Post-Op Prosthetic Care Flashcards
What type of treatment offers the best result post-op?
co-treatment
What is the primary goal of skilled care prior to surgery?
education and prevention of further adversity
What is the most important thing following amputation?
reducing edema and promoting healing
The main goal is to shape the stump to fit into the prosthesis, what deformity is present following surgery that is a major setback to this?
“Dog ears”
What seems to be the best post-op option in regards to reducing edema and preparing for the prosthesis?
Immediate postoperative prosthesis (IPOP) pneumatic
What was once the standard for edema reduction that has since been ceased due to its ineffectiveness?
soft dressings such as ACE bandages
What is now being used as a replacement for ACE wrap?
Stockinet or Tubigrip
What is the major difference between non-removable and removable IPOPs?
Removable allows for the wound to be monitored while non-removable does not. Both improve the physiological and psychological response to amputation.
Describe a stump shrinker
It is an elastic compression bandage that provides significantly more distal compression than proximal
What type of contracture is most common? Why?
hip flexor
Pain can cause the flexor withdrawl reflex
What position should a patient be positioned in in bed?
Prone lying is best as it is a position that avoids hip and knee flexion
What wheelchair adaptation is helpful in preventing contractures?
A stump board which avoids dependent positioning of the affected extremity
Why is prevention of knee flexor contracture imperative for optimal prosthetic fit and ambulation?
Knee extension is essential to establish terminal stance
What special test can be used to determine whether or not a patient may be developing a flexion contracture?
Thomas test
What is a reasonable plan of care for post-op amputees?
prone lying, modified Thomas test, mobility exercises
Why is monofilament testing important?
If the patient is unable to feel abnormal pressures within their socket skin breakdown can occur. It is also important for donning the prosthesis and balance during ambulation.
What are Elizabeth Kubler-Ross 5 stages of loss?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What are the 4 requirements in order for an amputee to be discharged?
- must have adequate strength for transfers, ADL’s, and bed mobility
- balance must be adequate for mobility and ADL’s
- appropriate wheelchair has been prescribed
- adaptive equipment has been installed in the home
What things must be done to prepare the residual limb for gait in the prosthetic?
- increase ROM
- muscle strengthening of residual musculature
- desensitization
- skin mobility
- edema control
Why is skin mobility important?
Adherent skin can make prosthetic use more painful
Other than decreasing edema and shaping the residual limb, what are 2 advantages of compression?
- decreased phantom limb pain
- promotes quicker healing
What is an important thing to remember when beginning gait/weight bearing activities?
Ensure the patient maintains a neutral pelvis
Define phantom sensation
sensation that the amputated limb remains in place in the days and weeks after surgery
What is phantom sensation described as?
- numbness
- tingling
- tickling
- pressure
- formication (bugs crawling)
- itching
- cold
- wetness
What are the 3 categories of phantom sensations? Give some examples of each…
1) Kinesthetic Sensation
- posture
- length
- volume
2) Kinetic sensations
- willed movements
- spontaneous movements
- associated movements
3) Extroceptive Sensations
- touch
- temperature
- pressure
Define phantom pain
A painful sensation experienced within the limb that is now not part of the body
What is the typical onset of phantom pain?
1 week to several months post-op
Phantom pain usually decreases within _ months
6
What types of things evoke phantom pain?
- emotional stress
- cold
- local irritants
What things can help to relieve phantom pain?
- wearing prosthesis
- stroking
- heat
- mental distraction
What are the 3 theories as to why patients experience phantom limb pain and sensation?
1) The remaining nerves continue to generate impulses.
2) The spinal cord nerves begin excessive spontaneous firing in the absence of expected sensory input from the limb.
3) There is altered signal transmission and modulation within the somatosensory cortex.
In most cases phantom limb pain is _______.
unpredictable
What is phantom pain described as?
- Dull, aching
- Stabbing
- Squeezing
- Leg being pulled off
- pain similar to pre-Op pain
- Burning
- Sticking
- Electric shocks
- Unnatural positioning
Define residual limb pain
Pain that arises in the residual limb from a specific anatomical structure that can be identified
What is residual limb pain described as?
- prosthetic
- neuroma
- sympathetic (CRPS)
- referred
- abnormal tissue
- joint pain
- bone pain
- soft tissue pain
- residual limb change
What is the importance of the initial PT evaluation?
- Provides Base line Assessment
- Identifies potential accommodations to prescription
- Establishes documentation to support prescription
- Identifies Functional Level
What are the 5 levels of functioning?
1) Functional Level 0: no ability or potential for weight bearing or transfer
2) Functional Level 1: Ability or potential to transfer and ambulate within the household with an assistive device
3) Functional level 2: Community ambulator with the ability or potential to traverse minor environmental barriers, fixed cadence
4) Functional Level 3: Community ambulator with the ability or potential to traverse all environmental barriers with a variable cadence
5) Functional Level 4: higher functioning athletes
