Rehab w/ Limb Loss (2)

Question 1

acute post surgical phase

Answer 1

from surgery to wound closure

Question 2

how long is the acute post surgical phase

Answer 2

12-14 days

Question 3

what could the acute post surgical phase be delayed by

Answer 3

meds (like steroids)

trauma

compromised circulation

infection

Question 4

goals of acute post surgical

Answer 4

early mobilization

encourages wound healing

pain management

reduce post op complication

optimize ROM and motor control

Question 5

what is the primary goal of APSP

Answer 5

encourage wound healing

Question 6

pain management –> goals

Answer 6

facilitate rehab process

critical to prevent opioid complications

Question 7

what if complications occur

Answer 7

phase is prolonged

Question 8

complications of APSP

Answer 8

contractures

muscle atrophy

skin breakdown

trauma

Question 9

contractures –> complications

Answer 9

pre existing

d/t mobility

Question 10

muscle atrophy –> complications

Answer 10

deconditioning

Question 11

skin breakdown –> complications

Answer 11

comorbidities like diabetes

Question 12

pain control –> APSP

Answer 12

RL pain

phantom limb pain

Question 13

RL pain –> pain control

Answer 13

pain medication during PT

non opioid

Question 14

phantom limb pain –> pain control

Answer 14

education/medication etc.

Question 15

APSP includes

Answer 15

assessment

systems review

girth and length measurements

Question 16

assessment

Answer 16

general

subjective

observation

cognitive/mental status

systems review

Question 17

general –> assessment

Answer 17

medical history

Question 18

subjective –> assessment

Answer 18

pt’s goals

psychological well being

pain level

Question 19

psychological well being –> subjective

Answer 19

how is the pt dealing w/ the amputation

Question 20

pain level –> subjective

Answer 20

0-10

pain control critical to facilitate rehab and non-opioid use recommended

Question 21

observation –> assessment

Answer 21

position of RL

position in bed

fit of immobilizer/rigid dressing or ace bandage

overall skin assessment

Question 22

cognitive/mental status –> assessment

Answer 22

alertness, orientation, etc

mini mental state

Question 23

systems review –> assessment

Answer 23

CP

vascular

NM

MSK

integ

Question 24

CP –> systems review

Answer 24

vital signs

Question 25

vascular --> systems review

Answer 25

pulses capillary refill temp

Question 26

NM --> systems review

Answer 26

light touch proprioception *semmes weinstein

Question 27

MSK --> SR

Answer 27

passive ROM active ROM muscle strength muscle/tendon length A/P ROM, MMT of UE and uninvolved extremity

Question 28

passive ROM --> MSK

Answer 28

of amputated extremity pre-existing contractures

Question 29

muscle strength --> MSK

Answer 29

no resistance to any muscle involved in the amputation TF, TT

Question 30

muscle/tendon length --> MSK

Answer 30

sound/ RL

Question 31

integ --> SR

Answer 31

texture, hair, nail beds hemosiderin staining, color RL and sound limb pitting edema

Question 32

pitting edema

Answer 32

0-4+

Question 33

0 --> pitting edema

Answer 33

none

Question 34

1+ --> pitting edema

Answer 34

min

Question 35

2+ --> pitting edema

Answer 35

skin rebound < 15 s

Question 36

3+ --> pitting edema

Answer 36

skin rebound 15-30 s

Question 37

4+ --> pitting edema

Answer 37

skin rebound in > 30s

Question 38

Observation

Answer 38

abrasions, bruising, blisters is the incision healing shape of the RL

Question 39

shape of the RL --> observation

Answer 39

bulbous conical dog ears bone spurs

Question 40

girth and length measurements are

Answer 40

easily palpable bony --> not moving

Question 41

the length measurements is the

Answer 41

most distal intact joint

Question 42

how are length and girth measurements taken

Answer 42

position to eliminate external forces straight line

Question 43

where do we record length and girth measurement

Answer 43

note in chart

Question 44

girth measurement

Answer 44

consistent distances every 2-3"

Question 45

length measurement

Answer 45

fxnal actual 2x and average

Question 46

fxnal length measurement

Answer 46

bone lenggth

Question 47

actual soft tissue length

Answer 47

soft tissue length

Question 48

subcutaneous tissue

Answer 48

punch < 1/2 " = light > 1/2 " = heavy

Question 49

muscle firmness

Answer 49

palpate contracted muscle (subjective) soft, average, firm

Question 50

APSP intervention

Answer 50

prevent contracture compression methods will continue

Question 51

most common contractures for TF

Answer 51

flexion ABD ER

Question 52

most common TT contractures

Answer 52

knee flexion hip flexion, ABD, ER

Question 53

how long does someone stay in one position

Answer 53

1-2 hrs day prone

Question 54

TT position to prevent contracture

Question 55

TF position to prevent contracture

Question 56

compression methods

Answer 56

removable rigid dressing elastic wrapping (ace bandage) elastic shrinker

Question 57

elastic shrinker

Answer 57

difficult to use while healing pulling on incision

Question 58

purpose of ACE

Answer 58

shrinkage shaping healing

Question 59

TT ACE

Answer 59

2/4" ace bandages

Question 60

TF ACE

Answer 60

2/6" ace bandage 1/4" and 1/6"

Question 61

when is an ACE used

Answer 61

immediately after surgery

Question 62

how to put on ace

Answer 62

no wrinkles pressure greater distal

Question 63

what do we use ace for

Answer 63

shape good ace

Question 64

what do we instruct the pt with

Answer 64

washing the ace

Question 65

when do we change ace

Answer 65

every 2-3 hrs

Question 66

no... --> ace

Answer 66

clips or tape on skin

Question 67

when do we stop ace

Answer 67

when wearing prosthesis all day