Amputation is the surgical or traumatic removal of all or part of a limb. Most lower-limb amputations in adults are done for peripheral artery disease and diabetes. The nursing diagnoses used most often are Acute Pain (including phantom limb pain), Impaired Physical Mobility, Risk for Surgical Site Infection, and Disturbed Body Image. The nurse watches for bleeding, manages pain, shapes and protects the residual limb, prevents contractures and falls, and supports the client through grief and rehabilitation.
At a glance
- What it is
- Removal of a limb or part of a limb, planned (surgical) or from injury (traumatic). The part that remains is the residual limb.
- Main causes
- Peripheral artery disease and diabetes with gangrene, non-healing ulcers or severe infection; trauma; bone or soft-tissue tumours; congenital limb differences.
- Common levels
- Toe, transmetatarsal, transtibial (below the knee), knee disarticulation, transfemoral (above the knee); upper limb: transradial and transhumeral.
- Nursing focus
- Bleeding and wound healing, pain (residual limb and phantom), limb shaping, contracture prevention, safe mobility, the other foot, and grief and body image.
- Report promptly
- Bright red bleeding or a soaked dressing, signs of infection, a dusky or cold residual limb, sudden chest pain or shortness of breath, uncontrolled pain, or new confusion.
Why amputation is done and what happens after
Most adult lower-limb amputations are dysvascular: poor arterial blood flow from peripheral artery disease, often with diabetes, leaves tissue unable to heal. A foot ulcer becomes infected, infection spreads to bone (osteomyelitis), or tissue dies (gangrene). When revascularization is not possible or has failed, the surgeon removes the limb at the lowest level that has enough blood flow to heal. Keeping the knee greatly improves the chance of walking with a prosthesis, because walking with an above-knee prosthesis takes much more energy.
Traumatic amputations follow crush injuries, machinery or motor vehicle accidents, blast injuries, and severe burns. They are more common in younger adults. Other causes include malignant bone tumours and congenital limb differences.
After surgery, the residual limb swells, then gradually shrinks and changes shape over weeks to months. Compression and shaping help it form a firm, cone-shaped end that fits a prosthesis. Healing is slower when blood flow is poor, blood glucose is high, the client smokes, or nutrition is low.
Almost everyone feels the missing limb is still there for a time (phantom sensation). Many people also feel phantom limb pain: burning, cramping, shooting, or crushing pain in the part that is gone. It is real nerve pain, not imagined, and is different from pain in the residual limb itself. Unused joints above the amputation tighten quickly into flexion contractures, which can make fitting a prosthesis and walking much harder.
Nursing assessment
Subjective data
- Pain in the residual limb: location, character, intensity, and what helps
- Phantom sensation (tingling, itching, the limb feeling present) and phantom pain (burning, cramping, shooting)
- History before surgery: diabetes, smoking, peripheral artery disease, kidney disease, previous amputations, and how well the client walked
- Feelings about the loss: grief, anger, fear, worries about work, driving, intimacy, and independence
- Home layout (stairs, bathroom access), who is at home, and the client’s goals for rehabilitation
- What the client understands about limb care, prosthetic fitting, and the recovery timeline
Objective data
- Vital signs and the amount and colour of drainage on the dressing or in any drain
- Residual limb: colour, temperature, edema, incision edges, sutures or staples, and odour
- Pulses, colour, and sensation in the remaining limb, including the other foot in a client with diabetes
- Range of motion of the hip and knee above the amputation, and the resting position of the limb
- Strength in the arms and the other leg, sitting balance, and transfer ability
- Skin over pressure areas: sacrum, heels, and the remaining foot
- Blood glucose, hemoglobin, white blood cell count, albumin or other nutrition markers, and kidney function as ordered
- Mood, sleep, appetite, willingness to look at or touch the limb, and signs of delirium in older clients
