O&P - 2.2 - Acute Post-Op Management

Acute Post Op Management and Pre Prosthetic Training

pre-amputation

patients in the _________ phase are preparing for an amputation

• explain sequence of events

• discuss REALISTIC expectations

• patient education

• answer questions

goals in the pre-amputation phase are: (4)

• pain

• edema management

• skin integrity

• contracture prevention

• strengthening/HEP

patient education focuses about residual limb care in the pre-amputation phase: (5)

immediate recovery

the acute postoperative phase is when a patient is in the ___________ from the amputation surgery

acute care hospital

the acute postoperative phase is when the patient is in a _______________

• prevent postop medical complications

• manage residual limb (wound healing)

• prevent contractures & loss of motion

the key objectives during the acute postoperative phase are: (3)

DIFFERENT

people have ___________ responses to amputation

pre prosthetic training

the _______________ phase occurs in a patient whose residual limb is not ready to be fit with a prosthetic limb

IPR, SNF, OP, home

the preprosthetic training phase is when the patient is in a _______________

• manage residual limb health

• scar management and limb shaping

• prevent contractures!!

the key objectives during the pre prosthetic training phase are: (3)

prosthetic training

the ______________ phase occurs in a patient whose limb has healed enough to tolerate using a prosthesis

IPR, SNF, OP, home, prosthetist clinic

the prosthetic training phase is when the patient is in a _______________

• same as pre prosthetic objectives

• incorporate prosthesis use into activities

• address community reintegration

the key objectives during the prosthetic training phase are: (3)

lifetime care

the _________ phase is for any post-acute person with amputation

OP clinic, prosthetist clinic

the lifetime care phase is when the patient is in a _______________

• maintain function and qol

• promptly address any medical or prosthetic concerns

the key objectives during the lifetime care phase are: (2)

• soft

• rigid

• WBing - immediate postop prosthesis IPOP

• NWB removable rigid

different types of post-op dressings are: (4)

rigid

a ________ post op dressing is a cylindrical plaster or fiber glass cast applied to residual limb immediately after surgery

decreased

clinical use of rigid post-op dressings has (increased/decreased)

• requires careful application

• NOT removable

• NOT able to inspect daily

disadvantages to rigid dressings: (3)

• best for limiting edema

• limits contractures

• can allow early ambulation (w IPOP)

advantages to rigid dressings: (3)

removable rigid

a _________ post op dressing is a plaster cast or prefabricated shell worn over a soft dressing and held in place by a suspension belt or cuff

limb protectors

removable rigid dressings can also be called ____________

soft dressings

with removable rigid dressings, _________ are used to fill volume as residual limb shrinks

transtibial

removable rigid dressings are recommended as the first treatment of choice for _________ amputations

• limits edema

• provides residual limb protection

• helps prevent contractures

• promotes socks to regulate fit and desensitize

• allows for daily inspection

advantages of removable rigid dressings: (5)

• application by a skilled professional

• basically only used for TT amputation

• requires external suspension system

disadvantages of removable rigid dressings: (3)

immediate postop prosthesis IPOP

an ___________ is a rigid or removable rigid dressing designed to allow the attachment of temporary components and allow ambulation as soon as possible

TRUE

T/F: with IPOPs early mobilization in the first 3 days is feasible and leads to functional gains and earlier discharge

• reduce extrinsic risk

• facilitates healing

• promotes early fitting and training

• reduced inpatient length of stay

advantages to IPOPs: (4)

soft

_______ dressings are most common

soft

a _________ post op dressing is elastic material that provides an evenly distributed pressure gradient

shrinkers

________ are a soft dressing most commonly used once the suture line is healed

shaping

shrinkers serve the purpose of _________ the residual limb

• can be laundered

• cheap

• easily removable

• can help with limb shaping

advantages of soft dressings: (4)

• poor control of edema

• little protection

• requires careful reapplication

• requires frequent reapplication bc of shifting

disadvantages of soft dressings: (4)

TRUE

T/F: overall the examination for a patient with an amputation is similar to a typical patient exam

