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Amp/Pros > Ch. 1 > Flashcards

Ch. 1 Flashcards

1
Q

Which is more prevalent, LE or UE amputations?

A

LE

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2
Q

What is the most common causative factor of LE amputations?

A

Dysvascular disease

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3
Q

4 Most common causes of amputations from most to least:

A
  1. Dysvascular
  2. Trauma
  3. Tumore
  4. Congenital
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4
Q

T/F Because of the disease process associated with PVD, this etiology often leads to unilateral amputations.

A

False, bilateral

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5
Q

T/F Because of PVD, many initial toe amputations will progress to BKA and AKA.

A

True

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6
Q

Trauma tends to lead to what type of amputations?

A

tends to affect more distal areas of the limb leading to a BKA and UE injuries

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7
Q

Cancer tends to lead to what type of amputations?

A

tumors tend to occur more frequently in the more proximal part of the femur, leading to an AKA.

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8
Q

T/F There is approximately a 25% risk of death within one year of lower limb amputation and a 50% mortality after 3 years.

A

True

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9
Q

There is a ___% risk of contralateral limb loss within 3-5 years of amputation of the original side.

A

30-50%

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10
Q

Arteriosclerosis Obliterans (ASO) -

A

Narrowing and occlusion of the arterial lumen of the larger arteries, often associated with hypertension (HTN) and coronary artery disease (CAD).

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11
Q

Etiology of Arteriosclerosis Obliterans (ASO) -

A 
>50 yo 
males>females
smoking (doubles risk) overweight
HTN
High CHO
sedentary lifestyle
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12
Q

Symptoms of Arteriosclerosis Obliterans (ASO) -

A
  1. intermittent claudication
  2. decreased pedal pulses
  3. dry skin, hair loss
  4. clubbing nails
  5. ischemia
  6. ulceration of anterior foot
  7. pain relieved with standing
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13
Q

Arteriosclerosis with Diabetes -

A

In the presence of diabetes, ASO develops at a younger age and is often seen in those <40 yo.

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14
Q

Symptoms of Arteriosclerosis with Diabetes -

A

Symptoms are the same as in ASO except you also have:

  1. decreased sensation on plantar surface
  2. renal involvement
  3. impaired vision
  4. decreased strength
  5. may also see ulcers on plantar surface due to insensate foot
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15
Q

85% of all amputations in diabetics are preceded by what?

A

foot ulcer

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16
Q

Possible complications of diabetes associated with amputation include:

A
  1. neuropathy
  2. circulation disorders
  3. foot ulcers
  4. Charcot foot
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17
Q

How does elevated blood glucose levels lead to diabetic neuropathy?

A

The elevated blood glucose levels causes reduced blood flow to the nerve

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18
Q

What does it mean if a foot is insensate?

A

the person may not feel the buildup of excessive pressures which can lead to breakdown

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19
Q

Where will you often see thick calloused tissue with an ulceration in the middle of the calloused area?

A

sole of the foot and the toes, particularly the lateral aspect of the great toe.

  • 25% occur at the 1st metatarsal head
  • 12% at the calcaneus
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20
Q

What will wearing shoes with a negative block heel do?

A

may help to displace weight slightly posteriorly and take pressure off the metatarsal head.

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21
Q

Diabetic neuropathy also leads to motor changes in the foot intrinsics leading to what?

A
  1. hammer toes

2. potential breakdown on the anterior surfaces of the toes

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22
Q

Chronic Venous Insufficiency (CVI) -

A
  • inefficiency of the superficial or deep veins and valvular incompetence which causes blood to pool in the legs
  • can cause infection in the lower limb which can lead to amputation
23
Q

lipodermatosclerosis -

A
  • appearance of CVI infection in lower limb

- brawny edema in the limb which can lead to ulceration

24
Q

Symptoms of CVI:

A
  1. edema in lower extremity
  2. dilation of veins because of pooling of blood
  3. dermatitis
  4. ulcers near medial malleolus because of long saphenous vein involvement
  5. pain relieved with elevation
25
Q

Thromboangitis Obliterans (Buerger’s Disease) -

A
  • Inflammation of the small and medium arteries and veins involving bilateral UEs and LEs
  • This disease is directly related to smoking
  • primarily males aged 20-40 yo
26
Q

Because it involves both the arteries and veins, you will see what symptoms?

A
  1. bilateral intermittent claudication
  2. phlebitis - inflammation of vein
  3. cold intolerance
  4. bilateral ischemia
  5. ulcerations
  6. dysaesthesias - abnormal pain to touch
  7. pain with rest
27
Q

Interventions for arterial disease:

A
  1. controlled activity to avoid claudication pain
  2. Protection of limb against injury, cuts, burns
  3. Indirect warming
  4. Avoidance of lotions which can cause maceration
  5. Avoid leg elevation
  6. Promote collateral circulation through exercise
  7. Progressive walking program
  8. Padding without compression
  9. Protection between toes
  10. Preserve joint mobility
  11. Manage diet
  12. Cessation of smoking
28
Q

Interventions for Venous disease:

A
  1. Reduction of edema
  2. Education in skin care
  3. Compression with semirigid dressing
  4. Intermittent compression
  5. Pressure wraps
  6. Leg elevation to heart level
  7. Ambulation
  8. Active exercise to promote muscle pumping
29
Q 
Wagner ulceration scale:
Grade 0 = 
Grade 1 =
Grade 2 = 
Grade 3 =
Grade 4 = 
Grade 5 =
A

Grade 0 = ulcers with intact skin
Grade 1 = superficial ulcer
Grade 2 = deep ulcer invading tendon and bone
Grade 3 = ulcer with abscess or osteomyelitis
Grade 4 = gangrene on foot
Grade 5 = gangrene in majority of foot

30
Q

Protection against ulcer development:

A
  1. Daily skin inspection
  2. Skin cleansing
  3. Minimize negative environmental factors
  4. Minimize skin exposure to moisture
  5. Prevent friction and shear forces
  6. Judicious use of lotions and moisturizers
  7. Footwear
31
Q

T/F The immediate post- op period is crucial for optimal outcomes

A

True

32
Q

How much WB in IPOP?

A

20% but greatly enhances, balance, proprioception, shrinking of residual limb and early gait

33
Q

Length of residual limb is a major determining factor for fit and function, and determines what?

A
  1. Lever control
  2. Proprioception
  3. Complexity of fit
  4. Degree of balance disturbance
  5. Muscle mass retained/ weight loss
  6. Number of mechanical joints
  7. Force distribution
  8. Weight of prosthesis
34
Q

Goals of post-op rehab:

A
  1. Reduce edema
  2. Maintain motion
  3. Maintain/increase strength
  4. Increase mobility
  5. Education about sound limb preservation 7. Psychological considerations for return to work/function, preservation of self
35
Q

Pre-prosthetic examination -

A
  1. Integumentary
  2. Sensory
  3. Cardiovascular
  4. ROM
  5. Strength
  6. Balance
  7. ADL
  8. Cognition
36
Q

Pre-prosthetic program includes what aspects?

A
  1. Full functional ROM
  2. W/C - parts and mobility
  3. Ambulation
  4. Strength - muscles for transfers, gait, and prosthetic management
  5. Care of limb (bilateral)
  6. Bed mobility
  7. Transfers - to all surfaces and sit to stand
  8. Residual limb size and shape - Promote shrinkage and stabilization of size
37
Q

Pre-prosthetic program includes what ROM?

A

Active and passive

38
Q

Pre-prosthetic program includes instruction in proper positioning for what purpose?

A

To prevent contracture of hip flexors and abductors

39
Q

Pre-prosthetic program includes what type of therex?

A
  • may include pool therapy

- definitely incorporate dynamic stump exercises and balance activities.

40
Q

T/F Ambulation preprosthetically would be addressed with a appropriate assistive device.

A

True

41
Q

Day 1 post op includes what with patient?

A
  • seen the day following surgery
  • bed mobility and proper positioning
  • ROM and therex to the sound side
  • The patient may sit and dangle at bedside.
42
Q

Day 2 post op includes what with patient?

A
  • Transfers would be initiated post-op day 2 to the bedside chair.
  • Therex to the involved side would include ROM and muscle sets
  • Therex to sound side and UE would continue.
43
Q

Day 3 post op includes what with patient?

A
  • Ambulation is frequently initiated on post-op day 3, with continuation and progression of all previous activities.
  • The patient should begin to be introduced to caring for the residual limb
44
Q

Day 5 post op includes what with patient?

A
  • The patient is often discharged post-op day 5 to rehab or home.
  • A HEP should be included with all D/C instructions.
45
Q

Week 3 post op includes what with patient?

A
  • Once the staples are removed and the wound is closed, the use of stump shrinkers can be initiated.
  • Ace wrapping is utilized until a shrinker can be safely used.
46
Q

What is the time frame for suture removal?

A
  • Time frame for suture removal is dependent on wound healing and can vary greatly.
  • Around 3 weeks
47
Q

Week 6 post op includes what with patient?

A
  • Casting for diagnostic socket.

- Dependent on incision healing.

48
Q

Week 6-8 post op includes what with patient?

A

Prosthetic gait training

49
Q

What 3 things can cause the short residual limb of AKA to “float up” and decreased ROM of hip flexors and abductors?

A
  1. upright activities due to the loss of the weight of the distal aspect of the leg
  2. loss of proprioception inherent in the loss of multiple joints
  3. prolonged sitting
50
Q

How can hip flexor/abductor tightness be countered?

A

Prone lying

Proper W/C positioning

51
Q

Some post-op exercise activities to be considered during therapy sessions:

A
  • balance over a bolster
  • dynamic stump exercises
  • rhythmic stabilization
  • UE strengthening
  • pregait weightshifting and balance
  • manual resisted exercise and PNF to limbs and trunk
  • cable column
  • ball exercises
  • wobble board, rocker board, foam standing
52
Q

Special emphasis on what muscle in AKA?

A

As the hip extensors control the knee in AKA, special emphasis must be given to strengthening hip extensors.

53
Q

Amputee experience is dependent on what 3 factors?

A
  1. Amputee Experience of using a Prosthesis: This is a consideration for both the functional limitations and functional failures of using a prosthesis
  2. Amputee Behavior - Promote active use of the prosthesis for better adjustment
  3. Amputee Psychodynamics
54
Q

4 stages of adjustment:

A
  1. initial shock
  2. defensive retreat
  3. acknowledgment
  4. adaptation

Amp/Pros (12 decks)

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