{
  "name": "Amputation",
  "slug": "amputation",
  "url": "https://nursingplex.com/care-plans/amputation",
  "category": "Surgery & Perioperative",
  "summary": "Limb loss care covering stump healing, phantom limb pain, prosthesis readiness and body image.",
  "nursing_diagnoses": [
    "Acute pain",
    "Disturbed body image",
    "Impaired physical mobility",
    "Risk for infection"
  ],
  "overview": [
    "Amputation is the surgical or traumatic removal of part or all of a limb, performed most often because of peripheral vascular disease and diabetic complications, but also for trauma, malignancy, congenital deformity or overwhelming infection. It represents a major physical loss that changes mobility, body image and independence, and nursing care must address both the surgical wound and the profound psychological adjustment that follows.",
    "The immediate postoperative period focuses on protecting the residual limb (stump), monitoring for hemorrhage and infection, and controlling pain — including the often distressing phenomenon of phantom limb sensation and pain, in which the brain continues to perceive the missing limb. As healing progresses, care shifts toward shaping the residual limb for prosthetic fitting, rebuilding strength, and helping the patient relearn functional tasks.",
    "Because many amputations occur in patients with underlying vascular disease or diabetes, wound healing is often compromised and the contralateral limb remains at ongoing risk. Nursing care therefore extends beyond the surgical site to protecting remaining tissue, optimizing glycemic and vascular status, and supporting a realistic, hopeful rehabilitation trajectory."
  ],
  "key_facts": [
    {
      "label": "Phantom sensation",
      "text": "The vast majority of amputees experience a sense that the limb is still present; phantom pain is a distinct, treatable phenomenon that differs from stump pain."
    },
    {
      "label": "Positioning caution",
      "text": "Avoid prolonged hip or knee flexion (pillows under the stump, sitting with legs bent) after lower limb amputation to prevent contractures that block prosthetic fitting."
    },
    {
      "label": "Residual limb shaping",
      "text": "Elastic bandaging or a shrinker sock is applied in a figure-eight pattern to shape the stump into a cone for prosthetic fit."
    },
    {
      "label": "Hemorrhage risk",
      "text": "Keep a tourniquet at the bedside for major limb amputations in case of sudden bleeding from the surgical site."
    },
    {
      "label": "Vascular etiology",
      "text": "In vascular or diabetic amputations, protecting the remaining limb from injury is as important as caring for the amputation site."
    }
  ],
  "nursing_priorities": [
    "Monitor for and immediately manage postoperative hemorrhage.",
    "Control surgical pain and phantom limb pain effectively.",
    "Prevent contractures through positioning and early mobilization.",
    "Assess and promote residual limb wound healing.",
    "Support the patient through grief and body image changes.",
    "Prevent complications of immobility and protect the remaining limb.",
    "Prepare the patient for prosthetic fitting and functional rehabilitation."
  ],
  "assessment": {
    "subjective": [
      "Reports of pain at the surgical site, described in quality and intensity",
      "Sensation that the amputated limb is still present, with or without pain (phantom phenomenon)",
      "Expressions of grief, anger, denial or altered body image",
      "Fear about future mobility, independence or return to work",
      "Reports of itching, tingling or cramping in the residual limb",
      "Concerns about appearance and how others will perceive them"
    ],
    "objective": [
      "Surgical dressing for drainage, bleeding or signs of infection",
      "Residual limb color, temperature, edema and shape",
      "Range of motion of proximal joints and evidence of contracture development",
      "Vital sign changes suggesting hemorrhage or infection",
      "Skin integrity of the remaining limb and pressure points",
      "Muscle strength and ability to perform transfers or use assistive devices",
      "Affect and coping behaviors observed during care and interactions"
    ],
    "related_factors": [
      "Peripheral vascular disease or diabetic complications causing tissue ischemia and infection",
      "Trauma resulting in irreparable limb damage",
      "Malignant tumor requiring surgical removal of the limb",
      "Severe infection or gangrene threatening life or the rest of the limb",
      "Congenital limb deficiency or deformity",
      "Loss of a valued body part contributing to disturbed body image and grief"
    ]
  },
  "goals": [
    "The client will exhibit a clean, healing residual limb wound free of infection.",
    "The client will report pain, including phantom pain, controlled to an acceptable level.",
    "The client will maintain full range of motion of proximal joints without contracture.",
    "The client will demonstrate beginning acceptance of altered body image.",
    "The client will participate actively in mobility and rehabilitation activities.",
    "The client will verbalize understanding of residual limb care and prosthetic preparation."