• bone length

• soft tissue

• integumentary

three key categories to observe of the residual limb with examination are:

ischial tub/greater troch

when examining residual bone length of a TF amputation, measure from the _____________ to the end of the bone

medial tibial plateau

when examining residual bone length of a TT amputation, measure from the _____________ to the end of the bone

cylindrical

when examining soft tissue of a residual limb, a good residual limb is ________

bulbous, conical, redundant

when examining soft tissue of a residual limb, a bad residual limb is ________

8-10 cm

when examining soft tissue of a residual limb, measure circumference every __________ from the same starting points as length to the end

incision line, signs of infection

when examining the integumentary system of the residual limb, look at the __________ and check for any ___________

PRESSURE DISTRIBUTION

the shape of the residual limb is important for __________________

IS NOT

phantom limb sensation (is/is not) painful

phantom limb sensations

_______________ are sensations perceived as originating from the amputated limb

are

phantom limb sensations (are/are not) common immediately after amputation

FALSE - beneficial or problematic

T/F: phantom limb sensations are problematic

• touch

• pressure

• numbness

• tingling

• mild cramping

• cold

• wetness

• itching

• formication (bugs)

• telescoping limb

• phantom movements

examples of phantom limb sensation: (read)

phantom pain

_______________ is painful sensations perceived as originating from the amputated limb

FALSE - constant or intermittent

T/F: phantom pain is intermittent

phantom pain

(phantom pain sensations/phantom pain) is less common

TRUE

T/F: phantom pain tends to decrease with time

• dull aching

• burning knife like

• sticking

• intense cramping

• squeezing

• electric shocks

• uncomfortable pin and needles

• leg being pulled off

• in unnatural position

examples of phantom pain: (read)

residual limb pain

_______________ is painful sensations in the residual limb

• nerve

• bone

• vascular

• wound

intrinsic factors of residual limb pain are: (4)

• cast pressure

• socket fit

extrinsic factors of residual limb pain are: (2)

TRUE

T/F: heterotrophic ossification is possible in residual limbs

• reduce edema

• control pain

• wound/incision healing

• protect incision during functional activity

• prevent contractures

NO MATTER WHAT 5 goals of residual limb management post-op are:

facilitate preparation for prosthetic placement by shaping and desensitizing limb

an additional goal of residual limb management post-op that only applies to some individuals is _________________

0-5

for incision healing timeline, the inflammatory phase is the first ___-____ days

5-21

for incision healing timeline, the fibroplastic phase is the first ___-____ days

21+

for incision healing timeline, the remodeling phase is the first ___-____ days

protective, 1-2 weeks

the MOST IMPORTANT thing with skin integrity post-op is _________ healing for the first ___-___

infection

closely monitor for _________ with dressing changes, and record quantity and quality of drainage

TRUE

T/F: clear drainage for the first few days at the incision site is normal, decreasing with more time

healed

a shrinker can only be used after the wound is __________

ADHERED , breakdown

___________ scars can’t move under a socket → creates tension causing ____________

scar mobility, tensile strength

for skin integrity, start developing _________ and __________ once primary healing of the incision is established

external stress

the tension theory of wound healing says that ___________ can effect the strength of a wound and improve collagen organization

GLIDE

a skin integrity goal is that skin and tissues must be able to ______

shearing

scar adhesions promote _________ forces with limb movement and prosthetic use

early, continual

_______ and ________ mobilization of the scar tissue decreases adhesions

2

at around ___ weeks of healing, move above and below the incision without putting tension on the incision

3

at around ___ weeks of healing once the wound is well-closed with no steri strips, gently begin to mobilize the scar itself

6, epithelial line

continue scar massage for at least ___ weeks or until the _________ is gone

epithelial line

the _________ is the lump under the skin at the incision site

FALSE HELLO they can do it themselves

T/F: patients have to come to PT for scar massage

24

shrinkers are worn ______ hours a day

TRUE

T/F: a shrinker is often used for the rest of a person’s life

MINIMALLY

shrinkers are __________ effective at preventing edema

FALSE DO NOT

T/F: when donning shrinkers, pull onto the limb like a sock

• distal pressure should exceed proximal

• pressure applied on oblique turns only

• should be reapplied every 4 hours

• no wrinkles

• don’t use metal clips, tape down

• no aching burning or numbness - remove

• wear 23 hours a day

• wash daily, squeeze, don’t wring, and air dry

• continue until pt had prosthesis and can leave stump unwrapped

ace wrapping tips (that PTs generally aren’t doing): (read)

hypersensitive

sometimes the residual limb becomes too __________ to touch and pressure inhibiting dressing and prosthetic use

STOPP SLIDE 36

residual limb sensation ******