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PTH 703 - Unit 2 (Amputations and Protheses) > Skin Care > Flashcards

Skin Care Flashcards

1
Q

What are the 5 different stages of recovery?

A 
Pre-op
Aucte post-op
Pre-prosthetic
Prosthetic training
Long-term management
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2
Q

How will you get a safety fail?

A

Because you did not check the skin. That is how you lose limbs, per Towle.

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3
Q

What are 4 areas of management?

A

Medical Co-Morbidity Management
Residual Limb Management
ADL/Functional Activities
Patient Education***

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4
Q

What are the three parts of Pre-Op stage?

A

C/L limb inspection
Medical co-morbidities
Education*** (in practically every stage)
(see PPT for other 4 stages in detail)

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5
Q

Is the C/L limb a risk factor in the traumatic or non-tarumatic amputee?

A

BOTH! C/L limb is always a risk factor

-Previous amputation is a risk factor for another amputation

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6
Q

What patients need to know about general skin care?

A

ALL PATIENTS.

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7
Q

When do you begin skin care?

A

Early! In pre-op stage

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8
Q

Is group skin care education effective?

A

Yes, and written materials are essential

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9
Q

What are the 6 important concepts of skin care?

A
  1. Inspect skin and shoes daily
  2. Use supportive but non-restrictive socks
  3. Do NOT use strong chemicals or products
  4. NEVER walk barefoot
  5. Avoid extreme temperature exposure
  6. Proper nail care
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10
Q

How to limb inspection?

A

Inspect the entire limb! (and C/L limb too)

Feel temp

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11
Q

How should you check temperature?

A

Proximal to distal!

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12
Q

How should you wash the skin?

A

Daily, luke warm water, best at NIGHT
Mild soap, avoid brisk rubbing, do NOT soak
Use lotions as needed

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13
Q

Do you even need to manage or inspect the “good” limb?

A

Yes, have you been paying attention? And don’t call it that.

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14
Q

What are shoe recommendations?

A 
Leather
Ties or Velcro
Thick sole
Spacious
Aim for protection
Always look inside shoe prior to donning!
**Purchase LATE in the day**
Break-in gradually
Square toe box
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15
Q

What are some sock recommendations?

A

Cotton vs wool for warm vs cool air temps (CW/WC)
Stretchable
Wide, roomy at toes
Loose at top

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16
Q

How often should girth measurements be taken?

A

Towle: 2 cm
McAuley: 2.5-5cm
British Lab Lady: 8-10cm for Transfemoral, per O’S
and 5-8cm for Transtibial, per O’S text

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17
Q

Should girth measurements be taken bilaterally?

A

Yes, document use and time of day. Also note shape

18
Q

How to measure length?

A

Measure to end of tissue AND to end of bone

19
Q

Alternatives to traditional wound measurements?

A

Tracing
Narrative description
Photography

20
Q

What are 3 post-op dressing options?

A
  1. Soft dressing: Bulky gauze dressing with ace wrap or shrinker overlay, w or w/o knee immobilizer
  2. Semi-rigid dressing: Unna boot
  3. Rigid/rigid-removable dressing: typically with soft dressings and compression (IPOP and APOP)
21
Q

What is the goal of RL shaping?

A

Improved prosthetic fit and longevity
-working to prevent deformities (dog/adductor)
Vol reduction starts with p/o dressings

22
Q

When do you move to goals of more aggressive volume reduction and limb shaping?

A

AS THE INCISION HEALS

23
Q

Five guidelines for RL shrinking devices?

A

reapply frequently throughout the day, if removable
Avoid wrinkles
Wearing schedules for progressive tolerance
Can typically use thin dressings over the incision
Patient/caregiver education is Essential

24
Q

Most common shrinkers?

A

ACE Wraps and Elastic

25
Q

What is goal wear-time for shrinkers

A

24 hours a day. Especially check for skin integrity with IPOP

26
Q

Which dressing is typically most preferred?

A

Soft over Rigid and IPOP

27
Q

When is a soft dressing indicated?

A

For compormised incisions and local infection

  • Oldest type
  • Bulky dressing (dependent by physisican) are covered by ACE wrap and loose shrinker
28
Q

Goal of RL wrapping? (seen in earlier lecture)

A

Reduce edema and shape for prosthetic fitting

Dependent on preference, staples, skin integrity, and pt sensation/strength

29
Q

Which wrap is an elastic stockinette: easy to don/doff, inexpensive, and likely less compression than the skrinker (with shorter 2nd layer)?

A

Tubigrip

30
Q

Which dressing is light weight, consist of material impregnated with stuff, better edema control than soft dressings, typically applied immediately in OR, and have to be removed to monitor skin?

A

SEMI-RIGID DRESSING (example, unna boot - no stretch)

31
Q

Which dressing is typically for TT pts, excellent protection/shrinking/forming, end-weight bearing potential, easy to apply, more expensive, rigid material with suspension, prosthetic socks used to adjust fit?

A

Rigid / Rigid-Removable Dressing

32
Q

Even though the IPOP is infrequently used due to expensive, time consuming, and skin management, what are the benefits (3)?

A

Good shrinking and forming
Early WB and gait
Psychological impact

33
Q

Do you use TT or TF for Shrinkers?

A

BOTH

-more uniform compression, easier to apply, and more costly, but more durable

34
Q

When are shrinkers used?

A

Typically used once staples/stitches removed

35
Q

What is recommended wear time progression with shrinkers?

A

Start with ONE HOUR, increase by one hour each time.
Start next day with one hour less than previous day ended
Wear overnight once tolerance reaches 8 hours
(hand-wash and dry daily)

36
Q

How do you do Friction Massage?

A

Perpendicular to scar, along entire incision

-mobilizes scare along tissue at incision

37
Q

What does general tapping and massage do?

A

Desensitizes to decrease phantom sensation and pain

38
Q

What are TFA pressure areas?

A

Distal femur and ischial tubes

39
Q

What are TTA Pressure sensitive areas?

A

Tibial condyles, fibular head, tibial tubercle, distal tibia, distal fib, and HAMSTRING TENDONS (often forgotten, mentioned in class)

40
Q

What are TTA pressure tolerant areas?

A

Patellar tendon, popliteal fossa, medial tibial flare, pretibial muscles and lateral flat aspect of fibula

41
Q

How long is redness normal regarding shrinker wear?

A

15-20 mins

42
Q

Can you bump up shrinker wear time more in traumatic or non-traumatic patients?

A

Traumatic

PTH 703 - Unit 2 (Amputations and Protheses) (17 decks)

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