(3) Follow the physician's orders for therapeutic measures used to stabilize
any chronic medical conditions such as diabetes, hypertension, or any other condition
that may interfere with surgery or rehabilitation.
(4) If ordered, arrange preoperative counseling with the physical therapist.
If a mobilization aid such as a walker or crutches is to be used postoperatively, it is
easier to provide instruction in the preoperative period. The physical therapist will also
inform the patient about his postoperative rehabilitation program.
(5) If authorized by the physician, schedule a visit from the prosthetic
specialist. This may help to alleviate some of the patient's anxieties about the fitting and
wear of prosthetic devices.
b. Postoperative nursing care involves routine nursing observation, pain control,
positioning and exercise, stump conditioning, and patient education. Patient education
should be done in conjunction with all nursing interventions.
(1) Monitor the patient's vital signs closely for changes in pulse or blood
pressure that may indicate hemorrhage under the bulky dressing. A temperature
elevation may indicate the presence of infection.
(2) Check the stump dressing regularly. Evidence of bloody drainage
should be marked with date and time, and excessive bleeding reported to the physician.
Check the proximal end of the stump dressing for swelling. The dressings are applied
to provide some compression of the stump, but a dressing that is too tight may cause
ischemia at the stump end.
(3) Observe the patient for pain. Pain medication may be required for
several days post-operatively. Some patients experience a phenomenon known as
"phantom pain" or "phantom sensation" in which they "feel" the lost limb.
(4) Maintain the prescribed position of the stump. Depending upon the type
of procedure used, the extremity may be in a splint, in traction, or elevated on pillows.
Proper positioning will prevent contracture of the involved muscles.
(5) Encourage prescribed exercises to preserve the range of motion in the
affected limb and to strengthen the remaining limbs.
(6) Remove and reapply the bandage. When the wound is healed, the
stump must be conditioned and shaped for the proper fitting of a prosthesis. A special
bandaging technique is used to shrink and mold the stump to a smooth, conical shape.
During the shaping process, the bandage is worn day and night. It is customarily
removed and reapplied twice daily or as ordered by the physician. Different methods