Residual limb pain vs. phantom limb pain
| Feature | Residual limb pain | Phantom limb pain |
|---|---|---|
| Where it is felt | In the remaining part of the limb | In the part of the limb that has been removed |
| Common causes | Surgical pain, infection, poor blood flow, a neuroma, a poorly fitting prosthesis | Changes in the nerves, spinal cord, and brain after the limb is lost |
| What the client describes | Aching, throbbing, tenderness at the incision or pressure point | Burning, cramping, shooting, crushing, or the limb “twisted” in an odd position |
| Nursing priority | Inspect the limb and look for a cause that needs treatment | Believe the client, treat it as real pain, and combine medicines with non-drug measures |
Nursing diagnoses used with amputation
- Acute Pain — surgical pain in the residual limb and phantom limb pain
- Chronic Pain — phantom or residual limb pain that persists for months
- Impaired Physical Mobility — loss of a limb, pain, weakness, and changed balance
- Risk for Surgical Site Infection — poor blood flow, diabetes, and a large wound
- Risk for Ineffective Peripheral Tissue Perfusion — in the residual limb and the remaining limb of a client with arterial disease
- Risk for Adult Falls — changed balance, new mobility aids, and getting up at night forgetting the limb is gone
- Disturbed Body Image and Grieving — the loss of a body part and of former roles
- Risk for Impaired Skin Integrity — pressure from immobility and, later, from the prosthetic socket
Worked care plans
Four plans in the same ADPIE shape. The scenario is a 68-year-old man with type 2 diabetes and peripheral artery disease. A non-healing foot ulcer became infected and gangrenous, and yesterday he had a left transtibial (below-the-knee) amputation. He is on post-op day 1 on the surgical unit, with a compression dressing on the residual limb. He lives with his wife in a two-storey house and smokes.
1. Acute Pain
Problem-focusedSubjective: “My stump throbs, but the worst part is my left foot. It’s burning and cramping — and I know it isn’t there.” Rates residual limb pain 6/10 and phantom pain 8/10.
Objective: Grimacing and guarding the residual limb. Heart rate and blood pressure above his pre-op baseline. Dressing dry and intact. Declined physiotherapy this morning because of pain.
Acute Pain related to surgical tissue trauma and nerve injury from amputation, as evidenced by reported residual limb and phantom limb pain rated 6–8/10, guarding, grimacing, and declining activity.
- Client reports pain at or below his own acceptable level within the shift
- Client takes part in physiotherapy with pain controlled
- Client describes phantom pain as real and names two strategies that help
- Assess residual limb pain and phantom pain separately with a pain scale, and reassess after each intervention
- Inspect the residual limb when pain changes, to rule out bleeding, a tight dressing, or infection
- Give ordered analgesics on time, and before therapy and dressing changes; use the multimodal plan the provider orders, which may include medicines for nerve pain
- Tell the client that phantom pain is common and real, and that reporting it is important
- Offer non-drug measures that are in the plan: repositioning, gentle massage or tapping of the residual limb once the incision allows, distraction, relaxation, mirror therapy, or TENS as ordered
- Watch for sedation and slowed breathing with opioids, especially in an older client or one with kidney disease
By the end of the shift, residual limb pain is 3/10 and phantom pain 5/10. He completed bed exercises with physiotherapy. Goal partially met; phantom pain still above his goal — report to the provider and continue the plan.
2. Impaired Physical Mobility
Problem-focusedSubjective: “I’m afraid I’ll fall if I try to get up. I don’t know how I’ll ever manage the stairs at home.”
Objective: Needs help of one to move up the bed and sit at the edge. Unsteady sitting balance. Keeps the left knee bent on a pillow for comfort. Upper-body strength good.
Impaired Physical Mobility related to loss of the lower leg, pain, and altered balance, as evidenced by needing assistance with bed mobility and transfers, unsteady sitting balance, and fear of moving.
