Within the two-hour case presentation, the level III nursing students shall gain adequate knowledge, develop

competent nursing skills, and manifest desirable attitudes towards the care of patients undergoing below the knee amputation.

 At the end of the two-hour case presentation, the level III nursing students will be able to: 1. Review the anatomy and physiology of the lower extremity. 2. Define the related terms correctly. 3. Trace the pathophysiology of diabetes mellitus. 4. Identify the types of amputation appropriately. 5. Described below the knee amputation satisfactorily. 6. Discuss its indications correctly.

7. Appreciate the responsibilities of the nurse during below the knee amputation. 8. Formulate a nursing care plan for patients undergoing below the knee amputation comprehensively.

INTRODUCTION

 Amputation is the removal of a body extremity by trauma, prolonged constriction, or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene.

 There are many types of amputation, specifically: for the arms: - we have amputation of digits -metacarpal amputation -wrist disarticulation -forearm amputation (transradial) -elbow disarticulation -above-elbow amputation (transhumeral) -shoulder disarticulation and forequarter amputation

 We also have on the lower extremeties namely: -amputation of digits -partial foot amputation -ankle disarticulation -below-knee amputation (transtibial) -knee-bearing amputation -above-knee amputation (transfemoral)

ANATOMY AND PHYSIOLOGY

 Below the knee amputation is a surgery or a type of amputation which is to remove all or part of the foot or of the leg below the knee cap. It is also called BKA (Thomson, 2012).

 A person may need a BKA for a health problem that causes poor blood flow, such as diabetes or a severe infection. A person may have been in an accident that injured his/her leg beyond repair. BKA may also be indicated for patients with cancer, or were born with a deformed leg. Amputations are either planned or done in an emergency.

Infection Blood Clot Phantom Limb Joint Contracture Wound Complications

 Evaluate the neurovascular and functional status of the extremity through history and physical assessment. Assess the circulatory status and function of the unaffected extremity.

 Any concurrent health problems (eg, dehydration, anemia, cardiac insufficiency, chronic respiratory problems, diabetes mellitus) need to be identified and treated so that the patient is in the best possible condition to withstand the trauma of surgery.

 The nurse assesses the patients psychological status. Determination of the patients emotional reaction to amputation is essential for nursing care.

Identify the patient. Position the patient. Ensure safety of the patient. Maintain surgical asepsis. Proper handling of equipment.

 Changing the patients position or placing a light sandbag on the residual limb to counteract the muscle spasm may improve the patients level of comfort.

 Keeping the patient active helps decrease the occurrence of phantom limb pain. Early intensive rehabilitation and stump desensitization with kneading massage brings relief. Distraction techniques and activity are helpful.

 The residual limb must be handled gently. Whenever the dressing is changed, aseptic technique is required to prevent wound infection and possible osteomyelitis.

 The nurse who has established a trusting relationship with the patient is better able to communicate acceptance of the patient who has experienced an amputation. The nurse encourages the patient to look at, feel, and then care for the residual limb.

 The nurse acknowledges the loss by listening and providing support. The patient is encouraged to be an active participant in self-care.

 Positioning assists in preventing the development of hip or knee joint contracture in the patient with a lower extremity amputation. Abduction, external rotation, and flexion of the lower extremity are avoided.

 The nurse assesses body systems (eg, respiratory, gastrointestinal, genitourinary) for problems associated with immobility (eg, pneumonia, anorexia, constipation, urinary stasis) and institutes corrective management. Avoiding problems associated with immobility and restoring physical activity are necessary for maintenance of health.

Nursing Dx: Anxiety related to impending loss of limb secondary to below the knee amputation

CUES AND OUTCOME EVIDENCES CRITERIA

Subjective data: Nakulbaan ko sa mahitabo nako inig putlon na ni akong tiil, as verbalized.

INTERVE RATION EVALUA NTIONS ALE TION

At the end of our nursing care the client manifested reduced anxiety as evidenced by: 1. Wa na kayo ko nakulbaan karon, salamat sa pagtaban g as verbalized.

At the end Independent: of our 1. Continue nursing care -To monitor to assess the client progress of anxiety will manifest his anxiety. level of reduced the anxiety as patient. evidenced 2. Establish -For the by: open and patient to 1. Verbalizat honest be aware ion of communic of his real reduced ation. present anxiety condition. before surgery.

CUES AND OUTCOME EVIDENCES CRITERIA

Objective data: Restless Poor eye contact Increased perspiratio n RR= 25cpm PR=104bp m BP=140/90 mmHg

INTERVE RATION EVALUA NTIONS ALE TION

To allow the patient to express his hidden feelings and feel much better. 2. More relaxed. 3. Absence of perspirati on. 4. RR=19cp m 5. PR=87bp m

2. More 3. Encourag relax e the and patient to able to express rest his 3. Absence anxiety or of fears and perspirati negative on feelings 4. Return of about the RR to loss of a normal limb. rate of 12-20cpm

CUES AND OUTCOME EVIDENCES CRITERIA

INTERVE RATION EVALUA NTIONS ALE TION

4. Encourag e the patient to ask questions if he has any that he didnt understan d or reinforce accurate informati on.
To let the patient understa nd more what he will go through, helps him to identify what is reality based and to decrease anxiety.

CUES AND OUTCOM EVIDENCES E CRITERIA

INTERVE RATION EVALUA NTIONS ALE TION

5. Provide a calm/quiet environment .

- Allows relaxation and decreases anxiety level.

Nursing Dx: