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Prosthetics > Post-Op Care > Flashcards

Post-Op Care Flashcards

1
Q

What is included in immediate post-op care

A
  1. Acute surgical pain
  2. Grieving the loss of their limb
  3. Medical staff concerns: overall health status, healing suture line, risk of infection.
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2
Q

What are the rehab staff concerns post amputation

A
  1. Single limb mobility
  2. Potential for prosthetic use
  3. Shaping of residual limb
  4. Residual limb edema control
  5. Early mobility training
  6. Avoidance of contractures
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3
Q

What are limb shaping ideals for transfemoral amputations

A
  1. Conical
  2. Distal circumference significantly < proximal
  3. Minimizes shear forces during donning/doffing
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4
Q

What are the ideal limb shaping for transtibial amputations

A
  1. Cylindrical
  2. Distal circumference slightly less than proximal.
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5
Q

What are the residual limb changes

A
  1. Skin thinning
  2. Muscle atrophy
  3. Loss of fat and interstitial fluids
  4. Changes in blood flow
    sedentary lifestyles impact patients a ton
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6
Q

What are the options for post-surgical dressings

A
  1. Soft dressings
  2. Rigid dressing/cast
  3. Removable rigid dressings
  4. Immediate postoperative prosthesis (IPOP)
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7
Q

What are some post-surgical dressing considerations

A
  1. Etiology and level of amputation
  2. Condition of the skin
  3. Medical and functional status of the patient
  4. Surgical techniques
  5. Patient compliance.
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8
Q

What are soft dressings

A
  • ACE wraps
  • Shrinkers
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9
Q

Pros and cons of soft dressings

A

Pros
- Ease of application
- Ability to easily inspect the wound
- Ability to alter the wound environment as needed

Cons
- Need for frequent re-application
- Application may create tourniquet effect or varied pressure to the limb
- Movement of dressing over the wound can create pain and apprehension

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10
Q

What are shrinkers/ pros of shrinkers

A
  • Commerically manufactured elastic garments
  • Apply significant compressive force to the residual limb
  • Very effective for control of edema and limb volume
  • Most convenient and more likely to remain in place on TFA than ACE wrap
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11
Q

Shrinkers precautions

A
  • Can be difficult to apply for patients with limited manual dexterity or poor UE strength
  • Must avoid excessive shearing forces over the incision when donning/doffing
  • No protection of residual limb from trauma
  • Patients may continue to wear their Shrinkers for up to 6 months when not wearing their prosthesis
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12
Q

What are rigid dressings

A
  • Plater bandages, fiberglass casting material, copolymer plastics
  • Surgical dressing over incision
  • Protection padding — for bony prominences
  • Plaster of Paris casting material
  • Pressure above femoral condyles is applied to create supracondylar suspension
  • Cast is usually left in place for 3 days, then the incision is assessed.
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13
Q

Advantages of removable rigid dressings

A
  • Easy to don/dog to assess the skin and incision site and provide daily wound care
  • Faciliates residual limb shrinking and shaping
  • Patients may be ready for prosthetic fitting sooner
  • Edema control and pain management
  • Faster desensitization of the residual limb
  • Protects residual limb during higher level activities.
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14
Q

Indications for removable rigid dressings

A
  1. Transtibial amputations in initial stages of healing
  2. No signs of infection, ecchymosis, or wound dehiscence
  3. Fluctuating edema
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15
Q

Wear/use of removable rigid dressings

A
  1. Designed to be worn continuously
  2. Inspect the skin within the first 60-90 minutes of initial wearing
  3. Significant change in shape or configuration of residual limb requires fabrication of a new RRD
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16
Q

What is an IPOP

A

Immediate Post-Operative Prosthesis
- Rigid cast with features of patellar tendon-bearing socket and incorporation of an attachment plate for a pylon and inexpensive foot/ankle assembly
- Objective: reduce the time without bipedal ambulation
- Limited, protected, toe-touch partial weight bearing initially.

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17
Q

Advantages AND disadvantages of IPOPs

A

Advantages
- Psychological and physiological benefits attributed to walking
- Potentially shorter hospital length of stay
- Reduction in the severity of of phantom pain

Disadvantages
- Potential risk for fall or injury
- Limited weight-bearing could impair the healing site
- Inability to access the wound to monitor healing

18
Q

What are indications for changing rigid dressings or IPOP?

A
  • Severe pain or excessive tightness of the cast
  • Slippage, rotation, or pistoling of the cast
  • Damage to the cast
  • Febrile patient or an odor associated with infection
19
Q

How do you select an appropriate compression device?

