Richard L. Pullen, Jr., EdD, RN, replies: Lower extremity amputations are most commonly performed because of advanced chronic peripheral arterial disease. Amputation can relieve signs and symptoms, improve function, and maintain or improve the patient's quality of life.1 Most postoperative nursing care priorities are the same as for any surgical patient: assessing and maintaining the patient's airway, breathing, and circulation; monitoring vital signs; managing pain; taking steps to prevent respiratory complications and venous thromboembolism; and watching for signs and symptoms of hemorrhage.

After surgery, the patient will have a soft dressing or a rigid dressing made of fiberglass or plaster. Assess the surgical dressing for integrity and drainage. Elevate the stump for the first 24 to 48 hours.2

Move and turn the patient gently and slowly to prevent severe muscle spasms. Reposition the patient every 2 hours, turning the patient from side to side and prone, if possible. Lying prone helps reduce hip flexion contractures.2 Avoid placing pillows between the patient's legs or under the back.2

Unwrap the stump dressing every 4 to 6 hours for the first 2 days postoperatively as prescribed and then at least once daily. Assess the stump for signs and symptoms of infection and skin irritation or breakdown. Assess the color, temperature, and most proximal pulse on the stump before rewrapping it, comparing findings to the contralateral extremity.

Before rewrapping the stump, provide periwound skin care as ordered, but avoid lotion. Wrap the stump when it's elevated to prevent edema and vascular stasis. Follow your facility's policy for replacing the bandage, such as every 2 to 4 days or sooner if it becomes soiled.

Help the patient perform range-of-motion and muscle-strengthening exercises. Encourage the patient to push the residual limb into a soft pillow, then into a firmer pillow, and finally against a hard surface to prepare for prosthesis fitting and to reduce the incidence of phantom limb pain and sensation.1

Encourage the patient to eat a well-balanced diet. Provide emotional support and patient teaching to help your patient deal with altered body image and lifestyle changes. Help with the grieving process.

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