In general, amputation of limbs is the result of trauma, peripheral vascular disease, tumors, and

congenital disorders. This is an amputation nursing care plan for a patient with impaired physical
mobility. 

Nursing Diagnosis
Impaired Physical Mobility
Related to: 
  Loss of a limb (particularly a lower extremity); pain/discomfort; perceptual impairment (altered

sense of balance)

Desired Outcomes: 
 Verbalize understanding of individual situation, treatment regimen, and safety measures.
 Maintain position of function as evidenced by absence of contractures.
 Demonstrate techniques/behaviors that enable resumption of activities.
 Display willingness to participate in activities.

Nursing Interventions Rationale

Provide stump care on a routine basis, Provides opportunity to evaluate healing and
e.g., inspect area, cleanse and dry note complications (unless covered by immediate
thoroughly, and rewrap stump with prosthesis). Wrapping stump controls edema and
elastic bandage or air splint, or apply a helps form stump into conical shape to facilitate
stump shrinker (heavy stockinette fitting of prosthesis. Note: Air splint may be
sock), for “delayed” prosthesis. preferred, because it permits visual inspection of
the wound
Measure circumference periodically Measurement is done to estimate shrinkage to
ensure proper fit of sock and prosthesis.
Rewrap stump immediately with an Edema will occur rapidly, and rehabilitation can
elastic bandage, elevate if be delayed
“immediate/early” cast is
accidentally dislodged. Prepare for
reapplication of cast.
Assist with specified ROM exercises Prevents contracture deformities, which can
for both the affected and unaffected develop rapidly and could delay prosthesis usage.
limbs beginning early in
postoperative stage.
Encourage active/isometric exercises Increases muscle strength to
for upper torso and unaffected limbs. facilitate transfers/ambulation and promote
mobility and more
 normal lifestyle.
Provide trochanter rolls as indicated. Prevents external rotation of lower-limb stump
Instruct patient to lie in prone position Strengthens extensor muscles and prevents
as tolerated at least twice a day with flexion contracture of the hip, which can begin to
pillow under abdomen and lower- develop within 24 hr of sustained malpositioning.
extremity stump.
Caution against keeping pillow under Use of pillows can cause permanent flexion
lower-extremity stump or allowing contracture of hip; a dependent position of stump
BKA limb to hang dependently impairs venous return and may increase edema
over side of bed or chair. formation.
Demonstrate/assist with transfer Facilitates self-care and patient’s independence.
techniques and use of mobility aids, Proper transfer techniques prevent shearing
e.g., trapeze, crutches, or walker. abrasions/dermal injury related to “scooting.”
Assist with ambulation. Reduces potential for injury. Ambulation after
lower-limb amputation depends on timing of
prosthesis placement.
 Instruct patient in stump-conditioning Hardens the stump by toughening the skin and
exercises altering feedback of resected nerves to facilitate
use of prosthesis.
 Refer to rehabilitation team Provides for creation of exercise/activity program
to meet individual needs and strengths, and
identifies mobility functional aids to promote
independence. Early use of a temporary
prosthesis promotes activity and enhances
general well-being/positive outlook. Note:
Vocational counseling/retraining also may be
indicated.
 Provide foam/flotation mattress.  Reduces pressure on skin/tissues that can
impair circulation, potentiating risk of tissue
ischemia/breakdown

Risk for Infection — Amputation

In general, amputation of limbs is the result of trauma, peripheral vascular disease, tumors, and
congenital disorders. This is an amputation nursing care plan for a patient with a risk for infection.
Nursing Diagnosis
Risk for Infection

Desired Outcomes
§     Achieve timely wound healing; be free of purulent drainage or erythema; and be afebrile.
 

