |
| Observe vital signs. Examine the strength and equality of the peripheral pulses. | General indications of circulatory health and perfusion sufficiency. |
| Make regular neurovascular evaluations (sensation, movement, pulse, skin color, and temperature). | Tissue necrosis can result from postoperative tissue edema, hematoma development, or tight dressings that reduce circulation to the stump. |
| Examine the dressings and drainage device, noting the amount of drainage and its characteristics. | Continued blood loss may necessitate additional fluid replacement, coagulation testing, or surgical intervention to ligate the bleeder. |
| If a hemorrhage occurs, apply direct pressure to the bleeding location. Contact the doctor right away. | Once bleeding has been controlled, apply direct pressure to the bleeding location before applying a bulk dressing fastened with an elastic wrap. |
| The bandage may be too tight if the patient has throbbing after the stump is wrapped. Reapply the bandage after removing it. | Circulation problems are indicated by throbbing. |
| Regularly inspect the bandage. | In order to avoid more complications. |
| Examine any complaints of chronic or unusual pain at the surgical site. | A hematoma might develop in the muscle pocket behind the flap, limiting circulation and exacerbating pain. Check for inflammation and a positive Homans’ sign in the non-operated lower leg. |
| Check for inflammation and a positive Homans’ sign in the non-operated lower leg. | Patients with previous peripheral vascular disease and diabetes alterations have a higher risk of thrombus development. |
| Hb and Hct tests should be monitored. | Hypovolemia and dehydration indicators that can affect tissue perfusion. |
| PT and activated partial thromboplastin time should be monitored (aPTT). | Assesses the necessity for and efficacy of anticoagulant medication, as well as potential complications including posttraumatic disseminated intravascular coagulation (DIC). |
| Encourage early ambulation and provide assistance. | Improves circulation and helps to avoid stasis and its problems. Promotes a general feeling of well-being. |
Nursing Care Plan for Amputation 5
Nursing Diagnosis: Acute pain related to physical injury (e.g., tissue or nerve trauma) and psychological factors (e.g., impact of body part loss, stress, anxiety) secondary to amputation as evidenced by pain reports, both verbalized and coded, protective gestures and guarding behavior, narrowed focus, and vital signs changes.
Desired Outcomes:
- The patient will report that the discomfort has been eased or controlled.
- The patient will appear relaxed and capable of getting adequate rest and sleep.
- The patient will explain his/her understanding of phantom pain and how to relieve it.
| Amputation Nursing Interventions | Rationale |
| Document the location, intensity, and aggravating elements of the patient’s pain (0 to 10, or comparable coded scale). Examine numbness and tingling as pain features alter. | Aids in determining the need for and efficacy of interventions. Changes could suggest the onset of problems including necrosis or infection. |
| For upper-limb amputation, elevate the injured portion by lifting the foot of the bed slightly or using a cushion or sling. | Reduces muscle fatigue and skin or tissue pressure while reducing edema development by increasing venous return. Note: If there is no edema after the first 24 hours, the residual limb can be stretched and kept flat. |
| Provide or encourage general comfort measures (e.g., frequent bathroom breaks). Diversional actions (turning, back rub) Encourage the use of stress-reduction practices like deep breathing. Therapeutic Touch, visualization and guided imagery, and exercises. | It refocuses attention, encourages relaxation, improves coping capacities, and reduces the recurrence of phantom limb discomfort. |
| Investigate reports of analgesic-resistant pain that is progressive or poorly localized. | It’s possible that the patient is suffering from compartment syndrome, especially after a traumatic injury. |
| Patient-controlled analgesia should be taught and monitored (PCA). | PCA allows for consistent and timely medication administration, avoiding pain fluctuations, muscular tension, and spasms that might occur during surgical operations. |
Nursing References
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