- Client keeps full knee and hip extension on the amputated side
- Client transfers bed to chair with the assistance level set by physiotherapy before discharge
- Client does his prescribed exercises daily
- No falls during the hospital stay
- Position the residual limb as the surgeon orders; after the early post-op period, do not prop it on a pillow, and keep the knee straight rather than bent
- Avoid long periods sitting in a chair or with the head of the bed high, which keep the hip flexed
- Have the client lie prone or flat for periods during the day if ordered and tolerated, to stretch the hip flexors
- Reinforce the exercises physiotherapy teaches, including upper-body and other-leg strengthening for transfers
- Use a gait belt and the transfer method physiotherapy has set; keep the bed low, the call light in reach, and a non-slip shoe on the remaining foot
- Remind the client that he may feel the leg is still there when he wakes, and to call before getting up at night
On post-op day 3 he moves in bed on his own, keeps the knee straight, and transfers to a wheelchair with standby assistance. No falls. Goal met for this stage; continue the plan and refer to inpatient rehabilitation.
3. Risk for Surgical Site Infection
Risk diagnosis- Diabetes with high blood glucose
- Peripheral artery disease, which reduces blood flow to the wound
- Amputation through an area close to recent infection and gangrene
- Smoking
- Age and possible low protein intake
No “as evidenced by” — this names a problem that has not happened yet.
Risk for Surgical Site Infection related to diabetes, peripheral artery disease, recent foot infection, smoking, and possible inadequate protein intake.
- Incision stays clean, dry, and closed, with edges together
- Temperature and white blood cell count stay within the ranges the provider has set
- Blood glucose stays within the target range the provider orders
- Client states the signs of infection to report
- Do hand hygiene and use aseptic technique for every dressing change, following the surgeon’s dressing orders
- Assess the incision, drainage, colour, warmth, and odour each shift and when the dressing is changed
- Monitor temperature, white blood cell count, and blood glucose; give insulin and antibiotics as ordered
- Encourage protein and calories, and request a dietitian review
- Offer smoking-cessation support and nicotine replacement if ordered, explaining that smoking slows wound healing
- Keep the residual limb clean and protected from incontinence and contamination
On day 4 the incision is closed with no redness or drainage, temperature is normal, and blood glucose is mostly within target. He names three signs of infection to report. Risk not realised; continue plan.
4. Disturbed Body Image
Problem-focusedSubjective: “I don’t want to look at it. I’m only half a man now. My wife shouldn’t have to deal with this.”
Objective: Turns away during dressing changes and keeps the limb covered. Quiet and withdrawn during his wife’s visit. Refers to the residual limb as “it.”
Disturbed Body Image related to loss of a body part and changed function, as evidenced by refusal to look at the residual limb, negative statements about himself, and withdrawal from his wife.
- Client looks at and touches the residual limb during care
- Client talks about his feelings about the loss with the nurse or his wife
- Client takes part in residual limb care before discharge
- Client agrees to meet a peer visitor or support group
- Acknowledge the loss and invite him to talk; grief, anger, and sadness are expected after amputation
- Let him set the pace: offer to look at the limb together during a dressing change, then to touch it, then to help with care
- Use the words “residual limb” and talk about function and goals, not only what is missing
- Include his wife in teaching and care, with his consent
- Offer a peer visitor who has had an amputation, and information about amputee support groups
- Screen for depression and refer to social work or mental health services if low mood persists
He looked at the limb during the day-3 dressing change and helped apply the shrinker on day 5. He has agreed to a peer visit but is still reluctant to talk with his wife about the change. Goal partially met; continue plan.
Free download
NCLEX Readiness Diagnostic
Fifty questions with a written rationale on every option, scored by section so you can see which content area is weakest. Sent as a PDF.
