Term
| Important specific history questions (3) |
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Definition
| Previous surgery, cause for amputation, ambulation prior to prosthetic |
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Term
| Important things to know about pain in the preprosthetic pt. (3 major) |
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Definition
| Precise location and what relieves it or antagonizes it, Duration (intermittent, occasional, constant) and Whether or not they have phantom pain. |
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Term
| When inspecting the residual limb, what is the most critical step? |
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Definition
| To compare it to the contralateral side. |
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Term
| What do you want to look for when inspecting condition of residual limb? |
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Definition
| If the suture line is healed or open, drainage, wounds or pre-wounds, pain, itching of incision site, wound inspection. |
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Term
| What are the 3 major stump shapes? |
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Definition
| conical, bulbous, cylindrical |
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Term
| What is the worst shape of residual limb in terms of prosthetic fitting? |
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Definition
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Term
| What classifies a long AK and BK amputation? |
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Definition
| AK: above the femoral condyles. BK: 7-8" below tibial tubercle. |
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Term
| What to note during inspection of the amputated limb. (8) |
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Definition
| condition of the limb, edema, shape, length, pulses (B), color (B), temp (B), dressing |
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Term
| What are the benefits to using a rigid dressing post-amputation? (3) |
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Definition
| It limits swelling, prevents trauma and allows for early ambulation. |
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Term
| What are the disadvantages to using rigid dressings post-amp? |
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Definition
| A skilled prosthetist is needed to put it on, and the wound can't be monitored. |
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Term
| What are two types of semirigid dressings? |
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Definition
| Unna boot and air splints |
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Term
| What are some examples of soft dressings? (2) |
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Definition
| Ace bandage and compression grip/shrinker sock |
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Term
| How is sensation tested in the amputee? What is the impact on documentation? |
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Definition
| Semmes Weinstein monofilaments can be used, but they've been tested for plantar surface of the foot, not an amputated limb. So we can't say if protective sensation is intact or not, because we don't know if the gradations are the same. |
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Term
| What is the most important area of strength to address in the preprosthetic amputee? |
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Definition
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Term
| What are the impacts of amputation on strength testing? |
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Definition
| Because the limb is shorter, the tester can't obtain the same leverage on the limb. So if a pt can hold moderate resist at 3" below the knee, they aren't that strong. |
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Term
| What ROMs are critical for the preprosthetic pt to have in BK and AK? |
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Definition
| BK: Knee extension AK: Hip ext and adduction (common for hip flex and abd contractures) |
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Term
| What functional mobilities is it impt to assess in the amputee pt? (5) |
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Definition
| Bed mobility/rolling, sit--> supine, W/C to bed, sit to stand, ambulation. |
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Term
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Definition
| mobility, balance, stump management, exercise (strength and ROM), education. |
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Term
| Who determines the appropriate prosthetic? |
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Definition
| PT, prosthetist and MD as a team. |
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Term
| Who determines the appropriate prosthetic? |
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Definition
| PT, prosthetist and MD as a team. |
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Term
| What are the common AK contractures? |
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Definition
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Term
| What should you discourage in positioning of the residual limb? |
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Definition
| Propping it on pillows for extended periods, as it can promote flexion contractures of hip and knee. |
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Term
| What does the early post-op exercise program look like? |
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Definition
| isometric exercises for residual limb. gentle partial ROM of residual limb, and PRE to the contralateral limb (it will be supporting more weight now) |
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Term
| What will the exercise program look like from 3-10 days post op? |
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Definition
| Active exercise of residual limb and foll ROM of proximal joints, PRE to the uninvolved extremities. |
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Term
| What does the exercise program look like from 10 post op on? |
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Definition
| Gentle resisted exercises for residual limb when healing has occurred. |
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Term
| What to do in the case of phantom pain. (6) |
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Definition
| Inspect the limb to rule out any other cause of pain, relaxation techniques/hypnosis, acupressure, ultrasound, ice, massage. |
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Term
| What are the goals of edema management/shrink socks? |
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Definition
| Idependent application, secure and in place throughout the day, provides progressive shrinking, symmetrical shaping, prevention of skin breakdown, and that it is pain free. |
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Term
| What are the problems with elastic bandages in the amputee pt? |
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Definition
| It's not always put on properly, and it doesn't always stay where it's supposed to. |
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Term
| What are some benefits of elastic bandaging? |
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Definition
| It's good for decrease and avoid bulbous shaping, and you can put pressure where you want it by applying more elastic material to areas that need more shaping. |
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Term
| Tubigrip looks like a stockinette. What is a disadvantage to this material? |
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Definition
| It applies uniform pressure, so pressure can't be concentrated more in one area than another. |
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Term
| How do you determine which type of post-amp bandaging is appropriate? (8 considerations) |
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Definition
| activity level, physical characteristics of pt, independence, family help, appropriate amt of compression for shaping, level of protection, comfort, cost-effectiveness. |
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Term
| What are some important considerations when determining if a pt is a candidate for prosthesis? (4 major) |
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Definition
| Metal status, length of residual limb, medical condition, and if they can handle the energy expenditure of ambulation. |
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Term
| What is important to remember when placing an amputee in sidelying? |
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Definition
| That there's enough pillow between the knees to maintain the hip in neutral add/abduction. |
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Term
| When lying supine, have the AK amputee pt place their leg in: ____________ |
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Definition
| adduction. Not abduction!! |
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Term
| When prescribing a wheelchair for a BK amputee, what is important to remember? |
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Definition
| An insert to place the residual limb in knee extension. |
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