Acute Care Setting Considerations Flashcards
What are the some components we want to review for your post-surgery eval/treatment?
-chart/pt interview/systems review,
-cog/emotion
-pain and sensory
-residual limb
-ROM, strength,balance
-functional status
-post-surgical staus
Post-op complications
What is the difference between acute inpatient and subacute inpatient?
acute inpatient:intensive 3 hours/day
subacute: SNF-less therapy but still medical need for supervision
Describe 4 important aspects of the attn and cognition assessment .
A&O x 4, ability to follow directions, ability to recall new info, check adequate hearing and vision
what are 6 formal screens you can do for attn and cog.
MOCA,Mini-cog, MMSE; Delirium, depression, fear/avoidance
what should you include in your pain assessment?
location, type, nature, intensity, impact on. functional activities
what is the difference between phantom pain and sensation?
sensation is painless awareness that might involve tingling wheras pain is often described as crushing, cramping or stabbing
What pain meds might you see on your amp pt’s list?
NSAIDs, acetaminophen, opioids, gabapentin
what are some common interventions for pain treatment post-op?
meds, dressings and compression (desensitization), pain education, movement, modalities–ice when acute
what are you looking for in your residual limb assessment?
wound healing, vascularity (pulses, temp and color), length, volume (circumferential measures)
what lengths should you measure for a transtibial amp?transfemoral?
TT:medial joint line-end of limb
TF:ischial tub/glute tub-end of limb
what are you checking for in your contralateral/intact limb assessment?
diabetic foot screen if app, sensory testing, strength/ROM, DVT
what are the most common DVT symptoms?
swelling of the calf or entire leg, local tenderness along deep venous system, increased redness or warmth
list the 7 DVT risk factors.
previous thrombosis/embolism, immobility, severe infection, hormone replacement therapy, surgery/critical care admission, anesthesia, obesity
what are the PT considerations of antithrombotic meds?
falls- esp leading to internal bleeds, ecchymosis, pt report for pain in back, abdomen, joints
where should you test ROM and strength for a transtibial amp pt?
hip ROM, knee ROM, muscle length check
where should you test ROM and strength for a transfemoral amp pt?
hip flex/ext
hip abd/add
muscle length assessment
what kinds of treatment should you use for ROM/ preventing contractures
prone positioning (edema control, comfort, education)
stretching/AROM (esp illiopsoas)
what are the key muscles to stretch for TT amps?
hamstrings, hip flexors, contralat gastroc-soleal (their 1* weight bearing now)
what are the key muscles to stretch for TF amps?
hip flex
hip abd
hip ER
lumbar ext
contralat LE
how should you test strength post-op?
test active, non-resistive movement against gravity just proximal to amp
what areas should early post-op therex target?
Iso and AROM proximal to amp
core strength
contralat limb
what muscles should you aim to strengthen after a TT amputation?
quads and hamstrings
glute max and med
abdominals
UE
what muscles should you aim to strengthen after a TF amputation?
glute max and med
hip adductors
abdominals
lumbar spine
pelvic floor
UE
what 3 movements should AKA pts emphasize?
hip ext, ABD, pelvic movement
Key notes for balance assessments
-all must be done w/o prosthesis
-changes in COM/COG can greatly impact postural stability
condition of intact limb impacts standing ability
what determines a pt’s functional. status?
UE function, aerobic capacity, postural ctrl and balance
bed mobility and transfers, gait
what are the main takeaways for pt education on limb care?
limb shaping is critical (fn of effective edema ctrl and compression)
limb desensitization and prep for wearing prosthesis
watch for signs of infection
avoid weight bearing at end of limb
positioning to avoid contractures
