PT Care Flashcards
Pre-op visit goals
provide information, evaluate current physical condition, answer questions
post-surgical phase
surgery to DC from acute care
pre-prosthetic phase
- DC from acute care to prosthetic fitting OR
- DC from acute care to decision that patient is not a candidate for prosthesis
- Home, sub-acute/swing bed, LTC, inpatient rehab facility
Post-surgical phase goals
- Healing of residual limb
- Protect intact limb
- Increase independence in transfers and mobility
- Demonstrate proper positioning
- Understand prosthetic rehab process
- Note: education contributes to the success of this phase
post-surgical phase exam
- Systems review
- Post-surgical status: CP, diabetes control, infection, present level of mobility
- Pain - incisional, phantom, other
- Vascularity (if appropropriate)
- Functional status: bed mobility, transfers, sitting, standing, balance
- UE: to note any limitations that would interfere with functional activities
- ROM: only AROM until healing occurs; PROM before stretching
(Un-amputated, amputated, UE)
post-surgical phase interventions
- Positioning to avoid contractures
- Standing balance and transfers
- Mobility training
- Residual limb care and protection
- Care of non-amputated limb
- Education
- Strengthening
- Factors to consider: short time period; DC plans begin on day 1 (need to know what are the DC disposition options)
critical contracture period and joints
hip and knee flexion contractures - first 6 weeks
techniques to prevent contractures
- Spend time in prone
- Never place pillows under residual limb (especially knee)
- Avoid prolonged sitting
- When in sitting, use amputee board in WC for transtibial to knee knee in extension
- In side lying, keep residual limb in slight hip and knee extension
- Avoid side lying on residual limb side (early days)
what limb should amputee lead with during post-surgical phase during transfers?
Stand and transfer leading with un-amputated limb to protect residual limb from possible injury against chair or bed (only in post-surgical phase)
Why is standing balance and transfers important/beneficial during post-surgical phase?
- Sitting balance important with bilateral amputations
- Standing balance on un-amputated limb beneficial in helping regain sense of body in space and better balance = more likely to use crutches a lead a more active life during life before prosthesis
post-surgical care phase mobility training
- Dependent upon strength, balance, age, functional abilities, BMI
- May use walker, but crutches are better for flexibility in ADLs and balance practice for later prosthetic use
- Can’t use pylon + foot with an IPOP or RRD with a walker (crutches required)
- must have a good shoe on the un-amputated limb for gait training
- Incorporate mobility ASAP
post-surgical phase residual limb care and protection
- Manage post-surgical dressing
- Inspect residual limb
- Move residual limb
- Lift to move, do not drag!
- AROM at hip and knee (if applicable) in pain free range with no shearing
Post-surgical phase care of non-amputated limb
- Proper shoes and skin checks if vascular problems are present
post-surgical education goals
patient and caregivers assume responsibility for care, understand need for continued care, become active participants in rehab program
post-surgical education components
- Amputated limb: HEP to maintain healing precautions
- Non-amputated limb: proper shoes, WB pressure, shearing forces during transfers
- Be as mobile as possible
- Answer questions/providing information
