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POG (Prosthetic Orthotics & Gait) > Lect 3 - Acute Care Management of Patients S/P Amputation > Flashcards

Lect 3 - Acute Care Management of Patients S/P Amputation Flashcards

1
Q

Vital signs to assess for an Acute Care S/P amputation patient are:

  1. ___
  2. ___
  3. ___
  4. ___
A
  1. BP trends
  2. O2 saturation -→ esp important now bc of COVID
    1. normal O2 sats
  3. HR
    1. normal HR
  4. Pain level
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2
Q

Vital Signs: BP

Normal BP value =

A

<120 AND <80

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3
Q

Vital Signs: BP

Elevated BP value =

A

120-129 AND <80

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4
Q

Vital Signs: BP

HTN Stage 1 BP value =

A

130-139 OR 80-89

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5
Q

Vital Signs: BP

HTN Stage 2 BP value =

A

>140 OR >90

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6
Q

Vital Signs: BP

HTN CRISIS value =

A

>180 AND/OR >120

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7
Q

Lab Values

hematocrit - Male =

A

37-49%

  • Rehab considerations (Physiopedia)
    • <25% = No exercise
    • 25-30% = light exercise
    • >30% = Resistive exercise
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8
Q

Lab Values

hematocrit - Female =

A

36-46

  • Rehab considerations (Physiopedia)
    • <25% = No exercise
    • 25-30% = light exercise
    • >30% = Resistive exercise
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9
Q

Lab Values

Platelets= ______

what is the importance of this lab value?

A

150,000-400,000/µL

it measures blood clotting potential or inability

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10
Q

Lab Values

Hemoglobin - Male =

what is the importance of this lab value?

A

13-18

hemoglobin levels tell you about the patients O2 saturation potential

hemoglobin carries O2!

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11
Q

Lab Values

Hemoglobin - female =

what is the importance of this lab value?

A

12-16

hemoglobin levels tell you about the patients O2 saturation potential

hemoglobin carries O2!

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12
Q

Lab Values

Potassium:

Normal values =

Upper limit = ____\_

lower limit = ____\_

what is the importance of this lab value?

A

3.5-5.3

Upper limit = >5.1

lower limit = <3.2

irregular values indicate muscle weakness, arrhythmias, irritability, and issues with the heart

  • ↓K- Hypokalemia (alkalosis, RF, D&V,diuretics) – Weakness, ileus, hypotonia, confusion, depression, arrhythmias, alkalosis.
    ↑K- Hyperkalemia (catabolism, acidosis, RF) – Cardiac arrest with VF.
    • Reductions = Flattened T waves, arrthymias
      • The T wave flattening can reflect low K+, widespread CAD, or L Ventricular Dysfunction from any other cause
  • Elevations= Peaked T waves, shortened QT interval
    • peaked t-wave = hyperkalemia, potential for transmural myocardial ischemia or a sudden, complete occlusion of a coronary artery
    • short QT interval = causes disruption of the heart’s normal rhythm (arrhythmia).
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13
Q

Lab Values

Calcium=

what is the importance of this lab value?

A

8.5-10.5mg/dl (physiopedia, not given in med screen)

  • Reductions (Moderate to severe) = parathesias, muscle spasms and seizure and QT interval prolongation.
    • In long QT syndrome, the heart’s electrical system takes longer than usual to recharge between beats
    • QT prolongation may increase the risk of developing abnormal heart rhythms and may lead to sudden cardiac arrest.
  • Elevations (severe only) = Bradycardia, AV block, and short QT interval, coma
    • short QT interval = causes disruption of the heart’s normal rhythm (arrhythmia).
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14
Q

Lab Values

WBC =_____\_

what is the importance of this lab value?

what are the considerations if you see the values: <5000, <5000+fever, <1000

A

4,500-11,000 for adults

  • high levels = indicate an infection (nonspecific)
  • low levels = pt is susceptible to opportunistic infection!
    • <1000 = WEAR A MASK!
    • <5000 + fever = NO EXERCISE, not cleared
    • <5000 = LIGHT exercise only; use caution with an resisted exercises
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15
Q

Lab Values

c-reactive protein = _____

what is the importance of this lab value?

