Post-Surgical Amputee Care Flashcards
1
Q
what is the name of Phase 1
A
Acute
2
Q
what is the name of Phase 2
A
post acute/ pre-prosthetic
3
Q
what is the name of Phase 3
A
initial prosthetic/ rehab
4
Q
what is the name of Phase 4
A
prosthetic/ advanced rehab
5
Q
what is the name of Phase 5
A
return to PLOF
6
Q
where would a patient be located for phase 1
A
hospital or just transferred to rehab unit
7
Q
what are the main goals for phase 1
A
- edema/hypersensitivity
- basic mobility
- limb care
- positioning
- wound care
8
Q
what are the goals for phase 2
A
- edema/ hypersensitivity
- ROM/ strength deficits
- I with bed mobility, transfers, w/c mobility using AD
- education/ support services
- NOT casted/fitted with prosthetic
9
Q
what are the goals of phase 3
A
- intermediate rehab stage
- 50-90% strength returns
- temp prosthetic
- WBing activities
- prosthetic gait training
- education about prosthetic/ residual limb care
10
Q
what are the goals of phase 4
A
- edema/ limb sensitivity stable
- I prosthetic ambulation w/ and w/o prosthetic device
- minor difficulty with WB
- agility/endurance training
- higher level skills
- community level functional mobility
11
Q
what are the goals of phase 5
A
- edema/limb sensitivity stable
- I with prosthetic ambulation
- minor difficulty WBing
- agility/ endurance
- higher level skills
- community level functional mobility
12
Q
what are some residual limb management for phase 1
A
promote wound healing, control edema, improve strength/ROM, and manage pain
13
Q
for phase 1 what are some wound care techniques
A
cover wound with gauze/sterile dressing; monitor wound and periwound; watch dressing
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
15
Q
what are the pros of elastic bandages
A
- readily available
- inexpensive
- distal to proximal pressure gradient to control edema
- helps with limb shaping
16
Q
what are the cons of elastic bandages
A
- restrict circulation
- manual dexterity to apply
- doesn’t protect from trauma
17
Q
what is the advantage of shrinkers?
A
give more symmetrical pressure = provides same pressure gradient but its even
18
Q
what should you avoid with bandages
A
no circular turns, no open areas or wrinkles
19
Q
what kind of pressure should you use for bandages
A
distal > proximal
20
Q
what are pros of shrinkers
A
- more effective than elastic bandages in reducing edema
- shapes limb
- symmetrical pressure
21
Q
what are the cons of shrinkers
A
- careful with staples
- difficult to keep on TF liimb
- order new size for limb volume change
- need two
- doesn’t protect from trauma
22
Q
what are the pros of unna dressings?
A
- lightweight
- left for several days
- applied in OR
- TF stays on better
- TT - prevents flexion contracture
23
Q
what are the cons of unna dressings?
A
- can’t inspect wound
- itchy
- doesn’t protect from trauma
24
Q
what are the pros of air splint
A
- easy to get on/off
- uniform compression (25)
protects from trauma - cleaned/sterilized
- aluminum frame for early ambulation
25
what are the cons of air splint
1. cant use for TF limbs
2. need manual dexterity to apply
3. humid to wear
4. only PWB allowed
26
what are the pros of silicone gel liners?
1. compression for edema control
2. smooth scar tissue
3. learn to use it early
27
what are the cons of silicone gel liners?
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
28
what are the pros of rigid dressings
1. applied in OR
2. healing faster
3. protects against trauma
4. controlling edema decreases need for pain meds
5. shapes limb
29
what are the cons of rigid dressings
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
30
what are the pros of removable rigid dressing
1. can inspect the wound
2. protects from trauma
3. compresses wound
4. can be washed
5. adjustable with limb atrophy, volume reduction
31
what are the cons of removable rigid dressing
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
what are the pros of IPOP
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
what are the cons of IPOP
1. patient can WB too much and open surgial wound
2. can injure the sound leg
3. rigid dressing cons
34
what are the 3 pains amputees can have
1. phantom pain
2. nonpainful phantom sensations
3. residual limb pain
35
what is non-painful phantom limb sensations
feels like limb is present, can feel like limb is wrapped in cotton, feel itching,touch, pressure, and feelings of movement
36
what is phantom limb pain?
pain in the missing portion,
37
what is the prevalence of phantom limb pain?