Nursing Interventions Rationale

Maintain aseptic technique when changing Minimizes opportunity for introduction of bacteria.
dressings/caring for wound.
Inspect dressings and wound; note characteristics of Early detection of developing infection provides
drainage. opportunity for timely intervention and prevention of
more serious complications.
Maintain patency and routinely empty drainage Hemovac, Jackson-Pratt drains facilitate removal of
device. drainage, promoting wound healing and reducing risk
of
infection.
Cover dressing with plastic when using the bedpan Prevents contamination in lower-limb amputation.
or if
incontinent.
Expose stump to air; wash with mild soap and water Maintains cleanliness, minimizes skin contaminants,
after and
dressings are discontinued. promotes healing of tender/fragile skin.
Monitor vital signs. Temperature elevation/tachycardia may reflect
developing sepsis.
Obtain wound/drainage cultures and sensitivities as Identifies presence of infection/specific organisms and
appropriate. appropriate therapy.
Administer antibiotics as indicated. Wide-spectrum antibiotics may be used
prophylactically,
or antibiotic therapy may be geared toward specific
organisms.

Risk for Ineffective Tissue Perfusion — Amputation

In general, amputation of limbs is the result of trauma, peripheral vascular disease, tumors, and
congenital disorders.
Nursing Diagnosis:
 Tissue Perfusion, risk for ineffective: peripheral

Desired Outcomes: 
Patient will Maintain adequate tissue perfusion as evidenced by palpable peripheral pulses, warm/dry
skin, and timely wound healing.

Nursing Interventions Rationale

Monitor vital signs. Palpate peripheral General indicators of circulatory status and
pulses, noting strength and equality. adequacy of perfusion.
Perform periodic neurovascular Postoperative tissue edema, hematoma
assessments (sensation, movement, pulse, formation, or restrictive dressings may
skin color, and temperature). impair circulation to stump, resulting in
tissue necrosis.
Inspect dressings/drainage device, noting Continued blood loss may indicate need for
amount and characteristics of drainage. additional fluid replacement and evaluation
for coagulation defect or surgical
intervention to ligate bleeder.
Apply direct pressure to bleeding site if Direct pressure to bleeding site may be
hemorrhage occurs. Contact physician followed by application of a bulk dressing
immediately. secured with an elastic wrap once bleeding is
controlled.
Investigate reports of persistent/unusual Hematoma can form in muscle pocket under
pain in operative site. the flap, compromising circulation and
intensifying pain
Evaluate nonoperated lower limb for Increased incidence of thrombus formation
inflammation, positive Homans’ sign. in patients with preexisting peripheral
vascular disease/diabetic changes.
Encourage/assist with early ambulation. Enhances circulation, helps prevent stasis
and associated complications. Promotes
sense of general well-being.
Administer IV fluids/blood products as Maintains circulating volume to maximize
indicated. tissue perfusion.
Apply antiembolic/sequential compression Enhances venous return, reducing venous
hose to non-operated leg, as indicated. pooling and risk of thrombophlebitis.
Administer low-dose anticoagulant as May be useful in preventing thrombus
indicated. formation without increasing risk of
 postoperative bleeding/hematoma formation.
 Monitor laboratory studies, e.g.:  Indicators of hypovolemia/dehydration that
Hb/Hct; can impair tissue perfusion.
 PT/activated partial thromboplastin  Evaluates need for/effectiveness of
time (aPTT). anticoagulant therapy and identifies
developing complication, e.g., posttraumatic
disseminated intravascular coagulation (DIC)

Situational Low Self-Esteem — Amputation

Nursing Diagnosis
 Self-Esteem, situational low

Desired Outcomes
Begin to show adaptation and verbalize acceptance of self in situation (amputee).
Recognize and incorporate changes into self-concept in accurate manner without negating self-
esteem.
Develop realistic plans for adapting to new role/role modifications.