A

CRP: <5mg/l (physiopedia)

It is used as a predicitor for future MI, and CVA

produced by liver in response to trauma, inflammation, and infection

Physiopedia says c-reactive proteins are: An ‘acute phase’ protein

  • Monitoring infections (>100, more likely to be bacterial)
  • Distinguishing between AI diseases and active infection
  • Monitoring RA Rx
  • Checking for post-op infection
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16
Q

Lab Values

creatinine:

normal men = _____

normal women = ____

what is the importance of this lab value?

A
  • men = 0.6-1.2 (physiopedia)
  • women = 0.5-1.1 (physiopedia)

A creatinine test is used to see if your kidneys are working normally. It’s often ordered along with another kidney test called blood urea nitrogen (BUN) or as part of a comprehensive metabolic panel (CMP). A CMP is a group of tests that provide information about different organs and systems in the body

  • Renal Function Tests - Urea & creatinine
    • Urea: 2.5-6.5 mmol/l
    • Cr: 60-120μmol/l
    • Both should rise together in renal failure.
    • Creat is the more accurate measurement, urea is affected more by diet and dehydration.
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17
Q

Lab Values

ESR (erythrocyte sedimentation rate)

normal men = ____

normal women = ____

what is the importance of this lab value?

A

Men = up to 17 seconds

women = up tp 25 second

  • The erythrocyte sedimentation rate (ESR) is used as a diagnostic tool. As fibrinogen increases in acute inflammatory conditions, the ESR will also increase.
  • An ESR test can help determine if you have a condition that causes inflammation. These include arthritis, vasculitis, or inflammatory bowel disease. An ESR may also be used to monitor an existing condition
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18
Q

Lab Values

what are the lab values to consider for platelets based upon these numbers:

<20,000µL

20,000-50,000µL

>50,000µL

A

< 20,000µL = NO EXERCISE

20,000-50,000µL = Light exercise (safer)

> 50,000µL = cleared for resistive exercise

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19
Q

Lab Values

What happens when potassium levels drop?

  • ↓K- Hypokalemia (alkalosis, RF, D&V,diuretics) – Weakness, ileus, hypotonia, confusion, depression, arrhythmias, alkalosis.
  • ↑K- Hyperkalemia (catabolism, acidosis, RF) – Cardiac arrest with VF.
A
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20
Q

Lab Values

FYI stuff about creatinine

  • Renal Function Tests - Urea & creatinine
    • Urea: 2.5-6.5 mmol/l
    • Cr: 60-120μmol/l
    • Both should rise together in renal failure.
    • Creat is the more accurate measurement, urea is affected more by diet and dehydration.
A
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21
Q

Lab Values

FYI stuff about creatinine

A
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22
Q

–Directly AFTER an amputation physical therapy focuses on:–

  • _____ mobility and _____ mobility
  • ____ management
  • ____ management––
  • ____ healing–
  • Positioning***
  • Strengthening
  • Holistic care
    • Psychosocial needs
    • Comorbidities
A
  • functional mobility & joint mobility
  • Edema
  • Pain
  • Wound
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23
Q

–What are the indications for amputation?

hint: “DDD”

A

Dead

Deadly

Damn nuisance

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24
Q

Levels of LEA (LE Arthroses)

A
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25
Q

Levels of LEA (LE Arthroses)

name #1

A

hemipelvectomy

hemipelvectomy involves the removal or resection of the pelvis.

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26
Q

Levels of LEA (LE Arthroses)

name #2

A

hip disarticulation

the amputation of the lower limb through the hip joint

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27
Q

Levels of LEA (LE Arthroses)

name #3

A

AKA - above knee amputation

aka. TRANSFEMORAL

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28
Q

Levels of LEA (LE Arthroses)

name #4

A

knee disarticulation

Knee disarticulation is a muscle balanced amputation level that can be used in patients with diabetes, peripheral vascular disease, and trauma. Patients who are capable of sitting in a chair retain an excellent platform for sitting, a lever arm for transfer, and are unlikely to have joint contractures develop.

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29
Q

Levels of LEA (LE Arthroses)

name #5

A

BKA - below knee amputation

aka. TRANSTIBIAL

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30
Q

Levels of LEA (LE Arthroses)

name #6

A

transmetatarsal amputation

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31
Q

Levels of LEA (LE Arthroses)

name #7

A

Ray amputation

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32
Q

Levels of LEA (LE Arthroses)

name #8

A

Syme’s amputation

Syme amputation (SA) is a term used to describe an amputation at the level of the ankle joint in which the heel pad is preserved. It is performed for a number of indications in a pediatric population. SA is purported to hold the advantage of allowing weight bearing without a prosthesis.

