Unit 2: Rehabilitation Flashcards
Identify key aspects of pre-op management
Pre-op counselling
Assessment of haematological state
Assessment of electrochemical balance
What analgesia is used post-op
Opiates for at least 24hrs
If due to vascular problems: opiate for 24-48hrs followed by dihydrocodeine or paracetamol + codeine
If due to trauma or neoplasm: may continue opiates for much longer
What antibiotic prophylaxis is often used post-op to avoid ischaemic gangrene
Penicillin or metronidazole
What is phantom phenomena
The feeling that an amputated limb is still present (if pain is experienced: phantom pain)
What may be the causes of phantom phenomena
Terminal neuroma
Psychological factors
Abnormal reflexes
How is phantom phenomena managed
Reassurance
How is phantom pain managed
Analgesia
TENS
Antidepressants
Counselling
What are 4 methods of stump wound dressings
Soft dressing: gauze, soft crepe
Elastoplast: popular for transfemoral
Rigid dressing: popular for knee disarticulation and more distal sites of amputation
Elastic socks: can be used on top of gauze dressings
Identify some roles of nursing in amputation care
Day-to-day patient care Attending pressure areas Teaching patient how to care for stump Maintaining good patient nutrition Ensuring good care of the remaining foot
Who are the members of the rehabilitation team
Rehab medical specialist Nurses Physio OT Prosthetist Social worker Chiropodist GP/community service Outside groups
What is a case conference
A meeting between the rehab team members + patient to set definite treatment goals
What are some of the physical assessments performed by the physio
Muscle strength and joint range Sensation Proprioception and balance General condition of the contralateral limb Vision and hearing Exercise tolerance Levels of stump pain/phantom phenomena
What position does a trans-tibial amputee tend to adopt
Flexed knee
What position does a trans-femoral amputee tend to adopt
Flexed abducted hip
When is an early walking aid prescribed
Eight days post-op
What EWA is used for trans-tibial amputees
Pneumatic Post Amputation Mobility Aid (PPAM Aid)
What EWA is used for trans-femoral amputees
The LIC Femurett
What are benefits is using an EWA
Quick and easy device for early mobilisation
Commences gait re-education from an early stage
Re-educates balance response from an early stage
Gives objective measurement of the patient’s ability to use a prosthesis
When is the decision made by the MDT on whether or not to cast the patient for a prosthesis
Day 14 for transfemoral
Day 21 for transtibial
When are patients typically discharged following amputation
6 weeks post-amputation
When is a discharge review typically performed by a physio
6 weeks post-discharge
What are the 5 main roles of the OT in amputation management
Wheelchair assessment and training ADL Graded activity Environment constraints and requirements Community liaison and follow up
What is the difference in toilet seating position for unilateral and bilateral amputees
Unilateral: sits with back to cistern
Bilateral: sits facing the cistern
Give examples of graded activity that may be prescribed by an OT
Woodwork
Gardening
Kitchen activities
Darts and snooker