Nursing Interventions Rationale

Assess/consider patient’s preparation for Research shows that amputation poses serious
and view of amputation. threats to patient’s psychological and
psychosocial adjustment. Patient who views
amputation as life-saving or reconstructive may
be able to accept the new self more quickly.
Patient with sudden traumatic amputation or
who considers amputation to be the result of
failure in other treatments is at greater risk for
self-concept disturbances.
Encourage expression of fears, negative Venting emotions helps patient begin to deal
feelings, and grief over loss of body part. with the fact and reality of life without a limb.
Reinforce preoperative information Provides opportunity for patient to question and
including type/location of amputation, assimilate information and begin to deal with
type of prosthetic fitting if appropriate changes in body image and function, which can
(i.e., immediate, delayed), expected facilitate postoperative recovery.
postoperative course, including pain
control and rehabilitation.
Assess degree of support available to Sufficient support by SO and friends can
patient. facilitate rehabilitation process.
Ascertain individual strengths and Helpful to build on strengths that are already
identify previous positive coping available for patient to use in coping with
behaviors. current situation.
Encourage participation in ADLs. Promotes independence and enhances feelings
Provide opportunities to view/care for of selfworth. Although integration of stump
stump, using the moment to point out into body image can take months or even years,
positive signs of healing. looking at the stump and hearing positive
comments (made in a normal, matter-offact
manner) can help patient with this acceptance.
Encourage/provide for visit by another A peer who has been through a similar
amputee, especially one who is experience serves as a role model and can
successfully rehabilitating. provide validity to comments and hope for
recovery and a normal future.
Note withdrawn behavior, negative self- Identifies stage of grief/need for interventions.
talk, use of denial, or overconcern with
actual/perceived changes.
Provide open environment for patient to Promotes sharing of beliefs/values about
discuss concerns about sexuality. sensitive subject, and identifies
misconceptions/myths that may interfere with
adjustment to situation.
Discuss availability of various resources, May need assistance for these concerns to
e.g., psychiatric/ sexual counseling, facilitate optimal adaptation and rehab
occupational therapist.

Immediately After Surgery

Your hospital stay will be approximately 5 to 14 days after surgery. Your wound will be bandaged, and
you may also have a drain at the surgery site—a tube that is inserted into the area to help remove excess
fluid. Pain will be managed with proper medication.

Physical therapy will begin soon after surgery when your condition is stable and the doctor clears you for
rehabilitation. A physical therapist will review your medical and surgical history, and visit you at your
bedside. Your first 2 to 3 days of treatment may include:

 Gentle stretching and range-of-motion exercises

 Learning to roll in bed, sit on the side of the bed, and move safely to a chair
  Learning how to position your surgical limb to prevent contractures (the inability to straighten the
knee joint fully, which results from keeping the limb bent too much)

When you are medically stable, the physical therapist will help you learn to move about in a wheelchair,
and stand and walk with an assistive device.

Rehabilitation
Your physical therapist will work with you as you heal following the amputation, help to fit your
prosthesis, and guide your rehabilitation to ensure you regain your strength and movement in the safest
way possible. Your treatments may include:

Prevention of contractures. A contracture is the development of soft-tissue tightness that limits joint
motion. The condition occurs when muscles and soft tissues become stiff from lack of movement. The
most common contracture following transtibial amputation occurs at the knee when it becomes flexed and
unable to straighten. The hip also may become stiff.

It is important to prevent contractures early; they can become permanent if not addressed following
surgery, throughout recovery, and after rehabilitation is completed. Contractures can make it difficult to
wear your prosthesis and make walking more difficult, increasing the need for an assistive device like a
walker.

Your physical therapist will help you maintain normal posture and range of motion at your knee and hip.
Your therapist will teach you how to position your limb to avoid development of a contracture, and show
you stretching and positioning exercises to maintain normal range of motion.

Compression to reduce swelling. It is normal to experience postoperative swelling. Your physical

therapist will help you maintain compression on your residual limb to protect it, reduce and control
swelling, and help it heal. Compression can be accomplished by:

 Wrapping the limb with elastic bandages

 Wearing an elastic shrinker sock

These methods also help shape the limb to prepare it for fitting the prosthetic leg.

In some cases a rigid dressing, or plaster cast, may be used instead of elastic bandages. An immediate
postoperative prosthesis made with plaster or plastic also may be applied. The method chosen depends on
each person’s situation. Your physical therapist will help monitor the fit of these devices and instruct you
in their use. The main goal of your care during this time is to reduce swelling.

