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Practice topics Exam 6 > Management of the pt with LE amputation > Flashcards

Management of the pt with LE amputation Flashcards

1
Q

Diabetes

A

There is a 15 x greater rate of amputation in pts with DM than those without

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2
Q

Leading cause of amputation

A

Impaired vascular system

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3
Q

Pre-operative care issues

A 
Determine pt level of activity
Identify the pt support system
Identify the support medical team and the roles each - SOCIAL WORKER IS CRITICAL
Pt expectations
Explain sequence of events 
Identify realistic expectations
Answer questions
Listen to the pt
Determine functional level
Determine impairments
Practice transfer skills! CRITICAL
Begin proper bed positioning
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4
Q

Goals of pre prosthetic phase

A 
Dec edema
Promote healing
Inc strength
Promote mobility and self care! CRITICAL
Promote sound limb care
Assist with adjustment to limb loss
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5
Q

Medical info

A

Vitals
Condition of other limb
Lab results
Medications (narcotics)

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6
Q

Things that can be done with dressing on

A

Examine uninvolved extremity - general condition, sensation, ROM, strength

Balance (make sure to look at sitting B)
ADL
Condition of dressing
Pain

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7
Q

Things that can be done with dressing removed

A 
Pain
Condition of surgical site 
Residual limb shape and size
ROM/flexibility 
Balance
Strength
Sensation
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8
Q

Things that can be done with dressing removed - residual limb shape and size

A

two lengths (using non movable landmarks)
- Ischial tub to soft tissue end
- Ischial tub to bony end of TF amputation
SHOULD BE A DIFFERENCE

TT - tibial tubercle to soft tissue and bony ends too – Bony end will be tibia! (fibular should be shorter)

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9
Q

Phantom pain, phantom sensation, residual limb pain - how many experience these

A

85% of all pts with amputations

Difficult to predetermine which pt is likely to experience which type of pain

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10
Q

Phantom sensation

A

Non painful sensation that gives form and substance to areas distal to the level of amputation
Can be a safety issue
3 categories - kinesthetic, kinetic, exteroreceptive

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11
Q

Phantom sensation - categories

A

Kinesthetic - posture, length, volume
Kinetic - movements
Exteroreceptive - temp, pressure, touch

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12
Q

Residual limb pain

A

Within the residual limb
Specific anatomic structures can usually be identified as source (neuroma is common)
10% continue to report residual pain 2 years after surgery
57% within 8 days post surgery

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13
Q

Residual limb pain - how does a neuroma cause it

A

Tension on nerves and BVs when they make the flap - nerve can retract and cause a neuroma which can be the source of their pain - it is getting weird signals from pain fibers

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14
Q

Phantom pain

A

Painful sensation experienced below the level of amputation

Etiology is unknown

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15
Q

Phantom sensation - table

A 
Touch
Pressure
Cold
Itching
Phantom movement
Crawling
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16
Q

Phantom pain - table

A 
Dull aching
Burning
Stabbing knife-like
Leg being pulled off
Pre-operative pain
Electric shock
Unnatural position
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17
Q

Residual limb pain - table

A 
Neuroma
Referred
Abnormal tissue
Joint pain
Soft tissue pain
Bone pain
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18
Q

Treatment of phantom pain

A 
Sensory stimulation, overload (pounding with wooden mallet, rub with towel)
Surgery (ok short)
Spinal cord stimulation (ok short)
TENS
Vibration
Mirror therapy
Psych counseling
Analgesics
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19
Q

Strength

A

12 to 16 wks before getting prosthesis so early strengthening is important
When we see them will likely already be deconditioned
Need UE and LE strengthening program
Dynamic, Functional, Isometirc/Isotonic, Manual Resistane

20
Q

Positioning - Transtibial

A

AVOID knee flex, hip abd, hip flex, hip ER

21
Q

Positioning - Transfemoral

A

AVOID hip abd, flex, ER

22
Q

Skin condition and sensory system

A

Education - sensory loss, care of sound limb, care of residual limb
Activities to desensitize limb
Scar mobilization

23
Q

Balance

A

Pt has lost up 10% of weight - balance will be impacted!!!
Functional progressive exercise
Developmental sequence

24
Q

Equipment

A

Ambulation devices
Bathroom equipment
WC - anti-tips, wheels more post, stump board for residual limb

25
Q

Post op day 1

A 
Bed mobility 
Positioning 
PROM/AROM to uninvolved joints
Glut sets
Sound side exercises
Breathing exercises
26
Q

Post op day 2

A 
Transfer training
Sitting endurance
AROM to uninvolved joints
Glut sets, quad sets
Sound side exercises
Resp as needed
27
Q

Post op day 3

A

Ambulation
Sitting endurance
Continue AROM, isometrics, exercises
Dressing education

28
Q

Post op day 4

A

Ambulation with discharge device
Education regarding contracture prevention and protection of limbs
Continue other parts of program

29
Q

Post op day 5

A

Continue program
HEP given
Discharge

30
Q

Post op day 10-14

A

Rigid dressing changed
Dynamic strengthening exercises (avoid knee F/E TTA, avoid hip abd/add TFA)
Limited stretching (PROM) of involved side
Review and adjust HEP
Pt ed as needed

31
Q

Staples are removed when

A

Week 3
21 days for vascular
14 days for traumatic

32
Q

Week 6 to 8

A

Cast for temporary prosthesis, AKA diagnostic socket

33
Q

Week 10-12

A

Ready for prosthetic gait training

34
Q

K0

A

Will not ambulate

35
Q

K1

A

Transfer

36
Q

K2

A

limited community ambulator

single speed

37
Q

K3

A

typical community ambulator

variable speed

38
Q

K4

A

child, active adult/athlete

39
Q

SACH

A

Solid ankle cushion heel
Match amount of heel cushion to pt weight
If heel too soft - will get foot slap

40
Q

Probably need a new socket - at what plie

A

12

41
Q

TES

A

Total elastic suspension

Goes around the waist

42
Q

Carbon foot =

A

dynamic response

43
Q

Thigh lacer - often used when

A

Skin breakdown from pressure - thigh lace can help take weight off of the residual limb

44
Q

Knee disarticulation adv

A

End WB
Can do hands and knees stuff
All thigh muscles still intact

45
Q

Knee disarticulation disadv

A

Long thigh to deal with
Cosmetic - when sit, knee will always protrude out longer - Can use polycentric knee with manual unlocking mechanism to prevent this

Practice topics Exam 6 (3 decks)

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