Exam 1- amputation

Question 1

What are the 5 things do you need to remember when wrapping a trans tib?

Answer 1

1) no wrinkles
2) no windows
3) no circular (make figure 8)
4) ask pain before and after
5) have to go above the joint

Question 2

Why are we wrapping the joint?

Answer 2

~help with swelling

~help prepare for a prosthetic (want cylindrical, not bulbous/ straight/ “dog eared”)

Question 3

What are the 6 things do you need to remember when wrapping a trans fem?

Answer 3

1) no wrinkles
2) no windows
3) no circular (make figure 8)
4) ask pain before and after
5) have to go above the joint
6) adductor roll

Question 4

How many inches width for a trans tib when wrapping?

Answer 4

double length 4 inch

Question 5

How many inches in width for a tran fem when wrapping?

Answer 5

double length 6 inch

Question 6

Amputation levels

Answer 6

~partial toe
~toe disarticulation
~partial foot/ ray resection
~transmetatarsal 
~ankle disarticulation
~Transtibial
~knee disarticulation
~Transfemoral
~hip disarticulation
~hemipelvectomy
~hemicorporectomy

Question 7

Amputation level: partial toe

Answer 7

excision of any art of one or more toes

Question 8

Amputation level: toe disarticulation

Answer 8

disarticulation at the metatarsal

~usually the first step of diabetic

Question 9

Amputation level: partial foot/ ray resection

Answer 9

resection of the 3rd, 4th, 5h metatarsals and digits

Question 10

Amputation level: transmetatarsal

Answer 10

amputation through the midsection of all metatarsals

Question 11

Amputation level: ankle disarticulation

Answer 11

(also called Syme’s)
ankle disarticulation with attachments of heel pad to distal end of tibia; may include removal of malleoli and distal tibial/ fibular flares
~leave the calcaneus (able to have the same leg length)

Question 12

Amputation level: Transtibial

Answer 12

want to be as long as possible
~short TT: less than 20% of tibial length
~TT: btw 20-50% tibial length
~long TT: more than 50% of tibial length

Question 13

Amputation level: knee disarticulation

Answer 13

amputation through the knee jt

~not able to bend the knee jt

Question 14

Amputation level: Transfemoral

Answer 14

above the knee joint on the femur
~Long TF: more than 60% f Femur length
~TF: btw 35-60 femur length
~Short TF: less than 35% of femur length

Question 15

Amputation level: hip disarticulation

Answer 15

amputation through hip jt

Question 16

Amputation level: hemipelvectomy

Answer 16

resection of lower half of the pelvis

Question 17

Amputation level: hemicorporectomy

Answer 17

amputation both lower limbs and pelvis below L4-5 levels

Question 18

UE amputation levels

Answer 18

~tip of a finger
~part of a finger (at the joints)
~Rays
~metacarpals and rays
~disarticulate the wrist
~transulnar
~disarticulate the elbow
~transhumeral
~disarticulate the shoulder
~4 quarter

Question 19

What is a 4 quarter?

Answer 19

take out the clavicle, scapula, and shoulder (all of 1 UE)

Question 20

Details on the amputation wound

Answer 20

~Traumatic or scheduled
~Will be done by primary incisions (how is the wound going to be closed)
~Wrapping when there are no infections

Question 21

Details on Tran tib

Answer 21

~Don’t really care about the fibula
~Cut the body (curved/ not 90* edged); the muscles (gast and soleus) will be saved closer to the ankle so that it can be wrapped around; this will be used for wrapping around the bone
~Cannot be bone on skin- need the muscle in between; adding cushion

Question 22

Details about Trans Fem

Answer 22

~Quad and ham will be sown together to form the muscle flap instead of gast and soleus
~hopefully there will still be function with theses muscles

Question 23

What is a big difference in evaluating an amputation pt?

Answer 23

different because we have taken away a functional limb; have to eval how the pt functions without this limb

Question 24

What are some normal eval that you will do in an amputation pt?

Answer 24

~PMH
~vitals
~Prior level of fuct, house, care givers, psy, etc
~Skin- wound, pus/ infection; other leg (and vas to that area)
~ROM; strength (gross)
~girth measurements
~cardiovascular

Question 25

What are some things in a amputation pt eval?

Answer 25

~pain
~balance
~arm strength
~bed morbidity
~hopping
*falls?

Question 26

Pain in amputation

Answer 26

~surgical
~phantom limb pain
~phantom limb sensation

Question 27

Surgical pain in amputation

Answer 27

can feel achy, local, throbbing, etc

Question 28

Phantom limb pain in amputation

Answer 28

~Ants are biting, on fire

~the area itches that itches is not there

Question 29

Phantom limb sensation in amputation

Answer 29

~Non-noxious; from the area that’s not there, but the brain is telling them that ~Warm, wind, etc

Question 30

Balance in amputation

Answer 30

~balance will be impaired bc of the missing limb (the weight is thrown off)
~start with sitting balance
*trunk strength can also influence balance

Question 31

Standing in amputation

Answer 31

~make sure they lead to the whole leg (they will want to stand on the missing limb- falling!)
~if they can stand, Look at balance
~Cant stand, do slide board for transfers; all upper body and balance

Question 32

Sensory integration

Answer 32

~(how mash potatoes feel in your mouth, fruit, etc)
~Feel the limb, look at the limb; making the new pathway (new norm)
~First rubbing with hands, then towels (different textures); smash your leg (not hard); squeezing it
~Mirror therapy

Question 33

Falls

Answer 33

~its not if they are going to fall, it is when
~they are used to having that limb, so they will go to get up and go to stand and forget that the limb is gone
~Fall prevent is important!

Question 34

IPOP

Answer 34

~Like a helmet for the residual limb for protection and to reduce the chance of the amputation of dehiscing
~Can make them with a pros (in health ind)