60-85%
| adults > children > congenital amputees
38
when is the common onset of phantom limb pain?
1 week post op
39
what exacerbates the phantom limb pain?
stress
40
what causes phantom limb pain?
peripheral and central changes
41
what are some peripheral changes that cause phantom limb pain?
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
terminal swelling and regenerative sprouting of injured axon end creates a _________ which has ______ __________ which causes ____________ ___________ _________.
neuroma; ectopic charge; abnormal afferent input
43
what also has ectopic discharges?
DRG
44
DRG plus neuroma discharges create what?
barrage of afferent input
45
what can also contribute to a "barrage" of afferent input?
sympathetic sprouting (adrenergic blockers sometimes help)
46
what are some central changes that cause phantom limb pain?
unmasking, sprouting, general disinhibition, map remoderling, loss of neurons, denervation, and alterations in neuronal and glial activity
47
after UE amputation, there is what?
massive cortical reorganization
48
because of the reorganization after UE amputation, what is a result?
touch, cold, warmth, vibration that is applied to face refers to phantom sensation in the hand
49
why does the hand get phantom sensation when something is applied to the face?
brain perceives sensations as originating from the missing hand
50
the greater the phantom limb pain, _______.
the greater the sensory cortical reorganization
51
"cells that fire together, ____ ____________"
wire together - nerves for touch, pain, temp are close to each other and can "rewire"
52
what is phantom limb pain treated with?
medications, rehabilitation, and occasionally surgery
53
what is residual limb pain related to? will it go away?
surgical procedure (trauma), yes, it will go away
54
what are some residual limb pain causes?
neuroma, bone spurs, MS pain from overuse, prosthesis, referred LBP
55
what is part of the initial rehab?
positioning, functional mobility, W/C considerations, and psych
56
For initial rehab, what should you focus on relating to ROM
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
For initial rehab, what should you focus on relating to strength?
isometrics, AROM, resistance, closed chain activities
58
For initial rehab, what should you focus on relating to functional mobility?
transfers - sliding board, AD
| bed mobility - new awareness of body parameters, core strength issues
59
what are some w/c considerations?
cushions (ROHO), want max push efficiency, change in COG (anti-tippers needed)
60
when developing interventions, what should you think about?
1. impairments CANT be ignored
2. meaningful to the patient
3. relevant to pt in their specific life environment
61
How do you establish a foundation for success
setting goals, listen to your patient, provide them info about how to be an amputee
62
what are some considerations to think about when wrapping the residual limb?
no circular turns, distal > proximal, and no open areas/wrinkles
63
what should be included in patient education during the postacute/ pre-prosthetic phase?
1. residual limb care
2. use of shrinker
3. HEP
4. emphasis on rehab process
64
what are some considerations for residual limb management?
1. volume stabilization
2. shaping the limb
3. desensitization of phantom and residual limb pain
65
What should you do for edema management?
education, volume reduction with limb wrapping/shrinker, and diet
66
what should you do if the patient has soft tissue restrictions?
manual therapy - ST mobilization, self massage, general desensitization techniques
67
how would you address ROM limitations
1. stretching - prone position, thomas stretch
| 2. positioning device - posterior shell or leg board
68
How would you address strength deficits and motor control issues?
strengthen - LE, core, UE
69
what do you do about motor control?
coordination and agility
70
what do you do about decreased balance
sitting and standing balance,
71
why is SLS important
important for stance phase during walking
72
what are terms for body awareness?
proprioception and kinesthesia
73
what are some considerations for mobility?
w/c
| walker - energy expenditure and UE wear and tear
74
what should initial prosthetic wear schedule be based on?
skin integrity, cognition, and patient safety
