Nursing Care of Patients
With Musculoskeletal
Trauma
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Amputations
n Surgical amputation
n Traumatic amputation
n Levels of amputation
n Complications of amputations:
hemorrhage, infection, phantom limb pain,
problems associated with immobility,
neuroma (a growth or tumour of nerve
tissue), flexion contracture
Amputation
Nursing Management
n relieving pain
n minimizing altered sensory
perception
n promoting wound healing
n enhancing body image
n self-care
Question
Is the following statement True or False?
Phantom limb pain is perceived in the
amputated limb.
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Answer
True
Phantom limb pain is perceived in the
amputated limb.
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Phantom Limb Pain
n Phantom limb pain is a frequent
complication of amputation.
n Client complains of pain at the site of the
removed body part, most often shortly
after surgery.
n Pain is intense burning feeling, crushing
sensation or cramping.
n Some clients feel that the removed body
part is in a distorted position.
Management of Phantom Pain
Phantom limb pain must be distinguished from
stump pain because they are managed
differently.
Recognize that this pain is real and interferes
with the amputee’s activities of daily living.
n Some studies have shown that opioids are not
as effective for phantom limb pain as they are
for residual limb pain.
n Other drugs include intravenous infusion
calcitonin, beta blockers, anticonvulsants, and
antispasmodics.
(
Exercise After Amputation
n ROM to prevent flexion contractures,
particularly of the hip and knee
n Trapeze and overhead frame
n Firm mattress
n Prone position every 3 to 4 hours
n Elevation of lower-leg residual limb
controversial
Rehabilitation Needs
n Psychological support
n Prostheses fitting and use
n Physical therapy
n Vocational/occupational training and
counseling
n Use a multidisciplinary team approach
n Patient teaching
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Nursing Process: The Care of the Patient
with an Amputation—Assessment
n Neurovascular status and function of
affected extremity or residual limb and of
unaffected extremity
n Signs and symptoms of infection
n Nutritional status
n Concurrent health problems
n Psychological status and coping
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Nursing Process: The Care of the Patient
with an Amputation—Diagnoses
n Acute pain
n Risk for disturbed sensory perception
n Disturbed body image
n Ineffective coping
n Risk for anticipatory or dysfunctional
grieving
n Self-care deficit
n Impaired physical mobility
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Collaborative Problems/Potential
Complications
n Postoperative hemorrhage
n Infection
n Skin breakdown
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Nursing Process: The Care of the Patient
with an Amputation—Planning
n Major goals may include:
n relief of pain,
n absence of altered sensory perceptions,
n wound healing,
n acceptance of altered body image,
n resolution of grieving processes,
n restoration of physical mobility, and
n absence of complications.
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Interventions
n Relief of pain
n Administer analgesic or other medications as
prescribed
n Changing position
n Putting a light sand bag on residual limb
n Alternative methods of pain relief- distraction,
TENS unit
Note: Pain may be an expression of grief and
altered body image
• Promoting wound healing
• Handle limb gently
• Residual limb shaping 16
Resolving Grief and Enhancing Body
Image
n Encourage communication and expression of
feelings
n Create an accepting, supportive atmosphere
n Provide support and listen
n Encourage patient to look at, feel, and care for the
residual limb
n Help patient set realistic goals
n Help patient resume self-care & independence
n Referral to counselors and support groups
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Achieving Physical Mobility
n Proper positioning of limb; avoid abduction,
external rotation and flexion
n Turn frequently; prone positioning if possible
n Use of assistive devices
n ROM exercises
n Muscle strengthening exercises
n “Preprosthetic care”; proper bandaging,
massage, and “toughening” of the residual
limb 18
