Acute Care Setting Considerations

Question 1

What are the some components we want to review for your post-surgery eval/treatment?

Answer 1

-chart/pt interview/systems review,
-cog/emotion
-pain and sensory
-residual limb
-ROM, strength,balance
-functional status
-post-surgical staus
Post-op complications

Question 2

What is the difference between acute inpatient and subacute inpatient?

Answer 2

acute inpatient:intensive 3 hours/day
subacute: SNF-less therapy but still medical need for supervision

Question 3

Describe 4 important aspects of the attn and cognition assessment .

Answer 3

A&O x 4, ability to follow directions, ability to recall new info, check adequate hearing and vision

Question 4

what are 6 formal screens you can do for attn and cog.

Answer 4

MOCA,Mini-cog, MMSE; Delirium, depression, fear/avoidance

Question 5

what should you include in your pain assessment?

Answer 5

location, type, nature, intensity, impact on. functional activities

Question 6

what is the difference between phantom pain and sensation?

Answer 6

sensation is painless awareness that might involve tingling wheras pain is often described as crushing, cramping or stabbing

Question 7

What pain meds might you see on your amp pt’s list?

Answer 7

NSAIDs, acetaminophen, opioids, gabapentin

Question 8

what are some common interventions for pain treatment post-op?

Answer 8

meds, dressings and compression (desensitization), pain education, movement, modalities–ice when acute

Question 9

what are you looking for in your residual limb assessment?

Answer 9

wound healing, vascularity (pulses, temp and color), length, volume (circumferential measures)

Question 10

what lengths should you measure for a transtibial amp?transfemoral?

Answer 10

TT:medial joint line-end of limb
TF:ischial tub/glute tub-end of limb

Question 11

what are you checking for in your contralateral/intact limb assessment?

Answer 11

diabetic foot screen if app, sensory testing, strength/ROM, DVT

Question 12

what are the most common DVT symptoms?

Answer 12

swelling of the calf or entire leg, local tenderness along deep venous system, increased redness or warmth

Question 13

list the 7 DVT risk factors.

Answer 13

previous thrombosis/embolism, immobility, severe infection, hormone replacement therapy, surgery/critical care admission, anesthesia, obesity

Question 14

what are the PT considerations of antithrombotic meds?

Answer 14

falls- esp leading to internal bleeds, ecchymosis, pt report for pain in back, abdomen, joints

Question 15

where should you test ROM and strength for a transtibial amp pt?

Answer 15

hip ROM, knee ROM, muscle length check

Question 16

where should you test ROM and strength for a transfemoral amp pt?

Answer 16

hip flex/ext
hip abd/add
muscle length assessment

Question 17

what kinds of treatment should you use for ROM/ preventing contractures

Answer 17

prone positioning (edema control, comfort, education)
stretching/AROM (esp illiopsoas)

Question 18

what are the key muscles to stretch for TT amps?

Answer 18

hamstrings, hip flexors, contralat gastroc-soleal (their 1* weight bearing now)

Question 19

what are the key muscles to stretch for TF amps?

Answer 19

hip flex
hip abd
hip ER
lumbar ext
contralat LE

Question 20

how should you test strength post-op?

Answer 20

test active, non-resistive movement against gravity just proximal to amp

Question 21

what areas should early post-op therex target?

Answer 21

Iso and AROM proximal to amp
core strength
contralat limb

Question 22

what muscles should you aim to strengthen after a TT amputation?

Answer 22

quads and hamstrings
glute max and med
abdominals
UE

Question 23

what muscles should you aim to strengthen after a TF amputation?

Answer 23

glute max and med
hip adductors
abdominals
lumbar spine
pelvic floor
UE

Question 24

what 3 movements should AKA pts emphasize?

Answer 24

hip ext, ABD, pelvic movement

Question 25

Key notes for balance assessments

Answer 25

-all must be done w/o prosthesis
-changes in COM/COG can greatly impact postural stability
condition of intact limb impacts standing ability

Question 26

what determines a pt’s functional. status?

Answer 26

UE function, aerobic capacity, postural ctrl and balance
bed mobility and transfers, gait

Question 27

what are the main takeaways for pt education on limb care?

Answer 27

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