NCLEX RN Practice Question # 479

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Amuputation of Lower Extremity (NCLEX Review)

Description:

Amputation is the surgical removal of a limb or part of the limb.

Postoperative interventions

• Monitor vital signs.
• Monitor for infection and hemorrhage.
• Mark bleeding and drainage on the dressing if it occurs.
• Keep a tourniquet at the bedside if prescribed.
• Observe for and prevent contractures, which can result from prolonged residual limb elevation.
• Monitor for signs of infection, necrosis, and neuroma.
• Evaluate for phantom limb sensation and pain; explain sensation and pain to the client, and medicate the client as prescribed.
• First 24 hours: Elevate the foot of the bed to reduce edema; then keep the bed flat to prevent hip flexion contractures, if prescribed by the physician.
• After 24 to 48 hours postoperatively, position the client prone to stretch the muscles and prevent hip flexion contractures, if prescribed.
• To prevent hip flexion contractures, do not elevate the residual limb on a pillow.
• Maintain surgical application of dressing, elastic compression wrap, or elastic stump (residual limb) shrinker as prescribed to reduce swelling, minimize pain, and mold the residual limb in preparation for prosthesis.
• As prescribed, wash the residual limb with mild soap and water and dry completely.
• Massage the skin toward the suture line to mobilize scar and prevent its adherence to underlying bone.
• Prepare for the prosthesis and instruct the client in progressive resistive techniques by gently pushing the residual limb against pillows and progressing to firmer surfaces.
• Encourage verbalization regarding loss of the body part, and assist the client to identify coping mechanisms to deal with the loss.

Interventions for below-knee amputation

• Prevent edema.
• Do not allow the residual limb to hang over the edge of the bed.
• Discourage long periods of sitting to lessen complications of knee flexion.

Interventions for above-knee amputation

• Prevent internal or external rotation of the limb.
• Place a sandbag, rolled towel, or trochanter roll along the outside of the thigh to prevent external rotation.

Rehabilitation

• Instruct the client in the use of a mobility aid such as crutches or a walker.
• Prepare the residual limb for a prosthesis.
• Prepare the client for fitting of the residual limb for a prosthesis.
• Instruct the client in exercises to maintain range of motion and upper body strengthening.
• Provide psychosocial support to the client.