Post-Amputation and Type II Diabetes Mellitus Care in Adults

This essay discusses nursing interventions for post-amputation and type II diabetes mellitus care in adults. It includes patient history, problem identification, nursing goals, and actual action taken. The essay also highlights self-management techniques for type II diabetes. Subject: Nursing, Course Code: NURS, College/University: Not mentioned.

Running head: POST-AMPUTATION AND TYPE II DIABETES MELLITUS CARE 1
Post-Amputation and Type II Diabetes Mellitus Care in Adults
Name
Institutional Affiliation

POST-AMPUTATION AND TYPE II DIABETES MELLITUS CARE 2
Introduction
There are various reasons that could necessitate an amputation of the limb(s). Type II
diabetes mellitus is amongst the leading causes. After the amputation has been conducted, the
affected patient requires high levels of consumer-centered care for the amputated limb to recover
quickly. For amputations resulting from type II diabetes, the patient should also receive relevant
care and education on how to handle his/her blood sugars at levels that will not result in another
amputation. This essay, therefore, contains details of the nursing interventions applied in the
provision of patient-centered post-amputation and type II diabetes mellitus care.
Patient’s History and Current Information
Kath, the patient, is aged 62 years and is a native Australian woman. In the past, she has
suffered from Peripheral Vascular Disease (PVD) which is known to result from type II diabetes
mellitus. Kath is an independent woman who lives in the rural setting and earns a living by
working as a part-time local newsagent. She is divorced and a mother of two Males who are both
mine employees. About six months ago, Kath fell and subsequently developed a bruising and
large graze. It later attained infections, turned gangrenous and have been unresponsive to
treatment in the preceding six months.
Having no other option, the doctors resolved to perform a below-knee amputation for the
right leg. 5 days after the operation, she is now recovering well and the amputated stump is also
healing promisingly. She will now have to be discharged and relocated to a rehabilitation facility
where she will receive the proper care she needs to facilitate her mobility as well as ease any
post-amputation trauma. She is also to receive relevant education on how to effectively manage
her type II diabetes. She is currently on Metformin medication at 1g TDS.

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Analysis and Interpretation of Information
From the above patient’s information, it goes without saying that the functionality of the
patient’s right leg has been altered by the amputation. More antibodies will, however, have to be
produced in the body and relocated to the stump to counter any kind of infection that could
prevail in the stump (Abramson & Miller, 2012). Additionally, prescription of the right
medication will be necessary to ease pain and aid natural antibodies in preventing any kind of
infection (Benzon, Rathmell, Wu, Argoff, & Turk, 2014). It is worth noting that there are several
complications that could arise in the stump over time and hence close monitoring is crucial.
Oedema could occur as a result of mishandled tissues during the surgery. It is most likely to
occur if there is an existence of inter-capillary membrane fluid transfer and lymphatic
reabsorption imbalance.
Problem Identification
There are several post-amputation problems that Kath is likely to suffer in the course of
her healing. First, she will have to cope with trauma and emotional pain of losing her lower right
leg (Malchow, 2016). She is also likely to experience post-amputation pain at the wound site.
Additionally, present will be phantom limb pain which is classified as neuropathic pain
(Sherman, 2013). The intensity of the pain is varied across the remaining part of the leg but is
most intense in the distal portion of the phantom limb. Factors that could stimulate pain include
exertion of pressure on residual limb, weather and emotional stress.
Kath also likely to experience muscle weakness, muscle contractures and joint instability
(Braddom, 2010). All the aforementioned are results of compensatory structures performing
additional functions to cover for the phantom limb. Additionally, deconditioning will result in

POST-AMPUTATION AND TYPE II DIABETES MELLITUS CARE 4
diminished muscle mass, shortening of the sarcomere, changes in cartilaginous structures and
reduced muscle strength. Finally, Kath will receive valuable education pertaining to management
of type II diabetes which will reduce chances of another amputation (Burant, 2012).
Nursing Goals for Kath’s Situation
The first nursing goal will be post-amputation wound management and care (Dougherty,
Lister, & West-Oram, 2015). This will speed up healing of the stump and avoid any infections
that could arise. Secondly, Kath will have to receive counselling to counter post-amputation
trauma and effect acceptance of the reality. Acceptance is known to speed up the entire healing
process. The last nursing goal is offering type II diabetes management education. Essential
information will be availed to Kath and will subsequently help her in maintaining her blood
sugars at the right levels and therefore avoid any future complications arising from the same.
Actual Action
a) Post-amputation Care
Sufficient nursing interventions should be implemented to get Kath accustomed to her
situation and subsequently get to her normal daily living. To begin with, Kath is overwhelmed by
feelings of depression, loss, anxiety, and fear in addition to changes in physical appearances and
presumed roles in the society (Gulanick & Myers, 2013). She has even testified of being afraid of
looking at her residual limb due to unacceptance of what has already happened. Arrangements
will, therefore, be made to avail a psychologist to help her overcome her grief. Emotional
support of the nurse is of significant weight as she is most likely to spend her recovery time with
nurses.