Interventions and rationales
Client and family teaching
- Look at the whole residual limb every day, using a mirror for the back, and report redness, blisters, drainage, or opening of the incision
- Wash the limb with mild soap and water, rinse, and dry it well; use lotions only if the care team recommends them
- Wear the shrinker or wrap as taught, and keep it smooth with no wrinkles
- Do the prescribed exercises every day, and lie flat or prone for periods if your therapist recommends it
- Do not rest the limb on a pillow, hang it over the edge of the bed, or sit for long periods with the hip or knee bent
- Phantom feelings and phantom pain are common and real; tell your care team about them
- Prosthetic fitting begins when the wound has healed and the limb shape has settled; your team will tell you when
- Check the other foot every day, wear well-fitting shoes, never walk barefoot, and keep blood glucose in your target range
- Stopping smoking protects the other leg and the healing wound
- Call your provider for fever, spreading redness, pus, a foul smell, or a cold, dusky limb; call 911 for heavy bleeding, chest pain, or trouble breathing
NurseStudyPrep.com
You’ve read the care plan. Now answer one.
A post-op care item in the NCLEX format. On Prep, every option gets a written rationale — including the three that are wrong.
A client is on post-op day 3 after a left transfemoral (above-the-knee) amputation. Which action by the nurse best helps prevent a hip flexion contracture?
Why C. Lying prone stretches the hip flexors and keeps the hip in extension. A pillow under the limb, a raised head of bed, and long periods of sitting all hold the hip bent, which is exactly how a flexion contracture forms. Prep also explains why each wrong option looks reasonable.
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Frequently asked questions
What is the nursing diagnosis for amputation?
Amputation is a procedure, so it goes in the “related to” part. Common nursing diagnoses are Acute Pain, Impaired Physical Mobility, Risk for Surgical Site Infection, Disturbed Body Image, Grieving, and Risk for Adult Falls.
What is the priority nursing care right after an amputation?
Airway, breathing, and circulation first: watch closely for hemorrhage and shock, then manage pain, protect the incision from infection, and position the limb to prevent contractures.
What is the difference between phantom sensation and phantom limb pain?
Phantom sensation is the painless feeling that the missing limb is still there, such as tingling or itching. Phantom limb pain is painful — burning, cramping, or shooting — and is felt in the part that was removed. Both are real and common.
Why shouldn’t a pillow be placed under the residual limb?
After the early post-op period, a pillow keeps the hip or knee bent, which can lead to a flexion contracture. Follow the surgeon’s positioning orders; any early elevation for swelling is usually short-term.
How do you wrap a residual limb?
With an elastic bandage in a figure-of-eight pattern, starting at the end of the limb and working upward, with firmer pressure at the end. Never wrap in circles, which can cut off blood flow. Many units use a shrinker sock or rigid dressing instead.
When can a client be fitted for a prosthesis?
When the incision has healed and swelling has gone down enough for the limb to keep a stable shape. Timing differs from person to person; the surgeon and prosthetist decide.
References
- Herdman, T. H., Kamitsuru, S., & Lopes, C. T. (Eds.). NANDA International Nursing Diagnoses: Definitions and Classification, 2024–2026. Thieme.
- Harding, M. M., Kwong, J., & Hagler, D. Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 12th ed. Elsevier, 2023.
- Ignatavicius, D. D., Rebar, C. R., & Heimgartner, N. M. Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th ed. Elsevier, 2024.
- U.S. Department of Veterans Affairs and Department of Defense. VA/DoD Clinical Practice Guideline for Rehabilitation of Individuals With Lower Limb Amputation.
- Heyns, A., et al. Systematic Review of Clinical Practice Guidelines for Individuals With Amputation. Archives of Physical Medicine and Rehabilitation, 2021;102(6):1191–1197.
- Amputee Coalition. Limb loss resources and peer support.
Positioning and elevation orders, dressing and compression methods, mobility progression, analgesic choices and doses, blood glucose targets, and tourniquet policy vary by client, by surgeon, and by facility. Follow the provider’s written orders and your own institution’s standards. This page supports study and does not replace course instruction or clinical judgement.
