Skin Care Flashcards
What are the 5 different stages of recovery?
Pre-op Aucte post-op Pre-prosthetic Prosthetic training Long-term management
How will you get a safety fail?
Because you did not check the skin. That is how you lose limbs, per Towle.
What are 4 areas of management?
Medical Co-Morbidity Management
Residual Limb Management
ADL/Functional Activities
Patient Education***
What are the three parts of Pre-Op stage?
C/L limb inspection
Medical co-morbidities
Education*** (in practically every stage)
(see PPT for other 4 stages in detail)
Is the C/L limb a risk factor in the traumatic or non-tarumatic amputee?
BOTH! C/L limb is always a risk factor
-Previous amputation is a risk factor for another amputation
What patients need to know about general skin care?
ALL PATIENTS.
When do you begin skin care?
Early! In pre-op stage
Is group skin care education effective?
Yes, and written materials are essential
What are the 6 important concepts of skin care?
- Inspect skin and shoes daily
- Use supportive but non-restrictive socks
- Do NOT use strong chemicals or products
- NEVER walk barefoot
- Avoid extreme temperature exposure
- Proper nail care
How to limb inspection?
Inspect the entire limb! (and C/L limb too)
Feel temp
How should you check temperature?
Proximal to distal!
How should you wash the skin?
Daily, luke warm water, best at NIGHT
Mild soap, avoid brisk rubbing, do NOT soak
Use lotions as needed
Do you even need to manage or inspect the “good” limb?
Yes, have you been paying attention? And don’t call it that.
What are shoe recommendations?
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
What are some sock recommendations?
Cotton vs wool for warm vs cool air temps (CW/WC)
Stretchable
Wide, roomy at toes
Loose at top
How often should girth measurements be taken?
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
Should girth measurements be taken bilaterally?
Yes, document use and time of day. Also note shape
How to measure length?
Measure to end of tissue AND to end of bone
Alternatives to traditional wound measurements?
Tracing
Narrative description
Photography
What are 3 post-op dressing options?
- Soft dressing: Bulky gauze dressing with ace wrap or shrinker overlay, w or w/o knee immobilizer
- Semi-rigid dressing: Unna boot
- Rigid/rigid-removable dressing: typically with soft dressings and compression (IPOP and APOP)
What is the goal of RL shaping?
Improved prosthetic fit and longevity
-working to prevent deformities (dog/adductor)
Vol reduction starts with p/o dressings
When do you move to goals of more aggressive volume reduction and limb shaping?
AS THE INCISION HEALS
Five guidelines for RL shrinking devices?
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
Most common shrinkers?
ACE Wraps and Elastic
What is goal wear-time for shrinkers
24 hours a day. Especially check for skin integrity with IPOP
Which dressing is typically most preferred?
Soft over Rigid and IPOP
When is a soft dressing indicated?
For compormised incisions and local infection
- Oldest type
- Bulky dressing (dependent by physisican) are covered by ACE wrap and loose shrinker
Goal of RL wrapping? (seen in earlier lecture)
Reduce edema and shape for prosthetic fitting
Dependent on preference, staples, skin integrity, and pt sensation/strength
Which wrap is an elastic stockinette: easy to don/doff, inexpensive, and likely less compression than the skrinker (with shorter 2nd layer)?
Tubigrip
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?
SEMI-RIGID DRESSING (example, unna boot - no stretch)
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?
Rigid / Rigid-Removable Dressing
Even though the IPOP is infrequently used due to expensive, time consuming, and skin management, what are the benefits (3)?
Good shrinking and forming
Early WB and gait
Psychological impact
Do you use TT or TF for Shrinkers?
BOTH
-more uniform compression, easier to apply, and more costly, but more durable
When are shrinkers used?
Typically used once staples/stitches removed
What is recommended wear time progression with shrinkers?
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)
How do you do Friction Massage?
Perpendicular to scar, along entire incision
-mobilizes scare along tissue at incision
What does general tapping and massage do?
Desensitizes to decrease phantom sensation and pain
What are TFA pressure areas?
Distal femur and ischial tubes
What are TTA Pressure sensitive areas?
Tibial condyles, fibular head, tibial tubercle, distal tibia, distal fib, and HAMSTRING TENDONS (often forgotten, mentioned in class)
What are TTA pressure tolerant areas?
Patellar tendon, popliteal fossa, medial tibial flare, pretibial muscles and lateral flat aspect of fibula
How long is redness normal regarding shrinker wear?
15-20 mins
Can you bump up shrinker wear time more in traumatic or non-traumatic patients?
Traumatic
