Post-Op Care Flashcards
What is included in immediate post-op care
- Acute surgical pain
- Grieving the loss of their limb
- Medical staff concerns: overall health status, healing suture line, risk of infection.
What are the rehab staff concerns post amputation
- Single limb mobility
- Potential for prosthetic use
- Shaping of residual limb
- Residual limb edema control
- Early mobility training
- Avoidance of contractures
What are limb shaping ideals for transfemoral amputations
- Conical
- Distal circumference significantly < proximal
- Minimizes shear forces during donning/doffing
What are the ideal limb shaping for transtibial amputations
- Cylindrical
- Distal circumference slightly less than proximal.
What are the residual limb changes
- Skin thinning
- Muscle atrophy
- Loss of fat and interstitial fluids
- Changes in blood flow
sedentary lifestyles impact patients a ton
What are the options for post-surgical dressings
- Soft dressings
- Rigid dressing/cast
- Removable rigid dressings
- Immediate postoperative prosthesis (IPOP)
What are some post-surgical dressing considerations
- Etiology and level of amputation
- Condition of the skin
- Medical and functional status of the patient
- Surgical techniques
- Patient compliance.
What are soft dressings
- ACE wraps
- Shrinkers
Pros and cons of soft dressings
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
What are shrinkers/ pros of shrinkers
- 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
Shrinkers precautions
- 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
What are rigid dressings
- 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.
Advantages of removable rigid dressings
- 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.
Indications for removable rigid dressings
- Transtibial amputations in initial stages of healing
- No signs of infection, ecchymosis, or wound dehiscence
- Fluctuating edema
Wear/use of removable rigid dressings
- Designed to be worn continuously
- Inspect the skin within the first 60-90 minutes of initial wearing
- Significant change in shape or configuration of residual limb requires fabrication of a new RRD
What is an IPOP
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.
Advantages AND disadvantages of IPOPs
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
What are indications for changing rigid dressings or IPOP?
- 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
How do you select an appropriate compression device?
- Ability to don/doff independently
- Security of device on limb for patient’s activity level
- Adequate compression for effective limb shrinking and shaping
- Protection of skin and suture line during daily activities
- Comfort with prolonged use - but still control edema
- Cost-effective in terms of fabrication, modification, and/or replacement
What is residual limb pain
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)
What are causes of residual limb pain
- 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 - Prosthogenic = improper prosthetic fit
- Referred pain = proximal pathology referring to the residual limb
- Sympathogenic = associated with the sympathetic nervous system.
What is phantom limb pain vs. Phantom limb sensation
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
Pain descriptors for phantom limb pain
Dull aching
Burning
Stabbing, knife like
Squeezing
Electric shocks
Leg is being pulled off
Trauma related pain
Pain descriptors for phantom limb sensation
Touch
Pressure
Cold
Wetness
Itching
Fatigue
Phantom movement
