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