(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 are employed in wrapping the bandage, but the objective is the same: to provide equal, firm compression to the stump. A criss-cross or spiral pattern is used to avoid constricting the stump and interfering with circulation. One technique for wrapping a stump is illustrated in figure 1-20.