NCLEX Review Guide: Amputation of a Lower Extremity

Assessment and Preparation

• Assess vascular status including peripheral pulses, capillary refill, and skin color/temperature to determine circulation adequacy
• Evaluate pain levels and establish baseline functional status to plan appropriate post-operative interventions
• Provide psychological support and assess coping mechanisms as amputation represents significant body image changes

Immediate Post-operative Management

• Monitor for hemorrhage by checking dressing for excessive bleeding and vital signs for shock indicators
• Position residual limb properly - elevate for first 24 hours to reduce edema, then avoid prolonged elevation
• Assess for phantom limb pain which occurs in 80% of amputees and requires specific pain management strategies

Stump Care Procedure

1. Inspect incision site for signs of infection (redness, warmth, drainage)
2. Change dressing using sterile technique as ordered
3. Apply compression bandage in figure-8 pattern to shape stump
4. Ensure bandage is snug but not constrictive to circulation

Major Complications

• Prevent contractures by avoiding prolonged hip/knee flexion and encouraging proper positioning
• Monitor for infection signs including fever, increased pain, purulent drainage, and elevated WBC count
• Watch for compartment syndrome in remaining limb due to increased weight-bearing demands

Mobility and Prosthetics

• Begin stump conditioning exercises to strengthen muscles and improve circulation for prosthetic fitting
• Teach proper stump hygiene including daily washing with mild soap and thorough drying to prevent skin breakdown
• Educate about prosthetic care including daily cleaning, proper storage, and signs of poor fit