Acute Post-operative Management of a Patient with an Amputation Flashcards
What are options to treat Residual Limb Pain (RLP)/post-surgical pain? (4)
Liberal narcotic use
Regional aesthesia
Non-narcotic medications, especially for neuropathic pain
Modalities (TENS, accupunture, etc)
What modality should you use for neuropathic pain?
Non-necrotic medications, as seen in the first note card.q
Is phantom limb pain (PLP) localized or diffuse?
Could be either.
How long does phantom limb sensation or PLP last?
It depends.
Sometimes just after surgery, sometimes for life.
Are medications effective for PLS or PLP.
No, especially not effective for PLS.
How to treat PLS or PLP?
Re-train the brain and the limb.
Do co-morbidities affect limb healing?
Yes. Patients should play an active role in management of their own health.
Does residual limb healing have psychological consequences?
Yes, remember the stages of coping.
Limb loss is similar to losing a good friend
Make referrals as appropriate
What are the three physical dimensions to measure during a residual limb eval?
Length to end of bone
Length to end of tissue
Circumferential girth (every 2.5 to 5 cm?)
What are the 8 things to measure during a residual limb evaluation?
Physical dimensions Appearance Temp Sensation Wound Assessment Dressings ROM and Strength at Proximal Joints! Contralateral limb assessment
How does a residual limb typically present?
Incision usually red, may have drainage
Typically staples or sutures intact in incision
Edema common
Decreased sensation around incision (typically returns but may not)
DO SKIN CHECKS BEFORE WRAPPING (you fail the class if you don’t)
What are 4 different post-op dressings?
Soft dressings Rigid removable dressings (RRD) Immediate post-op dressing (IPOP) Nonweight bearing rigid dressing (NWB) -Unna, gel
What is the goal of residual limb wrapping?
Decrease edema and shape for patient’s prosthetic fitting
What are 5 benefits of ACE Wrapping?
Transtibial and transfermoral Inexpensive Can use if stitches or staples or present Available Can provide gradient pressure
What are 5 limitations of ACE Wrapping?
Can be difficult to apply Frequent re-application needed Least effective Amount of compression is variable Loses elasticity over time (especially latex-free ones)
How many wraps should you use for Transtibial Residual Limb Wrapping?
Two, 4-inch wraps
Do you wrap above the knee with Transtibial RL wrapping?
*Always wrap above the knee
How many wraps should you use for Transfemoral Residual Limb Wrapping?
Two, 6-inch wraps and one, 4-inch wrap
Do you anchor around the pelvis with Transfemoral RL wrapping? Why or why not?
Yes, to prevent development of an adductor roll
Do you need to watch the wrapping videos on your own time?
Yes or you will fail. There’s a whole slide that discusses this. This is the “most challenging physical task.”
When does acute post-op d/c planning start?
At time of admission
- dependent on pt’s situation
- May need to consider a temporary solution as well
What are acute post-op rehab interventions?
Passive ROM (flex/ex and add/abd)
AROM of C/L limb FOR ALL MOTIONS!
Position to prevent hip and knee flexion contractures when sitting in bed
Progress to AAROM and AROM in all planes
Have program focus on pt assessment and typical problem areas
What 6 PROM positions should you work on?
Prone Hip ext Thomas test Hip Ext Sidelying hip ext Prone knee extension Supine knee extention Long-sitting knee extention
What are 3 AROM ideas for the residual limb discussed in class?
Active hip ext in supine - modified bridging
Hip ext prone
Hip ext in quadriped
What are 3 things to consider when positioning patients?
- Position to prevent contractures
- Hip ext/neutral hip
- Knee ext - Position to promote healing
- Pressure and edema management - What are the PT goals?
What are ROM examples for the C/L limb
C/L hip ext
- prone
- thomas test
- sidelying
C/L ankle DF
- seated
- standing
- long-sitting
Rehab interventions?
Strengthening
CV
Balance
ROM/Positioning
What are key muscles to strengthen (6 LE, 2 UE)?
Hip ext, hip abd, knee flex, knee ext, C/L ankle PF, C/L ankle DF
Triceps and Latissimus Dorsi
Should you incorporate CV component into therapy?
Yes. Establish cardiac precautions though. Also work on balance
What do you want ROM / Positioning to accomplish? What to promote? (3)
Promote hip and knee ext
Promote the neutral hip position
Prevent loss of C/L ROM, especially Ankle DF
Home Program Strengthening: what to include?
Preserve and improve hip ext and ABD
Strengthen knee flex and ext in TT amps
-Implement CV and Balance components too, if safe.
What are cute post-op rehab interventions for Mobility (5) ?
Establish upright tolerance
Initiate and progress to independent bed mobility, rolling, and transfers
Initiate W/C mobility
Progress to single limb gait in parallel bars only if appropriate
Determine the most appropriate device for this patient at discharge
Don’t forget ADLs too (wound care included)
What are 4 things to do regarding Community Integration?
Vocation and recreation (offer and promote trained peer visitation)
Home eval (assess pt’s home for accessibility and safety if not already completed, and provide info on home modifications)
Drivers Training
Prosthetist Interviews
4 things to consider w/ equipment?
Provide equipment recommendations based on assessment of living environment (including stairs, W/C access, bathroom accessibility)
W/C and seating (most go home with manual WC)
-usually need to change axle due to no front weight
Mobility devices
Transfer devices