Pain management. Your physical therapist will help with pain management in a variety of ways,
including:

 Manual therapy, which may include “hands-on” treatments performed by your physical therapist,
including soft tissue (ie, muscle, tendon) mobilization, joint manipulation, or gentle range-of-
motion exercises, in order to improve circulation and joint motion

 Stump management, including skin care and stump sock use

  Desensitization to help modify how sensitive an area is to clothing, pressure, or touch
Desensitization involves stroking the skin with different types of touch to help reduce or
eliminate sensitivity

 Mirror therapy and/or graded motor imagery

Approximately 80% of people who undergo amputations experience a phenomenon called phantom limb
pain, a condition in which some of their pain feels like it is actually coming from the amputated limb.
Your physical therapist will work with you to lessen and eliminate the sensation. Please see our guide
on Phantom Limb Pain for more details.

Prosthetic fitting and training. Your physical therapist will work with a prosthetist to prescribe the best
prosthesis for your life situation and activity goals. You will receive a temporary prosthesis at first while
your residual limb continues to heal and shrink/shape over the first 6 to 9 months of healing. The
prosthesis will be modified to fit as needed over this time.

Most people with transtibial amputations learn to walk well with a prosthesis. Physicians use the
following criteria to determine when you are ready for a temporary prosthesis, or your first artificial limb.

 Your incision should be almost healed or completely healed.

 Your swelling should have decreased to an acceptable amount.

 You will have regained sufficient overall strength to be able to walk safely.

After the limb has reached a stable shape, and your physician approves your condition, you will be fitted
for a permanent prosthesis.

Functional training. After you move from acute care to rehabilitation, you will learn to function more
independently. Your physical therapist will help you master wheelchair mobility and walking with an
assistive device like crutches or a walker. Your therapist also will teach you the skills you need for
successful use of your new prosthetic limb. You will learn how to care for your residual limb with skin
checks and hygiene, and continue contracture prevention with exercise and positioning.

Your physical therapist will teach you how to put your new prosthesis on and take it off, and how to
manage a good fit with the socket type you receive. Your therapist will help you to gradually build up
tolerance for wearing your prosthesis for increasingly longer times, while protecting the skin integrity of
your residual limb. You will continue to use a wheelchair for getting around, even after you get your
permanent prosthesis, for times when you are not wearing the limb.

Guided rehabilitation. Prosthetic training is a process that can last up to a full year. You will begin when
your physician clears you for putting weight on the prosthesis. Your physical therapist will help you learn
to stand, balance, and walk with the prosthetic limb. Most likely you will begin walking in parallel bars,
then progress to a walker, and later as you get stronger, you may progress to using a cane before walking
independently without any assistance. You will also need to continue strengthening and stretching
exercises to achieve your fullest potential, as you return to many of the activities you performed before
your amputation.

Return to Recreational and Sports Activities

If you are active or have a favorite sport you may also want to consult with a recreational physical therapist, who
can help you choose appropriate adaptive recreation equipment. Depending on your personal goals and preferred
leisure activities, the recreational physical therapist can help you return to sports such as golf, hiking, running,
swimming, or cycling. A prosthetist can help you choose the best prosthetic device for taking part in these types of
activities. You also may gain valuable advice from other individuals with amputations; your physical therapist can
help you find support groups for people with amputations in your area.

 A physical therapist who is experienced in treating people with rehabilitation and

amputation conditions. Some physical therapists have a practice with a focus on
rehabilitation and prosthetic training for extremity amputation.

General tips when you're looking for a physical therapist (or any other health care provider):

 Get recommendations from family and friends or from other health care providers.

 When you contact a physical therapy clinic for an appointment, ask about the physical
therapists' experience in helping people who have a below-knee amputation.

 During your first visit with the physical therapist, be prepared to describe your symptoms
in as much detail as possible, and say what makes your symptoms worse