Question

Pre and Post-operative Nursing
The following question relate to a 56 years old man with a History of Diabetes, HT and smoking. They are having a R) Below Knee Amputation (BKA).

12.1)   What psychological challenges are likely for a BKA? (15 -30 words)

12.2)   List 4(four) pre-operative nursing interventions

12.3)   List 4(four) post-operative nursing interventions for a client with Below Knee Amputation

Answer 1

Below knee amputation means the portion below the knee is surgically removed from a person's body due to any physiological or pathological cause.

12.1) The patient will undergo a stage of depression due to the loss of a leg as he may think he will never walk again and he will get depended on others for his needs to get ssatisfied.

• The patient will go through all the stages of grief such as denial, anger, bargaining, depression and acceptance.
• The person may experience a phantom limb (even after the removal of a limb from the body, the person experience the presence of that limb in his body) which makes him difficult to adapt to his situation.
• He will feel guilty of his bad habit of smoking for which he is suffering now and will think negatively.
• He may feel what others will think about him.
• He may over think that he will be depending on others which make others difficult to take care of him.

12.2) Pre - operative nursing interventions

1. ​​​​​​Provide psychological support to the client.

• As the client will have anxiety regarding the below knee amputation surgery, he will be very much anxious.

2. Keep the patient nil per oral (NPO) from midnight as per the doctor 's order.

• This is to prevent vomiting during the time of surgery as the patient will be unconscious.

3. Get the pre anesthetic checkup (PAC) done.

• During PAC, an anesthetist will monitor whether the patient can tolerate anesthesia.

4. Prepare the patient for the surgery.

• This step includes shaving or trimming of the area of surgery.
• Ask the surgeon regarding how much area has to be shaved.
• use 10% or 5% betadine solution or povidone iodine to clean the area of surgery.
• Mark the right knee below with a marker - site marking.

12.3) Post - operative nursing interventions

1. Administer analgesics or provide patient controlled analgesia (PCA) to the patient.

• As the patient will have acute pain related to the surgical intervention, the nurse should maintain a pain chart and assess the pain of the patient. If needed provide PCA or administration of analgesics can be done.

2. Help the client to do his ADL (Activities Of Daily Living ).

• As the client will be depending on the nurse initially, help them to get out of bed and help him to do his ADLs.

3. Provide a counseling session.

• As the patient needs the time to get adapted to his condition, before the discharge from the hospital he needs to be counselled.

4. Provide education regarding prosthesis ( an artificial body part)

• Teach the patient regarding the use of prosthesis and there is no need to loss hope as he can get back to his normal life once he gets appropriate prosthesis.

Note : loss of a body part is a catastrophe for everyone especially below knee amputation which makes body image disturbances. It is the duty of a nurse to console the patient by providing psychological support.