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33
Q

Levels of LEA (LE Arthroses)

name #9

A

toe amputation

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34
Q

In knee disarticulations,

a muscle balanced amputation level that can be used in patients with diabetes, peripheral vascular disease, and trauma. Patients who are capable of sitting in a chair retain an excellent platform for sitting, a lever arm for transfer, and are unlikely to have joint contractures develop.

A

knee disarticulation

Knee disarticulation is a muscle balanced amputation level that can be used in patients with diabetes, peripheral vascular disease, and trauma. Patients who are capable of sitting in a chair retain an excellent platform for sitting, a lever arm for transfer, and are unlikely to have joint contractures develop.

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35
Q

Syme amputation (SA)

a term used to describe an amputation at the level of the ankle joint in which the heel pad is preserved. It is performed for a number of indications in a pediatric population. SA is purported to hold the advantage of allowing weight bearing without a prosthesis.

A
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36
Q

What is the difference between a ray amputation and a toe amputation?

A

Toe amputation is appropriate for wounds limited to the middle and distal toe and not involving the skin over the metatarsal head. More proximal wounds typically necessitate ray amputation. Ankle or digital nerve block is preferred for most toe amputations, but spinal, epidural, or general anesthesia may be chosen.

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37
Q

Lower Extremity Amputation

What are the primary causes for LEAs (lower extremity amputations)?

A

–Peripheral vascular disease (PVD) with concurrent diabetes mellitus (DM) diagnosis–

Most significant predictor of amputation–

Peripheral neuropathy that progress to trophic ulcers–Progresses to–Subsequent gangrene–Osteomyelitis

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38
Q

Lower Extremity Amputation

What is the most significant predictor of amputation?

A

Peripheral neuropathies that progress to trophic ulcers because they can progress to subsequent gangrene and then osteomyelitis

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39
Q

Lower Extremity Amputation

_____ neuropathies that progress to ____ are the most significant predictors for amputations because they can progress to subsequent gangrene and then osteomyelitis

A

Peripheral; trophic ulcers

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40
Q

Lower Extremity Amputation

Peripheral neuropathies that progress to trophic ulcers are the most significant predictors for amputations because they can progress to subsequent ____ and then ____

A

gangrene; osteomyelitis

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41
Q

Lower Extremity Amputation

this is an example of a ______

A

trophic ulcer

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42
Q

Lower Extremity Amputation

PVD amputations:

  • Most frequently occurs in individuals aged ____–
  • Pre-amputation vascular surgery _____ is almost ALWAYS indicated
A
  • 50-75 y/o
  • consultation
43
Q

Lower Extremity Amputation

PVD amputations:

  • Indications for PVD amputations are: –
    • Uncontrollable ______ OR ____
    • _____ disease with _____ loss
    • Unrelenting rest pain due to muscle _____
A
  • soft-tissue OR bone infection
  • Non-reconstructable; persistent tissue
  • ischemia
44
Q

Lower Extremity Amputation

  • the primary predictors for LEA are PVD with a coexisting Diabetes Mellitus (DM) diagnosis.
  • Other Predictors of LEA are:
    • Prior ____
    • Prior ____
    • Low _____ (< 20 mm Hg unable to heal)
    • Low ____ (< 0.45 unable to heal)
    • _______
A
  • stroke
  • major amputation
  • transcutaneous oxygen levels
  • ankle-brachial index (ABI)
  • Smoking
45
Q

Lower Extremity Amputation

  • the primary predictors for LEA are PVD with a coexisting Diabetes Mellitus (DM) diagnosis.
  • Other Predictors of LEA are:
    • Prior stroke
    • Prior major amputation
    • Low transcutaneous oxygen levels ( < _____ unable to heal)
    • Low ankle-brachial index (ABI) (< ____ unable to heal)
    • Smoking
A
  • transcutaneous oxygen levels = < 20 mm Hg
  • ankle-brachial index (ABI) = <0.45
46
Q

Lower Extremity Amputation

Traumatic injuries such as motorcycle accidents or motor vehicle vs. pedestrians incidents are the leading indication for amputation in younger patients–

LEAs that result from traumatic injuries are more common in men––

In cases of traumatic injuries, an absolute indication for LEA is irreparable vascular injury in an ischemic limb