A
  1. Ability to don/doff independently
  2. Security of device on limb for patient’s activity level
  3. Adequate compression for effective limb shrinking and shaping
  4. Protection of skin and suture line during daily activities
  5. Comfort with prolonged use - but still control edema
  6. Cost-effective in terms of fabrication, modification, and/or replacement
20
Q

What is residual limb pain

A

Pain arising in the residual limb from a specific anatomical structure that can be identified
Neurogenic pain — sharp, shooting pain evoked by light tapping usually (tinel’s)

21
Q

What are causes of residual limb pain

A
  1. Abnormal residual limb tissue
    - bone pain = exostoses, heterotrophic ossification
    - joint pain = cartilage, ligament, capsule, or other articúlalas structures
    - soft tissue pain = bursitis, tendinitis, adherent scar tissue, ischemia
  2. Prosthogenic = improper prosthetic fit
  3. Referred pain = proximal pathology referring to the residual limb
  4. Sympathogenic = associated with the sympathetic nervous system.
22
Q

What is phantom limb pain vs. Phantom limb sensation

A

PLP = A painful sensation experienced within the residual limb that cannot be attributed to a specific structure/function
PLS = A non-painful sensation or awareness experienced that gives form to a body part with a specific dimensions, weight, or range of motion

initial onset is usually within the first week following amputation, but may occur several months later
intensity, duration, and severity may decrease after 6 months, but little change is expected thereafter

23
Q

Pain descriptors for phantom limb pain

A

Dull aching
Burning
Stabbing, knife like
Squeezing
Electric shocks
Leg is being pulled off
Trauma related pain

24
Q

Pain descriptors for phantom limb sensation

A

Touch
Pressure
Cold
Wetness
Itching
Fatigue
Phantom movement

25
Q

Provocational vs. Relieving phantom limb pain stimuli

A

Provocational
- Increased emotional stress
- Exposure to cold
- Local irritants to the stump

Relieving
- using the prosthesis
- stroking the residual limb
- heat
-distraction — mentally

26
Q

What does phantom limb pain/sensation treatment look like

A
  • Wear prostheses
  • Ultrasound, electrical stim
  • heat/cold
  • Massage
  • Meds
  • Education!!
27
Q

What is education for phantom limb pain/sensation

A
  • helps reduce patient’s anxiety
  • alerts patients to safety issues
  • Patients Inattention could cause a fall if they try to get up but they forget they don’t have the limb.
28
Q

What are PT post-op assessments

A
  1. Limb length
  2. Limb volume
  3. Range of motion
  4. Strength
  5. Postural control
  6. Bed mobility
  7. Transfers
  8. Residual limb healing
29
Q

What are landmarks for limb length

A

Proximal — transtibial = tibial plateau. Transfemoral = ischium
Distal — proximal incision, distal boney end of limb, soft tissue end of limb.

30
Q

why limb volume

A

Indicator of prosthetic readiness. Comparison of distal and proximal measurements.
- referral for prosthetic fitting occurs when distal circumference measurement is the same or less than proximal measurements.

31
Q

What is critical when assessing range of motion

A

Full hip extension is critical for kene stability when walking with a transfemoral prosthesis

Want full knee extension of transtibial

32
Q

What interventions to prevent/minimize flexion contractures in transfemoral amputations

A
  • Relaxed lying position: tendency for hip flexion, abduction and ER.
  • Resting in prone with towel under distal residual limb
  • Manual stretching of hip flexors
33
Q

What interventions to prevent/minimize flexion contractures in transtibial amputations

A
  • Position a small towel roll under the distal posterior residual limb to encourage knee extension
  • Prone lying with towel roll above patella, tibia handing loosely
34
Q

What about muscle strength in this population

A
  • Postpone MMT until adequate healing
  • But you can measure active strength
  • Observe the suture line when testing and do not perform through any dressings or pressure garments.
  • Hand placement for resistance will be more proximal than normal MMT
  • Mechanical advantage of tester is reduced.
35
Q

Strength training programs

A
  • TTA = Quad sets, SAQ can be initiated first week
  • TFA = glute sets, gravity eliminated hip extension
  • Progression of exercises with advanced wound healing
  • train UE for shoulder depression and elbow extension
  • train core
36
Q

What postural control should be done

A

In sitting: reaching, throwing/catching, therapist induced perturbations, alter extent of reaching, speed, weight of objects

  • Addition of prosthesis: increases the functional base of support in sitting and the weight of prosthesis serves as a stabilizing force during activity
37
Q

What bed mobility

A

Want to minimize risk of trauma.
TFA = may have difficult with rolling

Supine-> sit. General sequence is unchanged but probs need more UE. Bed rails and shit can be helpful early on

  • education about risk of pressure ulcers
  • frequent position changes, weight shifting, and exercise reduce risk .
38
Q

Transfers with this population

A
  1. Amount of assistance required will depend on pre-amputation condition
    - stand-pivot = initially toward the sound limb and then progress to either direction
    - transfer boards, AD, surface to surface bilaterally, different surface levels. To/from adaptive equipment
39
Q

Benefits and AD for single limb ambulation

A

Benefits
- Enhance postural control
- Build strength
- Improve cardiovascular endurance
- Move about the environment

AD
- parallel bars, walker, crutches.
- walkers make it hard for a hop-to gait limits forward progression of COG and is difficult to negotiate stairs/inclines
- when possible move to crutches and encourage use.

40
Q

What does residual limb healing look like

A
  1. Inspect wound during dressing changes
  2. Monitor quantity and quality of drainage
  3. Wound edges should closely approximate
  4. Areas of separation, scabbing, ecchymosis, or decreased tissue viability should be documented.

Prosthetics (7 decks)

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