Description
After an amputation, the bit that is left beyond a healthy joint is called a stump or residual limb .skin over the amputation stump may be left open initially as the case of open amputation (guillotine amputation) or it may be closed primarily as in the case of closed amputation.
Definition
Amputation stump care refers to the comprehensive nursing and medical management of the residual limb (stump) following surgical removal of a body part, typically an arm or leg. The goal is to promote healing, prevent complications, and prepare the limb for prosthetic use or optimal function.
Stump care Procedure
| Nursing action | Rationale | |
| 1 | Immediate care Monitor the patient’s vital signs for any change in pulse rate or blood Pressure | Change may indicate haemorrhage under the bulky dressing. |
| 2 | Monitor body temperature | Temperature elevation may be a sign of infection. |
| 3 | Inspect the stump dressing regularly. | To check for bleeding. |
| 4 | Check the proximal end of the stump dressing for any swelling. | Tight dressing may cause ischemia at the stump end. |
| 5 | Provide pain relief measures including analgesics. | |
| 6 | Dressing If soft dressing: After cleaning the stump apply gauze and cotton dressing. After that apply an elastic crepe bandage in figure of eight manner. If rigid dressing: Ensure that a well molded plaster stump of Paris cast remains on the stump. | Promotes stump shrinkage. Adds in immediate temporary fitting. |
| 7 | Wrapping of the stump Apply an elastic crepe bandage over the dressing using firm tension over the end of the stump, decreasing gradually as it is wrapped up the limb with figure of eight technique. | Promotes stump shrinkage and maturation. |
| 8 | Instruct to wear the bandage during day and night. | Helps to control swelling |
| 9 | Unwrap the stump dressing every 4-6 hours for the first two days post – operatively, as prescribed, and then at least once daily | To check for any sign of infection and to reduce discomfort. |
| 10 | Assess color, temperature, and the most proximal pulse on the stump. before re-wrapping it, comparing findings to the contralateral extremity. | To assess for any deviation from normal. |
| 11 | Provide peri-wound skin care as ordered before wrapping the stump. | For early wound healing. |
| 12 | Keep the stump elevated. | Prevents vascular stasis and edema. |
| 13 | Positioning the stump. Elevate the stump for the initial 24-48 hours. | To reduce edema. |
| 14 | Move and turn patient gently and slowly. | To prevent severe muscle spasms. |
| 15 | Reposition the patient every 2 hours from side to side and prone, if possible. | Lying prone helps to reduce hip flexion contractures. |
| 16 | Exercises Help the patient perform range-of motion and muscle-strengthening exercises. | |
| 17 | Encourage the patient to push the residual limb into a soft pillow first and then using a firmer pillow and finally against any hard surface. | To prepare for prosthesis fitting and to reduce the incidence of phantom limb pain and sensations. |
| 18 | Patient education for care of residual limb at home. Wash and dry the limb thoroughly every 12 hours. Remove all soap residues. Do not soak the residual limb as this may increase edema. Inspect the residual limb regularly for any deviation from normal. Encourage patients to push residual limb against firm surface to gradually condition residual limb for prosthesis. Teach the patient to massage the healed incision to soften scar tissue as it will reduce tenderness and improve circulation. | |
| Special considerations Involve the patient in self–care in order to encourage acceptance.Prepare the patient for the use of assistive devices in order to achieve independence. | ||
| Amputation stump complications Wound healing complications associated with lower limb amputation stumps include: Wound infection Tissue necrosis, Pain, Bone erosion, Hematoma, Stump edema and dehiscence. |
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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