A
47
Q

Lower Extremity Amputation

Traumatic injuries such as motorcycle accidents or motor vehicle vs. pedestrians incidents are the ______ for amputation in _____ patients–

LEAs that result from traumatic injuries are more common in men––

In cases of traumatic injuries, an absolute indication for LEA is ____ injury in an _____\_

A
  • leading indication
  • younger
  • irreparable vascular; ischemic limb
48
Q

More examples of Traumatic injuries leading to LEAs

  • War Wounds (Blast Injury)
  • Vehicular Accidents (Motorcycles)
  • Natural Disasters (Haiti Earthquake)
  • Occupational Injuries
    • Machinery/Equipment (Crush/Sever)
    • Explosion (Crush/Burn/Electrical)
    • Limb Salvage with Late Amputation
    • Electrocution Injury (Compartment Syndrome)
A
49
Q

Lower Extremity Amputation

LEAs that result from traumatic injuries are more common in ____\_––

A

men

50
Q

Levels of UEA
What is #1

A

Forquarter amputation (FQ)

A forequarter amputation = Above the shoulder

a radical surgical procedure that includes the entire UE along with its shoulder girdle.

this extensive procedure is indicated mostly in patients with malignant tumors that infiltrate the shoulder muscles or severe trauma. There are 2 approaches, anterior and posterior.

51
Q

Levels of UEA
What is #2

A

Shoulder Disarticulation (SD)

the surgical separation of the entire arm from the shoulder joint. In this surgery the humerus and the entire arm are removed from the scapula and clavicle. No bones are cut during this surgery.

52
Q

Levels of UEA

What is #3

A

Very short above elbow (AE)

This is when 0-30% of the humerus remains.

53
Q

Levels of UEA

What is #4

A

short above elbow (AE)

This is when 30-50% of the humerus remains.

54
Q

Levels of UEA

What is #5

A

Standard above elbow (AE)

This is when 50-90% of the humerus remains.

55
Q

Levels of UEA

What is #6

A

long above elbow (AE)

This is when 90-100% of the humerus is preserved.

56
Q

Levels of UEA

What is #7

A

elbow disarticulation (ED)

This is when 90-100% of the humerus is preserved.

when the elbow joint must be sacrificed, an elbow disarticulation is preferable to a more proximal amputation. Not only is greater length preserved, but also the broad flare of the remaining humeral condyles enhances prosthetic fitting and allows humeral rotation to be transmitted to the prosthesis.

57
Q

Levels of UEA

What is #8

A

Very Short Below Elbow (BE)

This is when the the elbow joint is preserved along with 0-35% of the forearm

when the elbow joint must be sacrificed, an elbow disarticulation is preferable to a more proximal amputation. Not only is greater length preserved, but also the broad flare of the remaining humeral condyles enhances prosthetic fitting and allows humeral rotation to be transmitted to the prosthesis.

58
Q

Levels of UEA

What is #9

A

Short Below Elbow (BE)

This is when the the elbow joint is preserved along with 35 - 55% of the forearm

59
Q

Levels of UEA

What is #10

A

Long Below Elbow (BE)

This is when 55 - 90% of the forearm is preserved

60
Q

Levels of UEA

What is #11

A

Wrist Disarticulation (WD)

amputation through the wrist joint

wrist disarticulation is different from the other BE amputations and disarticulations because the surgeon may or may not take the distal ulna and radius. This is why wrist disarticulations may have 90-100% of the forearm.

61
Q

Levels of UEA

What is #12

A

Carpal Disarticulation (WD)

62
Q

Levels of UEA

What is #13

A

Transmetacarpal

Fingers or partial hand amputation

63
Q

Clinical Significances of UEAs

Forequarter FQ = When possible, this amputation should occur at the lateral margin on the sternocleidomastoid insertion to preserve the contour of the neck.

A

Carpal Disarticulation (CD)

amputation through the wrist joint

64
Q

Clinical Significances of UEAs

Transhumeral = Length should be preserved as much as possible for improved shoulder range of motion and prosthesis use. A minimum of 5 to 7 cm of the humerus should be retained for proper prosthesis fit. Further, there should be minimal periosteal stripping to prevent the occurrence of bony spurs, and rough edges require removal. Generally, the anterior and posterior fascia over the flexor and extensor muscle groups are sutured together to cover the end of the humerus. Biceps and triceps myoplasty preserves the strength of prosthetic control and myoelectric signals.

