Acute care: postoperative

Question 1

Individuals with new amputation

Answer 1

• early days post amputation: pain and grief
• psychologist, social worker, vocation counselor, clergy

Question 2

Interdisciplinary team

Answer 2

• physician, surgeons: healing suture line, general health
• nursing: general medical and wound care, pain management
• registered dietitians: nutritional needs (protein, vitamins, fluids)
• prosthetist: fabricate early post op prosthesis or rigid dressing

Question 3

Acute care priorities post amputation

Answer 3

• surgical site healing
• pain management
• volume control of residual limb
• education

Question 4

PT acute care priorities

Answer 4

• bed mobility
• transfers
• positioning: avoid contractions such as hip flexor and knee flexor

Question 5

Phantom limb sensation

Answer 5

• possibility of phantom limb sensation should be discussed with patient and family before amputation
• very vivid
• can be disturbing and frightening
• need to know that normal
• TENS therapy and mirror therapy can help

Question 6

Early post surgical examination

Answer 6

• systems review
• pain: incisional, phantom, other
• vascularity (if appropriate): looking for color with capillary refill (is it blanch able and reprofusable)
• functional status, bed mobility, transfers, sitting, standing, balance
• gross ROM
• gross strength: active and functional assessment until wound healing for external resistance on residual limb incision
• cognition
• aerobic capacity/endurance

Question 7

Acute care PT intervention

Answer 7

focus on preparation for prosthetic use

• wound healing
• residual limb protection
• prevention of contractures
• Single limb mobility: monitor condition of remaining foot
• desensitize residual limb: handling, compression wrapping, different materials
• functional training in self care: bed mobility and transfers

Question 8

early wound healing: what is normal for first several days/what can delay healing

Answer 8

• first several posts days: signs of inflammation normal
• prolonged edema delays wound healing due to congestion and fluid

Question 9

Assessing wound healing: dressing

Answer 9

• initial dressing change as early as first day post (4 soft dressing)
• third post-op day 4 rigid dressing if pt is a candidate
• subsequent dressing changes

Question 10

Assessing wound healing: drainage

Answer 10

• initially: sanguineous (bloody)
• then: serosanguineous: red/pink and thin
• then serous: just clear fluid

Question 11

Assessing wound healing: report to surgeon when

Answer 11

• bright red blood (arterial hemorrhage)
• darker venous blood (draining hematoma)

Question 12

Assessing wound healing: signs of infection

Answer 12

• report immediately
• increase amounts of drainage
• thickening exudate

Question 13

Edema control postoperative care

what can be used

Answer 13

• important element in control of post-op pain
• ace warping
• shrinker garment
• nonremoveable rigid dressing
• removeable rigid dressing
• semirigid dressing (unna)
• pneumatic compression for early ambulation
• when rigid dressing is removed: soft compression as quickly as possible: for edema control

Question 14

Postsurgical dressing: elastic bandage: compressible soft dressing

advantages/disadvantages

Answer 14

Advantages:

• inexpensive
• easily removed for wound inspection
• allows for active joint ROM
• easy to apply

Disadvantages

• frequent changes may disrupt healing
• unable to control amount of tension in bandage
• risk of tourniquet effect

Question 15

Postsurgical dressing: shrinker

advantages/disadvantages

Answer 15

advantages:

• easy to apply
• inexpensive

Disadvantages:

• shrinker cannot be used until staples are removed
• need to change as limb shrinks

Question 16

Postsurgical dressing: Semi-rigid dressing

Answer 16

Advantages

• better edema control than soft dressings
• provides soft tissues support
• provides protection

Disadvantages

• less protection and requires more changing than rigid dressing
• allows for edema if becomes loosened
• may limit access to incision

Question 17

Postsurgical dressing: immediate post surgical prosthesis

advantages/disadvantages

Answer 17

Advantages

• protection of limb
• limits edema
• may allow for early ambulation w/pylon
• stimulates proprioception

Disadvantages

• may require professional application
• may limit wound inspection

Question 18

Positioning for transtibial amputation

Answer 18

• avoid hip flexion and knee flexion
• don’t let them sit with a pillow under knee

Question 19

Positioning for transfemoral amputation

Answer 19

• common contractures are: hip flexor, abductors and ER
• supine: no pillow under residual limb
• prone lying throughout the day: if not tolerate then side lying with active hip extension
• limit sitting

Question 20

bed mobility and transfers

goals and concerns

Answer 20

• minimize risk of trauma to newly amputated limb during activity
• early goal: safely move between seating surfaces
• transfers continue to be important after using prosthesis

Question 21

when might a pt might need to refrain from using prosthesis

Answer 21

• mechanical problems with prosthesis
• skin problems
• medical problem affecting socket fit

Question 22

Postural control with postop amputation

Answer 22

• after amputation, COM shifted upward, backward and toward CL limb
• can affect sitting balance, sit to stand, and single limb ambulation
• incorporate activities to improve ability to control COM over altered BOS

Question 23

Fall risk

Answer 23

• individuals with recent amputation
• risk of falling when awaken from sleep and attempt to stand and walk to bathroom
• can result in injury and require surgery

Question 24

Single limb ambulation

Answer 24

• provides mobility in environment
• consider use of crutches if possible: walker imposes hop to gait putting a lot pf pressure on other limb
• might interfere with step-through pattern once receive prosthesis

Question 25

Single limb ambulation: goals

Answer 25

- enhance postural control - build strength and cardiovascular endurance

Question 26

Preprosthetic gait | what should be done

Answer 26

- forward, backward, sideways, change direction, turn - stairs, inclines if indicated

Question 27

What to educate in regards of care of the remaining limb

Answer 27

- open wound on remaining limb precludes single limb ambulation which delays rehab and increases disability - program should include: position changes, pressure-distributing mattress, weight shifting, active exercise

Question 28

Demongraphics/medical history with discharge planning

Answer 28

- demographic, sociocultural information - living environment - emotional, cognitive status - medical, surgical history

Question 29

Wheelchair and equipment for postoperative amputation care

Answer 29

- W/C skills needed for pts and caregivers - may also need adaptive equipment or home modifications - referral to home services