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The earliest literary proofs of amputation exist from 1700 BCE in the Babylonian code of Hammurabi and from 385 BCE in Plato's Symposium. Stone Age (Neolithic period) caves have been found with imprints of hands with missing fingers; human remains have been discovered, some with a prosthetic lower extremity, that reveal amputations were performed early in time (Ertl, 2016). Ertl also noted lower extremity amputations (LEAs) now compose approximately 85% of all amputations performed. Irreversible ischemia related to peripheral vascular disease (PVD) is the primary cause of amputation (Daniels & Nicoll, 2012; Gulanick & Myers, 2014; Vetra, Lacis, Raipalis, Legzdina, & Logins, 2016). Trauma to a limb is the second leading cause of amputation (Gulanick & Myers, 2014). Key considerations for the nurse's role during care following LEA will be explored in this article.
Case Study
Mrs. M. was on Christy's list of patient care assignments for the first time. When she walked in Mrs. M.'s room, she saw a 57-year-old woman covering her eyes with her hands as tears streamed down her cheeks. She was going to be discharged to a rehabilitation facility at the end of the week. Mrs. M. had both legs amputated below her knees because of severely compromised circulation secondary to diabetes mellitus. She was experiencing severe phantom pain in her lower legs. She was anxious and afraid, and said she felt "incomplete." Cindy comforted Mrs. M., encouraging the patient to express her feelings, and began performing an in-depth assessment of pain and the patient's residual limbs. Cindy assisted Mrs. M. to a different position, started to play a compact disc of Mrs. M.'s favorite music at her bedside, and administered analgesia as ordered. Cindy knew pain management interventions, emotional support, and patient education would be central to her patient care today. Mrs. M.'s physical healing and emotional acceptance were just beginning. She could not visualize how a positive outcome would ever be a part of her life again.
Nursing Considerations
Nursing care of the patient following amputation is complex. In-depth and ongoing assessments, pain management, wound care, awareness of possible postoperative complications, education, safety, range of motion and mobility, and emotional needs are nursing priorities during the initial postoperative period (Ertl, 2016; Gulanick & Myers, 2014). See Table 1...