A
65
Q

Clinical Significances of UEAs

Elbow disarticulation= This amputation is preferred over transhumeral amputations because the humeral rotation is still preserved. For children, it is most suitable to preserve the epiphysis of the humerus in the residual limb to allow for growth and avoid revision. The posterior muscle flap is made to be longer than the anterior so that it can be wrapped and cushioned at the end of the humerus.

A
66
Q

Clinical Significances of UEAs

Transradial = It is crucial to preserve the length of the residual limb as much as possible to allow for improved pronation, supination, and prosthetic fit. For instance, a very short amputation allows for zero degrees of rotation, short allows 0 to 60 degrees, the medium allows 60 to 100 degrees, and long allows for 100 to 120 degrees. A minimum of 5 cm of the forearm preservation is needed for prosthetic fit and to allow platform weight bearing in patients with lower extremity disability. In some instances, the biceps tendon gets transferred to the ulna and tension of the muscle must be carefully calibrated to avoid elbow flexion contractures.[7] In some special situations, when one forearm bone is considerably longer than the other one, it may be preferable to create a one bone forearm rather than decrease prosthetic function by shortening the longer one.

A
67
Q

Clinical Significances of UEAs

Wrist = Additionally, the radial and ulnar styloid are resected to minimize bony protrusions and make prosthetic use comfortable. Of note, the radio-ulnar joint is preserved to allow for more forearm rotation.

A
68
Q

Clinical Significances of UEAs

Hand= Removal of specific sets of phalanges can have various effects. Radial amputation is the removal of the first and second proximal phalanges onward which can compromise pinch grasp. Thumb amputation is functionally compromising due to loss of palmar grip, side to side and tip to tip pinch. In patients with thumb loss, they can learn alternative grasps with the remaining digits

A
69
Q

Levels of Upper Extremity Amputations

Levels of upper extremity amputations include:

  • Fingers or partial hand (_____)
  • At the wrist (_______)
  • Below the elbow (______)
  • At the elbow (______)
  • Above the elbow (______)
  • At the shoulder (________)
  • Above the shoulder (_______)
A
  • transcarpal
  • wrist disarticulation
  • transradial
  • elbow disarticulation
  • transhumeral
  • shoulder disarticulation
  • forequarter
70
Q

Levels of Upper Extremity Amputations

Levels of upper extremity amputations include:

  • transcarpal =
  • wrist disarticulation =
  • transradial =
  • elbow disarticulation =
  • transhumeral =
  • shoulder disarticulation =
  • forequarter=
A
  • Fingers or partial hand (transcarpal)
  • At the wrist (wrist disarticulation)
  • Below the elbow (transradial)
  • At the elbow (elbow disarticulation)
  • Above the elbow (transhumeral)
  • At the shoulder (shoulder disarticulation)
  • Above the shoulder (forequarter)
71
Q

UE Amputations

––The primary causes of upper extremity amputations (UEA) are traumatic injuries, disease, and congenital limb deficiency

A
72
Q

UE Amputations

The primary causes of upper extremity amputations (UEA) are ____, ____, and ____

A

traumatic injuries

disease

congenital limb deficiency

73
Q

Other Amputation Indications

burns

frostbite

infections

tumors

congential anomalies

A
74
Q

Other Amputation Indications

  1. ____
  2. ____
  3. ____
  4. ____
  5. ____
A

burns

frostbite

infections

tumors

congential anomalies

75
Q

Wound Healing

The Integumentary system must be monitored for signs of _______ because it facilitates ______, but also because infections can _____.

Note: UNDERSTAND THAT INFECTIONS ARE RAMPANT IN THE HOSPITAL!

•Failed wound healing has been related to decreased success in ambulation with a prosthetic. DON’T OPEN UP THE BANDAGES TO LOOK AT WOUND. SURGEON WILL BE PISSED. Look at bandage, assess whether it’s clean. If it’s bleed after PT session, we need to report it

A

proper wound healing

prosthetic fitting

delay the process of receiving a prosthetic or DQ the patient from being a candidate for one.

