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735: Orthotics and Prosthetics > Post-Op Prosthetic Care > Flashcards

Post-Op Prosthetic Care Flashcards

1
Q

What type of treatment offers the best result post-op?

A

co-treatment

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2
Q

What is the primary goal of skilled care prior to surgery?

A

education and prevention of further adversity

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3
Q

What is the most important thing following amputation?

A

reducing edema and promoting healing

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4
Q

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?

A

“Dog ears”

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5
Q

What seems to be the best post-op option in regards to reducing edema and preparing for the prosthesis?

A

Immediate postoperative prosthesis (IPOP) pneumatic

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6
Q

What was once the standard for edema reduction that has since been ceased due to its ineffectiveness?

A

soft dressings such as ACE bandages

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7
Q

What is now being used as a replacement for ACE wrap?

A

Stockinet or Tubigrip

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8
Q

What is the major difference between non-removable and removable IPOPs?

A

Removable allows for the wound to be monitored while non-removable does not. Both improve the physiological and psychological response to amputation.

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9
Q

Describe a stump shrinker

A

It is an elastic compression bandage that provides significantly more distal compression than proximal

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10
Q

What type of contracture is most common? Why?

A

hip flexor

Pain can cause the flexor withdrawl reflex

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11
Q

What position should a patient be positioned in in bed?

A

Prone lying is best as it is a position that avoids hip and knee flexion

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12
Q

What wheelchair adaptation is helpful in preventing contractures?

A

A stump board which avoids dependent positioning of the affected extremity

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13
Q

Why is prevention of knee flexor contracture imperative for optimal prosthetic fit and ambulation?

A

Knee extension is essential to establish terminal stance

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14
Q

What special test can be used to determine whether or not a patient may be developing a flexion contracture?

A

Thomas test

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15
Q

What is a reasonable plan of care for post-op amputees?

A

prone lying, modified Thomas test, mobility exercises

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16
Q

Why is monofilament testing important?

A

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.

17
Q

What are Elizabeth Kubler-Ross 5 stages of loss?

A
  • Denial
  • Anger
  • Bargaining
  • Depression
  • Acceptance
18
Q

What are the 4 requirements in order for an amputee to be discharged?

A
  • 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
19
Q

What things must be done to prepare the residual limb for gait in the prosthetic?

A
  • increase ROM
  • muscle strengthening of residual musculature
  • desensitization
  • skin mobility
  • edema control
20
Q

Why is skin mobility important?

A

Adherent skin can make prosthetic use more painful

21
Q

Other than decreasing edema and shaping the residual limb, what are 2 advantages of compression?

A
  • decreased phantom limb pain

- promotes quicker healing

22
Q

What is an important thing to remember when beginning gait/weight bearing activities?

A

Ensure the patient maintains a neutral pelvis

23
Q

Define phantom sensation

A

sensation that the amputated limb remains in place in the days and weeks after surgery

24
Q

What is phantom sensation described as?

A
  • numbness
  • tingling
  • tickling
  • pressure
  • formication (bugs crawling)
  • itching
  • cold
  • wetness
25
Q

What are the 3 categories of phantom sensations? Give some examples of each…

A

1) Kinesthetic Sensation
- posture
- length
- volume
2) Kinetic sensations
- willed movements
- spontaneous movements
- associated movements
3) Extroceptive Sensations
- touch
- temperature
- pressure

26
Q

Define phantom pain

A

A painful sensation experienced within the limb that is now not part of the body

27
Q

What is the typical onset of phantom pain?

A

1 week to several months post-op

28
Q

Phantom pain usually decreases within _ months

A

6

29
Q

What types of things evoke phantom pain?

A
  • emotional stress
  • cold
  • local irritants
30
Q

What things can help to relieve phantom pain?

A
  • wearing prosthesis
  • stroking
  • heat
  • mental distraction
31
Q

What are the 3 theories as to why patients experience phantom limb pain and sensation?

A

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.

32
Q

In most cases phantom limb pain is _______.

A

unpredictable

33
Q

What is phantom pain described as?

A
  • Dull, aching
  • Stabbing
  • Squeezing
  • Leg being pulled off
  • pain similar to pre-Op pain
  • Burning
  • Sticking
  • Electric shocks
  • Unnatural positioning
34
Q

Define residual limb pain

A

Pain that arises in the residual limb from a specific anatomical structure that can be identified

35
Q

What is residual limb pain described as?

A
  • prosthetic
  • neuroma
  • sympathetic (CRPS)
  • referred
  • abnormal tissue
  • joint pain
  • bone pain
  • soft tissue pain
  • residual limb change
36
Q

What is the importance of the initial PT evaluation?

A
  • Provides Base line Assessment
  • Identifies potential accommodations to prescription
  • Establishes documentation to support prescription
  • Identifies Functional Level
37
Q

What are the 5 levels of functioning?

A

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

735: Orthotics and Prosthetics (14 decks)

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