Teaching Project

Daytonite, BSN, RN · Nov 14, 2007

Think of ADLs and how the patient is going to accomplish ADLs minus a leg. Mobility is going to be a problem for this patient. Healing of the amputation wound may also be a problem. Here is the patient teaching list for a patient who has had a amputation from Nurse's 5-Minute Clinical Consult: Procedures published by Lippincott Williams & Wilkins, page 473:

"Teach the patient how to care for the stump and prosthesis. Encourage proper daily stump care.
Emphasize that proper care of the stump can speed healing.
Tell the patient to inspect the stump every day, using a mirror.
Make sure that the patient knows the signs and symptoms that indicate problems in the stump.
Instruct the patient to call the practitioner if the incision appears to be opening, looks red or swollen, feels warm, is painful to touch, or is seeping drainage.
Explain to the patient that a 10-lb change in body weight will alter stump size and require a new prosthesis socket.
Tell the patient to massage the stump toward the suture line to mobilize the scar and prevent its adherence to bone.
Advise the patient to avoid exposing the skin around the stump to excessive perspiration, which can cause irritation.
Tell the patient to change the elastic bandages or stump socks daily.
Tell the patient that twitching, spasms, or phantom limb sensations, such as pain, warmth, cold, or itching, may occur as his stump muscles adjust to amputation.
Discuss measures, such as imagery, biofeedback, or distraction, to relieve phantom limb pain or other sensations.
Advise the patient to use heat, massage, or gentle pressure for these symptoms.
If the stump is sensitive to touch, tell the patient to rub it with a dry washcloth for 4 minutes, three times per day.
Stress the importance of performing prescribed exercises to help minimize complications, maintain muscle strength and tone, prevent contractures, and promote independence.
Stress the importance of positioning to prevent contractures and edema."

Complications of amputation include (page 472 of same reference):

Hemorrhage
Stump infection
Contractures
Swollen or flabby stump
Skin breakdown or irritation
Friction from an irritant in the prosthesis
Sebaceous cyst or boil
Psychological problems
Phantom limb pain

I had a patient many years ago whose husband allowed her to disobey the doctor's orders and her stump became contracted so that it was permanently frozen at a 90 degree angle at the hip (stuck up in the air when she was lying flat in bed but was fine when she was sitting in her W/C).

Check out this web page: http://www.limblossinformationcentre.com/content/LLIC/index.html

ljbutler · Nov 16, 2007

I have to do a teaching project for a patient next week. It can be on anything. I was wondering if anyone had any ideas on an interesting topic and/or aids to teach.

prinsessa · Nov 16, 2007

If they are going to have surgery I would teach them how to use an incentive spirometer. It is really easy to teach someone about that. You could also teach your pt about the S/S of infection. Good luck!

nurz2be · Nov 16, 2007

For my community health nursing rotation I have to come up with a teaching care plan for a patient undergoing an amputation (from an ulcer on her heel) soon..
I am lost for ideas of what I can teach them that is relevant at this time.. One thought is a coping mechanisms related teaching plan however that would be a hard thing to "teach" and have a measurable outcome...
Any ideas are appreciated!! Thanks in advance!!!

I would find out why this is being amputated. If it is related to diabetes, this can open a whole other can of worms as far as treatment, time to heal, rehabilitation, realistic outlook for a prosthetic device, future possibility of more amputations, healing process for diabetics, as you know, are long and more times than not result in more loss once the disease has gotten to this stage.

Just an idea.