76
Q

Wound Healing

PT involvement in wound healing

  • DON’T OPEN UP THE BANDAGES TO LOOK AT WOUND. SURGEON WILL BE PISSED. Look at bandage, assess whether it’s clean. If it’s bleed after PT session, we need to report it
  • Coordinate with nurse staff during dressing changes in order to inspect the skin and incision
  • Monitor the dressings for drainage. Particularly after physical therapy interventions
A
77
Q

–Avoid early unprotected weight bearing

  • –Sloughing of skin–Dehiscence–Delayed wound healing
A
78
Q

Wound Healing for patients with PVD

  • KNOW they’re at risk for skin breakdown on NON-involved extremity
  • Increased weight bearing during the pre-prosthetic time period
  • Educate pt on foot and shoe care with ____ self examinations
    • Ulcers should be treated by:
      • Off-loading
      • Orthoses
      • Wound care
A
  • frequent
79
Q

Edema Control

  • The residual limb may have volume changes for up to _____ after surgery
  • Maintain edema control techniques until:
    • Residual limb is _____
    • Wound is ______
    • Patient is _____

****Up to 3 months, we cant even consider getting pt in a prosthetic*****

A
  • 3 months
  • no longer painful
  • well healed
  • wearing the prosthetic most of the day
80
Q

–Positioning

The correct body position is extremely important–Educate patients about the proper positioning while in bed, sitting, and standing–Elevating the extremity by raising the foot of bed–Post-operative painManage edema

A
81
Q

Positioning

  • The correct body position is extremely important
  • Educate patients about the proper positioning while in bed, sitting, and standing
  • Elevating the extremity by raising the foot of bed to help with
    • _____
    • _____
A
  • Post-operative pain
  • Managing edema
82
Q

Positioning

Postional Cautions to be aware of:

  • Involved extremity in a dependent position for long periods of time
  • Placing pillows between thighs or beneath the involved extremity
    • Avoid keeping the extremity _____ or ____. Specifically for ________ amputations** **because any ______ developed during this time = no longer candidate for a prosthetic.
A
  • flexed; abducted
  • Transfemoral amputations
  • contractures
83
Q

Positioning

Patients with transtibial amputations are more susceptible to _____ contractures–

  • Place a pillow _____ to promote ____
  • Do not place pillow ______
A
  • knee flexion
  • under the tibia; extension
  • under the knee–
84
Q

Positioning

Patients with above-knee-amputations (AKA) are more susceptible to what type of contractures?

A

hip flexor contractures

85
Q

Pain Management

Phantom limb pain

  • Phantom limb pain is _____ pain defined as _____ perceived in the missing limb
  • Phantom limb sensations = any sensation, EXCEPT ____, in the missing limb. Examples of this are:
    • ______
    • ______
    • ______
A
  • neuropathic; painful sensation
  • pain
    • Tingling, Prickling, Pins & needles
86
Q

Pain Management

Involved extremity pain = pain in the residual portion of the amputated limb and may be caused by: _____, _____, or _____–

A

Neuromas

Bony spurs

Infection

87
Q

Pain Management

Post-operative pharmacological pain management:

  • Patients will almost always be on some kind of meds
    • Opioids
    • Patient-controlled analgesia (PCA)
    • Local anesthetics
      • Epidural infusions → patient wont feel things below a certain level
      • NSAID’s → given when patient doesn respond well to opiods
      • Antidepressants
      • Anticonvulsants → cause depressive moods
A
88
Q

Pain Management

The medications taking matters! Why?

L = patient chooses when they get their own pain meds; patient pushes it!

IV → hits system quick, but it’s a short window of time for Tx

Pills → patient needs to take it 30 min before PT session so that it kicks in

A

Because different meds have different lifespans and peak times → this directly affects how we have to go about our Tx sessions with the patient.

89
Q

Pain Management Considerations

  • When scheduling treatment sessions be aware of:
    • Patient’s ______–
    • The ____ of the effectiveness of the different pain medications
    • ______ may be necessary to optimized the intervention
A
  • pain medication schedule
  • duration
  • Premedication
90
Q

Pain Management Considerations

  • Post-operative NON-pharmacological pain management
    • Compression bandages
    • Massage
    • Relaxation techniques
    • Transcutaneous electrical stimulation (TENS)
      • Not used often in inpatient settings
    • Biofeedback
A
91
Q

Post-operative Care

  • Exercise begins ____ OR _____
  • Types of excercises to utilize are:
    • _____ since there are usually tolerated well
    • Exercises to ______–
  • Goal = Patient is _________ at the very least when possible
  • _____ is as tolerated as soon as the patient can control the limb
  • Baby steps toward ambulation include use of:
    • ____ mobility
    • Parallel bars
    • FWW
    • Crutches
A
  • POD #1 OR as soon as tolerated
  • isometric
  • mobilize joints
  • mobilized from bed to chair
  • Ambulation
  • Wheelchair
92
Q

