Acute Post-operative Management of a Patient with an Amputation Flashcards Preview

PTH 703 - Unit 2 (Amputations and Protheses) > Acute Post-operative Management of a Patient with an Amputation > Flashcards

Flashcards in Acute Post-operative Management of a Patient with an Amputation Deck (34)
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1

What are options to treat Residual Limb Pain (RLP)/post-surgical pain? (4)

Liberal narcotic use
Regional aesthesia
Non-narcotic medications, especially for neuropathic pain
Modalities (TENS, accupunture, etc)

2

What modality should you use for neuropathic pain?

Non-necrotic medications, as seen in the first note card.q

3

Is phantom limb pain (PLP) localized or diffuse?

Could be either.

4

How long does phantom limb sensation or PLP last?

It depends.

Sometimes just after surgery, sometimes for life.

5

Are medications effective for PLS or PLP.

No, especially not effective for PLS.

6

How to treat PLS or PLP?

Re-train the brain and the limb.

7

Do co-morbidities affect limb healing?

Yes. Patients should play an active role in management of their own health.

8

Does residual limb healing have psychological consequences?

Yes, remember the stages of coping.
Limb loss is similar to losing a good friend
Make referrals as appropriate

9

What are the three physical dimensions to measure during a residual limb eval?

Length to end of bone
Length to end of tissue
Circumferential girth (every 2.5 to 5 cm?)

10

What are the 8 things to measure during a residual limb evaluation?

Physical dimensions
Appearance
Temp
Sensation
Wound Assessment
Dressings
ROM and Strength at Proximal Joints!
Contralateral limb assessment

11

How does a residual limb typically present?

Incision usually red, may have drainage
Typically staples or sutures intact in incision
Edema common
Decreased sensation around incision (typically returns but may not)
DO SKIN CHECKS BEFORE WRAPPING (you fail the class if you don't)

12

What are 4 different post-op dressings?

Soft dressings
Rigid removable dressings (RRD)
Immediate post-op dressing (IPOP)
Nonweight bearing rigid dressing (NWB)
-Unna, gel

13

What is the goal of residual limb wrapping?

Decrease edema and shape for patient's prosthetic fitting

14

What are 5 benefits of ACE Wrapping?

Transtibial and transfermoral
Inexpensive
Can use if stitches or staples or present
Available
Can provide gradient pressure

15

What are 5 limitations of ACE Wrapping?

Can be difficult to apply
Frequent re-application needed
Least effective
Amount of compression is variable
Loses elasticity over time (especially latex-free ones)

16

How many wraps should you use for Transtibial Residual Limb Wrapping?

Two, 4-inch wraps

17

Do you wrap above the knee with Transtibial RL wrapping?

*Always wrap above the knee

18

How many wraps should you use for Transfemoral Residual Limb Wrapping?

Two, 6-inch wraps and one, 4-inch wrap

19

Do you anchor around the pelvis with Transfemoral RL wrapping? Why or why not?

Yes, to prevent development of an adductor roll

20

Do you need to watch the wrapping videos on your own time?

Yes or you will fail. There's a whole slide that discusses this. This is the "most challenging physical task."

21

When does acute post-op d/c planning start?

At time of admission
-dependent on pt's situation
-May need to consider a temporary solution as well

22

What are acute post-op rehab interventions?

Passive ROM (flex/ex and add/abd)
AROM of C/L limb FOR ALL MOTIONS!
Position to prevent hip and knee flexion contractures when sitting in bed
Progress to AAROM and AROM in all planes
Have program focus on pt assessment and typical problem areas

23

What 6 PROM positions should you work on?

Prone Hip ext
Thomas test Hip Ext
Sidelying hip ext
Prone knee extension
Supine knee extention
Long-sitting knee extention

24

What are 3 AROM ideas for the residual limb discussed in class?

Active hip ext in supine - modified bridging
Hip ext prone
Hip ext in quadriped

25

What are 3 things to consider when positioning patients?

1. Position to prevent contractures
-Hip ext/neutral hip
-Knee ext
2. Position to promote healing
-Pressure and edema management
3. What are the PT goals?

26

What are ROM examples for the C/L limb

C/L hip ext
-prone
-thomas test
-sidelying

C/L ankle DF
-seated
-standing
-long-sitting

27

Rehab interventions?

Strengthening
CV
Balance
ROM/Positioning

28

What are key muscles to strengthen (6 LE, 2 UE)?

Hip ext, hip abd, knee flex, knee ext, C/L ankle PF, C/L ankle DF

Triceps and Latissimus Dorsi

29

Should you incorporate CV component into therapy?

Yes. Establish cardiac precautions though. Also work on balance

30

What do you want ROM / Positioning to accomplish? What to promote? (3)

Promote hip and knee ext
Promote the neutral hip position
Prevent loss of C/L ROM, especially Ankle DF