Info

Medication or Drug Class

Dosage

Description

Rationale

Analgesia

Varies by drug

The amputation procedure is painful and generally requires narcotic analgesia

Relieve pains and allows for increasing mobility to limit surgical complications

Other Therapies: Intense burning, crushing, or knifelike pain responds to anticonvulsants such as phenytoin (Dilantin) and carbamazepine (Tegretol). The severe muscle cramps or spasmodic sensations that other patients experience respond better to a central-acting skeletal muscle relaxant such as baclofen (Lioresal). Besides the usual narcotics, a beta blocker such as propranolol may be used for the constant, dull, burning ache.

Independent

Postoperative pain located specifically in the stump can be severe and is not usually aided by positioning, distraction, or other nonpharmacologic measures. True stump pain should be short term and should decrease as healing begins. Stump pain that continues to be severe after healing progresses may indicate infection and should be investigated. Phantom limb pain, very real physical discomfort, usually begins about 2 weeks after surgery. It may be triggered by multiple factors, including neuroma formation, ischemia, scar tissue, urination, defecation, and even a cold temperature of the limb. The sensations of phantom limb pain may be described in two basic patterns and are treated with different types of medication. Some nonpharmacologic treatments have also shown success, especially transcutaneous electrical nerve stimulation, hypnosis, whirlpool, and massage therapy.

Grieving over loss of a body part is a normal experience and a necessary condition for successful rehabilitation. It becomes excessive when it dominates the person's life and interferes seriously with other functions. Explore concerns, and help the patient and family determine which are real and which are feared.

Looking at the stump when the dressing is first changed is usually difficult for the patient. It triggers a body image disturbance that may take weeks or months to overcome. The nurse's calm manner in observing and caring for the stump encourages the patient to move toward accepting the changes in her or his body.

Regardless of the type of dressing, stump sock, or temporary prosthesis, inspect the surgical area of an amputation every 8 hours for healing. The goal of bandaging is to reduce edema and shrink the stump into shape for a future prosthesis. Keep the wound clean and free of infection.

Many problems of safety or potential for injury exist for the patient who re-establishes her or his center of balance and relearns ambulation. Urge caution, especially with the young patient who denies having any disability. Safety concerns play a prominent role in planning for discharge. The nurse or physical therapist assesses the home situation.

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