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Med Surg II Final Exam > Post-Surgical Amputee Care > Flashcards

Post-Surgical Amputee Care Flashcards

1
Q

what is the name of Phase 1

A

Acute

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2
Q

what is the name of Phase 2

A

post acute/ pre-prosthetic

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3
Q

what is the name of Phase 3

A

initial prosthetic/ rehab

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4
Q

what is the name of Phase 4

A

prosthetic/ advanced rehab

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5
Q

what is the name of Phase 5

A

return to PLOF

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6
Q

where would a patient be located for phase 1

A

hospital or just transferred to rehab unit

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7
Q

what are the main goals for phase 1

A
  1. edema/hypersensitivity
  2. basic mobility
  3. limb care
  4. positioning
  5. wound care
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8
Q

what are the goals for phase 2

A
  1. edema/ hypersensitivity
  2. ROM/ strength deficits
  3. I with bed mobility, transfers, w/c mobility using AD
  4. education/ support services
  5. NOT casted/fitted with prosthetic
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9
Q

what are the goals of phase 3

A
  1. intermediate rehab stage
  2. 50-90% strength returns
  3. temp prosthetic
  4. WBing activities
  5. prosthetic gait training
  6. education about prosthetic/ residual limb care
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10
Q

what are the goals of phase 4

A
  1. edema/ limb sensitivity stable
  2. I prosthetic ambulation w/ and w/o prosthetic device
  3. minor difficulty with WB
  4. agility/endurance training
  5. higher level skills
  6. community level functional mobility
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11
Q

what are the goals of phase 5

A
  1. edema/limb sensitivity stable
  2. I with prosthetic ambulation
  3. minor difficulty WBing
  4. agility/ endurance
  5. higher level skills
  6. community level functional mobility
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12
Q

what are some residual limb management for phase 1

A

promote wound healing, control edema, improve strength/ROM, and manage pain

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13
Q

for phase 1 what are some wound care techniques

A

cover wound with gauze/sterile dressing; monitor wound and periwound; watch dressing

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14
Q

what kind of dressing can you use for wound care management for phase 1

A

soft elastic, unna dressing/air splint, semi-rigid dressings, rigid removable dressing, and immediate postoperative prosthesis

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15
Q

what are the pros of elastic bandages

A
  1. readily available
  2. inexpensive
  3. distal to proximal pressure gradient to control edema
  4. helps with limb shaping
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16
Q

what are the cons of elastic bandages

A
  1. restrict circulation
  2. manual dexterity to apply
  3. doesn’t protect from trauma
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17
Q

what is the advantage of shrinkers?

A

give more symmetrical pressure = provides same pressure gradient but its even

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18
Q

what should you avoid with bandages

A

no circular turns, no open areas or wrinkles

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19
Q

what kind of pressure should you use for bandages

A

distal > proximal

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20
Q

what are pros of shrinkers

A
  1. more effective than elastic bandages in reducing edema
  2. shapes limb
  3. symmetrical pressure
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21
Q

what are the cons of shrinkers

A
  1. careful with staples
  2. difficult to keep on TF liimb
  3. order new size for limb volume change
  4. need two
  5. doesn’t protect from trauma
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22
Q

what are the pros of unna dressings?

A
  1. lightweight
  2. left for several days
  3. applied in OR
  4. TF stays on better
  5. TT - prevents flexion contracture
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23
Q

what are the cons of unna dressings?

A
  1. can’t inspect wound
  2. itchy
  3. doesn’t protect from trauma
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24
Q

what are the pros of air splint

A
  1. easy to get on/off
  2. uniform compression (25)
    protects from trauma
  3. cleaned/sterilized
  4. aluminum frame for early ambulation
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25
Q

what are the cons of air splint

A
  1. cant use for TF limbs
  2. need manual dexterity to apply
  3. humid to wear
  4. only PWB allowed
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26
Q

what are the pros of silicone gel liners?

A
  1. compression for edema control
  2. smooth scar tissue
  3. learn to use it early
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27
Q

what are the cons of silicone gel liners?

A
  1. traps sweat
  2. manual dexterity needed
  3. can’t use with skin grafts, poor BF, necrosis, infection, and allergy
  4. must be cognitively aware and complaint
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28
Q

what are the pros of rigid dressings

A
  1. applied in OR
  2. healing faster
  3. protects against trauma
  4. controlling edema decreases need for pain meds
  5. shapes limb
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29
Q

what are the cons of rigid dressings

A
  1. can’t be used with infection
  2. can cause skin breakdown
  3. pain if limb swells
  4. paid onset of edema can cause pain after removal
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30
Q

what are the pros of removable rigid dressing

A
  1. can inspect the wound
  2. protects from trauma
  3. compresses wound
  4. can be washed
  5. adjustable with limb atrophy, volume reduction
31
Q

what are the cons of removable rigid dressing

A
  1. patient can take it off
  2. pre-fabricated RRDs may need to be replaced if limb loses volume
  3. not designed for ambulation
32
Q

what are the pros of IPOP

A
  1. detach from pylon to ensure compliance with WBing restrictions
  2. early ambulation possible
  3. limits deconditioning
  4. psychological benefit
  5. transition to prosthetic easier
33
Q

what are the cons of IPOP

A
  1. patient can WB too much and open surgial wound
  2. can injure the sound leg
  3. rigid dressing cons
34
Q

what are the 3 pains amputees can have

A
  1. phantom pain
  2. nonpainful phantom sensations
  3. residual limb pain
35
Q

what is non-painful phantom limb sensations

A

feels like limb is present, can feel like limb is wrapped in cotton, feel itching,touch, pressure, and feelings of movement

36
Q

what is phantom limb pain?