  ],
  "interventions": [
    {
      "title": "1. Immediate postoperative monitoring",
      "points": [
        "Monitor vital signs frequently and inspect the dressing for bleeding, since major vessels near the amputation site can hemorrhage suddenly.",
        "Keep a tourniquet visibly available at the bedside for major limb amputations in case of emergency hemorrhage.",
        "Assess the residual limb for warmth, color and capillary refill to evaluate perfusion at the incision.",
        "Monitor for early signs of infection, including fever, increasing pain, or purulent drainage.",
        "Elevate the residual limb per protocol for the first 24 hours to reduce edema, then follow positioning guidelines to prevent contracture."
      ]
    },
    {
      "title": "2. Pain and phantom limb management",
      "points": [
        "Differentiate surgical stump pain from phantom limb pain, since the two respond to different interventions.",
        "Administer prescribed analgesics on a scheduled basis initially, since preventing pain is easier than treating breakthrough pain.",
        "Validate that phantom sensations and pain are a real neurological phenomenon, not imagined, to reduce patient distress and stigma.",
        "Offer adjunct measures such as gentle massage, mirror therapy, distraction or relaxation techniques for phantom pain.",
        "Collaborate with the provider regarding adjunct medications such as gabapentin when phantom pain is significant."
      ]
    },
    {
      "title": "3. Preventing contracture and promoting mobility",
      "points": [
        "Position the residual limb in extension rather than flexion; avoid pillows propping a lower-extremity stump in a flexed position.",
        "Encourage the patient to lie prone periodically after lower-extremity amputation to stretch hip flexors, if not contraindicated.",
        "Begin range-of-motion exercises to proximal joints as soon as permitted.",
        "Collaborate with physical therapy for progressive strengthening, balance training and eventual gait training.",
        "Teach safe transfer and mobility techniques appropriate to the level of amputation before independent ambulation is attempted."
      ]
    },
    {
      "title": "4. Residual limb care and prosthetic preparation",
      "points": [
        "Apply elastic wraps or a shrinker sock in a figure-eight pattern as ordered to shape the residual limb into a cone for prosthetic fitting.",
        "Inspect the residual limb skin daily for redness, blistering or breakdown, particularly once prosthetic use begins.",
        "Teach proper hygiene of the residual limb, including daily washing and thorough drying before applying a liner or prosthesis.",
        "Coordinate timing of prosthetic fitting with the surgeon and prosthetist based on wound healing and limb shrinkage."
      ]
    },
    {
      "title": "5. Psychosocial support and body image",
      "points": [
        "Encourage the patient to express feelings of grief, anger or loss related to the amputation without judgment.",
        "Allow the patient to view and touch the residual limb when ready, supporting them through the initial reaction.",
        "Involve peer support groups or others who have successfully adapted to limb loss when appropriate.",
        "Include family in education and support, since their reactions strongly influence the patient's adjustment.",
        "Refer for counseling or psychiatric support if grief responses appear prolonged or complicated."
      ]
    }
  ],
  "patient_teaching": [
    "Inspect the residual limb daily for redness, open areas, or unusual drainage and report changes promptly.",
    "Follow the prescribed wrapping or shrinker sock schedule to shape the limb properly for a prosthesis.",
    "Avoid positions that keep the residual limb bent for long periods to prevent contractures that interfere with prosthetic fitting.",
    "Manage phantom limb sensations with prescribed techniques and understand that they often diminish over time.",
    "Protect the remaining limb carefully, especially if vascular disease or diabetes was the underlying cause, including daily skin checks and proper footwear.",
    "Participate actively in physical therapy sessions, since consistent practice speeds functional recovery.",
    "Reach out to support groups or counseling resources if feelings of loss or depression persist.",
    "Attend all follow-up appointments with the surgeon and prosthetist to monitor healing and prosthetic fit."
  ]
}