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Prosthetics and Orthotics > Acute care: postoperative > Flashcards

Acute care: postoperative Flashcards

1
Q

Individuals with new amputation

A
  • early days post amputation: pain and grief
  • psychologist, social worker, vocation counselor, clergy
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2
Q

Interdisciplinary team

A
  • physician, surgeons: healing suture line, general health
  • nursing: general medical and wound care, pain management
  • registered dietitians: nutritional needs (protein, vitamins, fluids)
  • prosthetist: fabricate early post op prosthesis or rigid dressing
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3
Q

Acute care priorities post amputation

A
  • surgical site healing
  • pain management
  • volume control of residual limb
  • education
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4
Q

PT acute care priorities

A
  • bed mobility
  • transfers
  • positioning: avoid contractions such as hip flexor and knee flexor
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5
Q

Phantom limb sensation

A
  • possibility of phantom limb sensation should be discussed with patient and family before amputation
  • very vivid
  • can be disturbing and frightening
  • need to know that normal
  • TENS therapy and mirror therapy can help
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6
Q

Early post surgical examination

A
  • systems review
  • pain: incisional, phantom, other
  • vascularity (if appropriate): looking for color with capillary refill (is it blanch able and reprofusable)
  • functional status, bed mobility, transfers, sitting, standing, balance
  • gross ROM
  • gross strength: active and functional assessment until wound healing for external resistance on residual limb incision
  • cognition
  • aerobic capacity/endurance
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7
Q

Acute care PT intervention

A

focus on preparation for prosthetic use

  • wound healing
  • residual limb protection
  • prevention of contractures
  • Single limb mobility: monitor condition of remaining foot
  • desensitize residual limb: handling, compression wrapping, different materials
  • functional training in self care: bed mobility and transfers
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8
Q

early wound healing: what is normal for first several days/what can delay healing

A
  • first several posts days: signs of inflammation normal
  • prolonged edema delays wound healing due to congestion and fluid
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9
Q

Assessing wound healing: dressing

A
  • initial dressing change as early as first day post (4 soft dressing)
  • third post-op day 4 rigid dressing if pt is a candidate
  • subsequent dressing changes
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10
Q

Assessing wound healing: drainage

A
  • initially: sanguineous (bloody)
  • then: serosanguineous: red/pink and thin
  • then serous: just clear fluid
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11
Q

Assessing wound healing: report to surgeon when

A
  • bright red blood (arterial hemorrhage)
  • darker venous blood (draining hematoma)
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12
Q

Assessing wound healing: signs of infection

A
  • report immediately
  • increase amounts of drainage
  • thickening exudate
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13
Q

Edema control postoperative care

what can be used

A
  • important element in control of post-op pain
  • ace warping
  • shrinker garment
  • nonremoveable rigid dressing
  • removeable rigid dressing
  • semirigid dressing (unna)
  • pneumatic compression for early ambulation
  • when rigid dressing is removed: soft compression as quickly as possible: for edema control
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14
Q

Postsurgical dressing: elastic bandage: compressible soft dressing

advantages/disadvantages

A

Advantages:

  • inexpensive
  • easily removed for wound inspection
  • allows for active joint ROM
  • easy to apply

Disadvantages

  • frequent changes may disrupt healing
  • unable to control amount of tension in bandage
  • risk of tourniquet effect
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15
Q

Postsurgical dressing: shrinker

advantages/disadvantages

A

advantages:

  • easy to apply
  • inexpensive

Disadvantages:

  • shrinker cannot be used until staples are removed
  • need to change as limb shrinks
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16
Q

Postsurgical dressing: Semi-rigid dressing

A

Advantages

  • better edema control than soft dressings
  • provides soft tissues support
  • provides protection

Disadvantages

  • less protection and requires more changing than rigid dressing
  • allows for edema if becomes loosened
  • may limit access to incision
17
Q

Postsurgical dressing: immediate post surgical prosthesis

advantages/disadvantages

A

Advantages

  • protection of limb
  • limits edema
  • may allow for early ambulation w/pylon
  • stimulates proprioception

Disadvantages

  • may require professional application
  • may limit wound inspection
18
Q

Positioning for transtibial amputation

A
  • avoid hip flexion and knee flexion
  • don’t let them sit with a pillow under knee
19
Q

Positioning for transfemoral amputation

A
  • common contractures are: hip flexor, abductors and ER
  • supine: no pillow under residual limb
  • prone lying throughout the day: if not tolerate then side lying with active hip extension
  • limit sitting
20
Q

bed mobility and transfers

goals and concerns

A
  • minimize risk of trauma to newly amputated limb during activity
  • early goal: safely move between seating surfaces
  • transfers continue to be important after using prosthesis
21
Q

when might a pt might need to refrain from using prosthesis

A
  • mechanical problems with prosthesis
  • skin problems
  • medical problem affecting socket fit
22
Q

Postural control with postop amputation

A
  • after amputation, COM shifted upward, backward and toward CL limb
  • can affect sitting balance, sit to stand, and single limb ambulation
  • incorporate activities to improve ability to control COM over altered BOS
23
Q

Fall risk

A
  • individuals with recent amputation
  • risk of falling when awaken from sleep and attempt to stand and walk to bathroom
  • can result in injury and require surgery
24
Q

Single limb ambulation

A
  • provides mobility in environment
  • consider use of crutches if possible: walker imposes hop to gait putting a lot pf pressure on other limb
  • might interfere with step-through pattern once receive prosthesis
25
Q

Single limb ambulation: goals

A
  • enhance postural control
  • build strength and cardiovascular endurance
26
Q

Preprosthetic gait

what should be done

A
  • forward, backward, sideways, change direction, turn
  • stairs, inclines if indicated
27
Q

What to educate in regards of care of the remaining limb

A
  • open wound on remaining limb precludes single limb ambulation which delays rehab and increases disability
  • program should include: position changes, pressure-distributing mattress, weight shifting, active exercise
28
Q

Demongraphics/medical history with discharge planning

A
  • demographic, sociocultural information
  • living environment
  • emotional, cognitive status
  • medical, surgical history
29
Q

Wheelchair and equipment for postoperative amputation care

A
  • W/C skills needed for pts and caregivers
  • may also need adaptive equipment or home modifications
  • referral to home services

Prosthetics and Orthotics (9 decks)

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