Practical Prompt Questions Flashcards
Typically what size ace wraps and how many should the physical therapist anticipate needing?
Transfemoral: 2 6-inch wraps and 1 4-inch wrap
Transtibial: 2 4-inch wraps
How might the physical therapist recognize if the ace wrap is an incorrect size?
Covers too much or not enough
How long should the physical therapist leave the ace wrap in place?
Until it gets loose or if patient complains of pain. Per Shelly, it is good to change at dressing changes, or roughly every 4 hours.
Should the physical therapist educate the patient regarding ace wrap use? (Considerations/Options?)
Yes, so they can better manage their own care
Have them get you if it is loose, oozing fluid, etc.
Upon inspection of the RL, what should the physical therapist be assessing?
Skin color, temp, pain, protective sensation, etc.
What recommendation might the physical therapist make to the physician in terms of patient safety?
Be safe
Check the skin first!
Should the physical therapist use a donning tube? Why or why not?
Yes, it makes it easier and reduces chances of shearing and irritation during application
How long should the physical therapist leave the shrinker in place?
FIRST, CHECK THE SKIN!
At first, wear for 60 minutes. If tolerable (and/or if normal redness subsides after 15-20 mins), add an hour. But the next day, take away one hour (e.g. if you end the day at 3 hours wear time, start tomorrow at 2 hours)
Progress up to 8 hours, at which point the patient can wear it overnight
How should the physical therapist educate the patient regarding shrinker use?
Stop if it gets painful. Redness is normal as long as it fades in 15-20 mins. Redness that lasts over an hour is concerning
How should the physical therapist mobilize this patient?
Do AROM to prevent contractures; do PROM if AROM is not tolerable (which may be the case due to AC separation and rib fx)
What is the goal for length of wear of the shrinker on a daily basis?
As long as possible (23-24 hours). At the least, overnight (8+ hours)
What are the pros/cons of a RR dressing?
Sturdy but troubling
How should physical therapist assess fit? How should the physical therapist adjust fit if needed?
Should be snug, but not too tight
Could you use a shrinker for the same pt under the RR?
Yes
What concerns would require alerting the healthcare team
Redness, pain, swelling, etc.
What does the AMP assess?
Mobility and functionality in certain scenarios
What might you be concerned about regarding the contralateral foot?
Possible amputation (if first foot was cut off for CV reasons, 2nd one might be cut too)
Overuse
Conditioning, skin, etc.
Vital signs a concern- what might you be concerned about? Why? How will you monitor?
HR, BP
Check BP in different positions to address syncope (orthostatic hypotension likely)
What areas of education might you touch on during your session?
Weight management, how to improve CV system (e.g. walking routine), smoking cessation, etc.
How long should the patient wear/use the prosthesis?
Start with 20 minutes use time (WB) and 45 minutes wear time. Progress accordingly.
You can take home the prosthesis if you can tolerate 45 minutes of wear time during therapy
How should PT educ pt re sock fit?
If it is too loose, add sock layers
If it is too tight, remove sock layers
Discuss advantages & disadvantages of a pin suspension?
Ad: secure
Dis: sometimes people don’t make pin “click” enough - could lead to safety fail, getting stuff stuck in the way of pin when locking may make it stuck, possible pistoning, etc.
What should the physical therapist do to address the maceration between the toes?
Care for the skin but don’t put lotion there
Use lambwool to wick away excess moisture, per The Colleague
How can PT tell if the patient is too far into the socket (end bearing)? What is the solution?
They’ll probably have gait deviations and feel too much pressure distally. If this is the case, add a foam pad to reduce how far down pin goes.
What might the clues be if the patient is not fully engaged in the socket? What is the solution?
Not enough clicks
Not secure
Hear more clicks during gait/WB
Patient falls out of leg
Solution: educate, adpat, be safe.
What might you expect in terms of postural bias for this patient?
It depends.
What gait deviation(s) does this patient demonstrate?
Depends on the video man
List one potential patient cause and one potential prosthetic cause for one deviation.
See Gait PPT
Assuming this deviation is patient related, name one treatment task the physical therapist might use as a treatment tool?
Address muscle weakness that is causing the problem?
Based on journal club discussions, what task(s) might be appropriate for the physical therapist to implement to improve gait efficiency and oxygen consumption?
Didn’t pay attention, but working on their CV system or doing gait training during visits would probably help.
What are the typical areas of concern for contracture or tightness for a pt with a TTA?
Hip flexion
Knee flexion
ABD
etc.
What suggestions might you have for the rehab team in terms of patient positioning when in her room?
Prevent contractures
No pillow under knee. Favor ADD more than ABD. See handout on BB
-What are the benefits of the RR that the pt should be aware of to increase compliance (short term and long term benefits)?
There are many (e.g. can lead to earlier WB)
If the pt reports she is removing her RR due to RL discomfort (despite the prosthetist adjusting fit), what non pharmacological interventions might the PT suggest?
(Pharm: Medicinal marijuana (may vary by state) and other pain relievers)
Non-pharm:
- Add/remove socks
- GMI
- ACE Wrapping
- eStim
- Desensitization
- Massage (not over staples)