Post-operative Care

(Active/ Passive) movements of all the joints (above/below) the level of the amputation should be performed

Be mindful of hand placement for ROM exercises to prevent excessive stresses on new incisions

A
  • Active
  • above
93
Q

Complications of amputations

  1. hematoma
  2. infection
  3. wound necrosis
  4. pain
  5. dermatological problems
  6. edema
  7. psychosocial problems
A

Wound necrosis → becoming necrotic or IS necrotic

94
Q

Complications of amputations

  1. _____
  2. infection
  3. wound _____
  4. pain
  5. _____ problems
  6. _____
  7. _____ problems
A

Complications of amputations

  1. hematoma
  2. infection
  3. wound necrosis
  4. pain
  5. dermatological problems
  6. edema
  7. psychosocial problems
95
Q

Psychosocial Problems

  • Post-traumatic stress disorder (PTSD)
  • Sexual dysfunction
  • Depression
  • Social isolation
  • Job loss → – which then turns into Financial burden
A
96
Q

Outcome Measures

  • Self-report outcomes measures
    • Amputee Activity Survey
    • Sickness Impact Profile
    • Reintegration to Normal Living
    • Prosthetic Profile of the Amputee
    • SF-36 (Health Status Profile)
    • SF-36V (Health Status Profile for Veterans)
    • Prosthetic Evaluation Questionnaire (PEQ)
    • Orthotic Prosthetic User’s Survey (OPUS)
    • Patient Specific Functional Scale
A
97
Q

Outcomes Measures

  • Physical performance instruments
    • Amputee Mobility Predictor (AMP)
      • Two-Minute Walk Test
    • Six-Minute Walk Test
    • Timed Up & Go (TUG)
    • Functional Ambulation Profile
    • Tinnetti Performance-Oriented Assessment of mobility
    • Berg Balance Measurement
    • Duke Mobility Skills Profile Test
    • Functional Reach Test
A
98
Q

Outcomes Measures

  • Physical performance instruments
    • Amputee Mobility Predictor (AMP)
      • Determines _____level as well as predicts functional ____ for amputees
      • Can be used for patients both before and after ____ and ____
A

functional ; ability

prosthetic fitting; rehabilitation

99
Q

Guarding your Amputee Patient

  • Transfers and gait training
    • Typically, slightly ____ and to ____ ( ___ degrees)
    • Typically guarding on the (stronger/weaker) side
    • Hand is on ____, with _____
  • Stairs
    • Typically to _____ OR _____ the patient
    • One hand on ____ and other hand on ____–
    • Reposition every ____
A
  • behind + to the side; 45 degrees
  • weaker
  • gait belt; palm up ( forearm supinated)–
  • the side or BELOW
  • gait belt; stair rail
  • step
100
Q

Assist Levels

  • I = _____
  • S = _____
  • SBA = _____
  • CGA = _____
  • MIN A = _____
  • MOD A = _____
  • MAX A = _____
  • DEP = ____
A
  • Independent
  • Supervised
  • Stand by assist
  • Contact guard assist
  • Minimum assist
  • Moderate assist
  • Maximum assist
  • Dependent
101
Q

Assist levels

MIN A = patient assists _____\_

MOD A= patient assists _____\_

MAX A = patient assists _____\_

Dependent = patient _______\_

A

MIN A = patient assists 75% or more

MOD A= patient assists 25-75%

MAX A = patient assists 25% or less

Dependent = patient DOESNT ASSIST AT ALL

102
Q
A
103
Q

Gait Training

  • Two-point: two phases of contact
  • Three-point: three phases of contact
  • Four-point: four phases of contact
  • Step-to
    • Meeting the assistive device that is on the ground–
  • Step-through
    • Stepping past and in front of the assistive device on the ground–
  • Swing to/ swing-through–
  • Non-weight bearing lower extremity
A
104
Q
  • *Balance**
  • *Static vs. Dynamic**
  • Sitting
  • Standing
  • Gait training
    • Good (G)–+ or -–
    • Fair (F)–+ or -–
    • Poor (P)–+ or -

These are good descriptors for whoever follows up after you

TEHSE SHOULD ALWAYS BE INCLUDED IN DOCUMENTATION

A

POG (Prosthetic Orthotics & Gait) (2 decks)

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