A

pain in the missing portion,

37
Q

what is the prevalence of phantom limb pain?

A

60-85%

adults > children > congenital amputees

38
Q

when is the common onset of phantom limb pain?

A

1 week post op

39
Q

what exacerbates the phantom limb pain?

A

stress

40
Q

what causes phantom limb pain?

A

peripheral and central changes

41
Q

what are some peripheral changes that cause phantom limb pain?

A

structure changes in neurons, ectopic impulses, ephaptic transmission, sympathetic-afferent coupling, down or up regulation of transmitters, alterations in channels and transduction molecules, and selective loss of unmyelinated fibers

42
Q

terminal swelling and regenerative sprouting of injured axon end creates a _________ which has ______ __________ which causes ____________ ___________ _________.

A

neuroma; ectopic charge; abnormal afferent input

43
Q

what also has ectopic discharges?

A

DRG

44
Q

DRG plus neuroma discharges create what?

A

barrage of afferent input

45
Q

what can also contribute to a “barrage” of afferent input?

A

sympathetic sprouting (adrenergic blockers sometimes help)

46
Q

what are some central changes that cause phantom limb pain?

A

unmasking, sprouting, general disinhibition, map remoderling, loss of neurons, denervation, and alterations in neuronal and glial activity

47
Q

after UE amputation, there is what?

A

massive cortical reorganization

48
Q

because of the reorganization after UE amputation, what is a result?

A

touch, cold, warmth, vibration that is applied to face refers to phantom sensation in the hand

49
Q

why does the hand get phantom sensation when something is applied to the face?

A

brain perceives sensations as originating from the missing hand

50
Q

the greater the phantom limb pain, _______.

A

the greater the sensory cortical reorganization

51
Q

“cells that fire together, ____ ____________”

A

wire together - nerves for touch, pain, temp are close to each other and can “rewire”

52
Q

what is phantom limb pain treated with?

A

medications, rehabilitation, and occasionally surgery

53
Q

what is residual limb pain related to? will it go away?

A

surgical procedure (trauma), yes, it will go away

54
Q

what are some residual limb pain causes?

A

neuroma, bone spurs, MS pain from overuse, prosthesis, referred LBP

55
Q

what is part of the initial rehab?

A

positioning, functional mobility, W/C considerations, and psych

56
Q

For initial rehab, what should you focus on relating to ROM

A
  1. positioning - hip and knee extension, hip adduction
  2. immobilization to maintain ROM (air splint, rigid dressing)
  3. Manual Therapy - at incision site for scar management
57
Q

For initial rehab, what should you focus on relating to strength?

A

isometrics, AROM, resistance, closed chain activities

58
Q

For initial rehab, what should you focus on relating to functional mobility?

A

transfers - sliding board, AD

bed mobility - new awareness of body parameters, core strength issues

59
Q

what are some w/c considerations?

A

cushions (ROHO), want max push efficiency, change in COG (anti-tippers needed)

60
Q

when developing interventions, what should you think about?

A
  1. impairments CANT be ignored
  2. meaningful to the patient
  3. relevant to pt in their specific life environment
61
Q

How do you establish a foundation for success

A

setting goals, listen to your patient, provide them info about how to be an amputee

62
Q

what are some considerations to think about when wrapping the residual limb?

A

no circular turns, distal > proximal, and no open areas/wrinkles

63
Q

what should be included in patient education during the postacute/ pre-prosthetic phase?

A
  1. residual limb care
  2. use of shrinker
  3. HEP
  4. emphasis on rehab process
64
Q

what are some considerations for residual limb management?

A
  1. volume stabilization
  2. shaping the limb
  3. desensitization of phantom and residual limb pain
65
Q

What should you do for edema management?

A

education, volume reduction with limb wrapping/shrinker, and diet

66
Q

what should you do if the patient has soft tissue restrictions?

A

manual therapy - ST mobilization, self massage, general desensitization techniques

67
Q

how would you address ROM limitations

A
  1. stretching - prone position, thomas stretch

2. positioning device - posterior shell or leg board

68
Q

How would you address strength deficits and motor control issues?

A

strengthen - LE, core, UE

69
Q

what do you do about motor control?

A

coordination and agility

70
Q

what do you do about decreased balance

A

sitting and standing balance,

71
Q

why is SLS important

A

important for stance phase during walking

72
Q

what are terms for body awareness?

A

proprioception and kinesthesia

73
Q

what are some considerations for mobility?

A

w/c

walker - energy expenditure and UE wear and tear

74
Q

what should initial prosthetic wear schedule be based on?

A

skin integrity, cognition, and patient safety

Med Surg II Final Exam (9 decks)

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