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Physiotherapy will also be conducted to aid Kath in regaining her functional and physical
abilities in addition to improving the quality of her life. She will also require a below-knee
prosthesis and trained adequately on how to navigate using it (Lusardi, Jorge, Jorge, & Nielsen,
2013). Kath will be guided into ambulating in a heel to toe pattern. She will also be educated on
how to decrease trunk flexion and hip/body swaying while simultaneously increasing hip
extension and making larger strides. To work on balance, nurses will guide her on walking
between parallel bars while she is on the prosthesis (Brooker, Nicol, & Alexander, 2011). She
will begin with weight shifting sideways and forward and backward with support. She will then
progress to shifting weight and standing without any support. The last balance trial will be
catching a ball thrown at her to her sides.
For her to achieve maximum levels of flexibility, hamstring and hip flexors are to be
implemented at 30 seconds hold for three to four times a day or for as many times as she is
willing to participate (Lusardi, Jorge, Jorge, & Nielsen, 2013). She will undergo an endurance
test to maximize her endurance while walking on the prosthesis. She is to start off with one-two
minutes and then increase the timeframe until she achieves the six-minute walk test.
Kath will also receive highlights on how to observe skin on the residual limb when
changing dressings on the wound. She will be taught how to use a knee immobilizer to prevent
contracture and to also keep the area protected in case of a fall. To manage pain, any Oedema
present in the stump should be controlled. Establishing a sleeping pattern that is restful will also
be of great aid. Counselling and open talks with friends and family will help Kath ease anxiety,
depression, and stress and subsequently, the pain will reduce. For the remaining limb,
desensitization techniques.

POST-AMPUTATION AND TYPE II DIABETES MELLITUS CARE 6
b) Type II Diabetes Mellitus Care
It will not be possible for Kath to receive care from nurses even while in her home. She
will, therefore, have to learn various self-management strategies to effectively handle her
condition at home. First, she will have to adhere strictly to medications prescribed for her
(Nejaddadgar, Solhi, Jegarghosheh, Abolfathi, & Ashtarian, 2017). Due to her age, she is bound
to forget constantly but setting reminders could be an effective counter. She can also link her pill
taking to her activities, such as, whenever she is going to work. Kath should also monitor her
glucose levels frequently.
She will also be familiarized with the A1C standard which assesses glycemic control by
measuring the average blood sugar. It will be advisable for her to conduct self-monitoring of
blood glucose at least twice per day (Mertig, 2011). Additionally, proper dietary will be
recommended to Kath. Carbohydrates that she is to consume should contain low glycemic load
and are to be sourced primarily from vegetables. The proteins and fats that she is to consume
should be from plant sources. Glycemic load/index are measures of the impact of carbohydrates
on blood sugars. Foods of a low glycemic index are known to raise the blood sugars modestly.
She will be recommended to feed on complex carbohydrates which are usually in their whole
food form. They contain additional nutrients such as fiber, vitamins and lesser quantities of lards
and proteins (Bagchi & Nair, 2012). Brown rice, quinoa, beans, steel-cut oatmeal and whole
wheat are the top complex carbohydrates recommended for Kath.
Since starchy vegetables are essential sources of important nutrients such as vitamin C,
Kath is highly recommended to include them in her diet. They include; potatoes, corn, squash

POST-AMPUTATION AND TYPE II DIABETES MELLITUS CARE 7
and a wide variety of other root vegetables (Ezrin & Kowalski, 2011). She should also include
loads of non-starchy vegetables in her diet. Such include green vegetables that can be eaten raw.
Proteins are known to stabilize blood sugars in addition to eradicating sugar cravings. Since
animal sources are springs of harmful and saturated fats, Kath could obtain healthy proteins from
beans, legumes, eggs, organic dairy products, fish, and seafood. Lastly, it is advisable for Kath to
perform physical activities. Shae was recommended to walk for at least fifteen minutes a day.
Evaluation and Reflection
Patient-centered care has been delivered effectively on Kath who has shown positive
responses to treatment and care administered to her. Sufficient and relevant emotional support
aided in countering depression as well as lowering anxiety and stress. It also aided in giving her
self-acceptance to her condition. Physiotherapy care availed to her will help her attain mobility
over time. The prosthesis will help her get back to her normal undertakings as if she is still on
her two feet. Wound dressing education will help her change her bandages successfully until the
stump is fully healed. She will also be able to identify any infection that could be developing on
the residual limb and seek help in time and thus avoiding any complications. She will
additionally be able to manage her blood sugars through the right diet.
Conclusion
Various post-amputation care strategies have been discussed in details. In the spotlight
are wound dressing, pain management, physiotherapy techniques as well as counselling
initiatives all aimed at ensuring quick recovery of the patient. With the patient also being type II
diabetic, various interventions have been highlighted indicating how self-management
techniques can be used to effectively tame the disease.

POST-AMPUTATION AND TYPE II DIABETES MELLITUS CARE 8
References
Abramson, D. I., & Miller, D. S. (2012). Vascular Problems in Musculoskeletal Disorders of the
Limbs (illustrated ed.). Springer Science & Business Media.
Bagchi, D., & Nair, S. (2012). Nutritional and Therapeutic Interventions for Diabetes and
Metabolic Syndrome. Academic Press.
Benzon, H. T., Rathmell, J. P., Wu, C. L., Argoff, C. E., & Turk, D. C. (2014). Practical
Management of Pain (illustrated ed.). Elsevier Health Sciences.
Braddom, R. L. (2010). Physical Medicine and Rehabilitation E-Book (4 ed.). Elsevier Health
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Hospital and Home - The Adult (4 ed.). Elsevier Health Sciences.
Burant, C. (2012). Medical Management of Type 2 Diabetes. American Diabetes Association.
Dougherty, L., Lister, S., & West-Oram, A. (2015). The Royal Marsden Manual of Clinical
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Ezrin, C., & Kowalski, R. E. (2011). The Type 2 Diabetes Diet Book, Fourth Edition (4,
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Rehabilitation (illustrated ed.). Elsevier Health Sciences,.

POST-AMPUTATION AND TYPE II DIABETES MELLITUS CARE 9
Malchow, D. (2016). Alive & Whole Amputation: Emotional Recovery (2 ed.). CreateSpace
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Sherman, R. A. (2013). Phantom Pain (illustrated ed.). Springer Science & Business Media.