Care of a stump and Rehabilitation
Pre-operative assessment
Evaluate the neurovascular and functional status of the the extremity
If infection or gangrene + look for purulent discharge and do a C&S
Assess the nutritional status of the patient
Look for dehydration, anemia, cardiac insufficiency, chronic respiratory problems, diabetes mellitus
Assess the psychological status
Post-operative Care
Relieve pain -
opioid analgesics
non pharmaceutical interventions
evacuation of hematoma or accumulated fluid,
treat infection and inflammation
Muscle spasm - change postition or place a light sand bag on the residual limb to counteract the muscle spasm
Assess the response to the interventions
The pain may be an expression of grief and alteration of body image
MiniAltered Sensory Perceptionsmizing
Phantom limbpain - keep the patient active - intensive rehabilitation and stump desensitization with kneading massage - use distraction techniques - TENS - ultrasound or local anesthetics - use of beta-blockers - antiseizure medications - tricyclic antidepressants
Promoting Wound Healing
Stump handled gently
Aseptic techniques followed
If the cast or elastic dressing comes off the stump must be immediately wrapped with an elastic compression bandage
Help in shaping the residual limb
After the incision is healed teach the pt to care for the residual limb
Enhancing Body Image
Encourage the pt to look at, feel and then care for the resicual limb
Identify the pt's strength and resources to facilitate rehabilitation
Help regain the previous level of independent functioning
Rehabilitation
Helping to Resolve Grieving
How the patient is coping with the loss is revealed by pt's behaviour e.g. crying, withdrawal, apthy, anger and expressed feelings e.g. depression, fear, helplessness
Listen and provide support
Make the pt and his family accept and create a supportive atmosphere
Arrange meeting with support group
Promoting Independent Self-Care
Encourage the pt to be an active participant in self-care but do not rush the pt.
Minimize fatigue, and frustration during the learning process
Arrange physical therapist and occupational therapist
Helping the patient to Achieve Physical Mobility
Proper positioning of the limb to prevent contractures
The foot of the bed is raised to elevate the residual limb rather than placing it on a pillow to avoid contracture at the hip
Encourage the patient to turn sides and to assume prone position and to stretch the flexor muscles
Discourage sitting for prolonged periods
The legs should remain close together to prevent abduction deformity
Post-operative ROM exercises are started early
In the upper extremities trunk and abdominal muscles are strengthened - use overhead trapeze. The extensor muscles in the arm and the depressor muscles in the shouler are strengthened to help crutch walking later.
Patient is taught safety consideratios : Environmental barriers e.g. steps, inclines, doors, wet surfaces are to be identified and methods of managing them are practised
Problems associated with the use of mobility aids e.g. pressure on the axilla from crutches skin irritatio of the hands from wheelchair use, residual limb irritation from a prosthesis to be dealt with.
Practice position changes and transfer techniques early
Shoes with Non skid sole
Guard with transfer belt at the waist to prevent falling
Lower extremity amputees are made to stand at the parallel bars to extend the limb to touch down the artificial foot
Start ambulation with parallel bars and crutches
The residual limb should never be heldup in a flexed position
Upper limb amputees are taught one handed self care and temporary prosthesis is encouraged
Periodically the prostheses are inspected for potential problems
Correct method of bandaging is taught to the family
Flexion deformities, nonshrinkage and abduction deformities are guarded against
Pt is taught to massage the residual limb to mobilize scar, decrease tenderness and improve vascularity
Prostheses are moulded to requirement and designed for specific activity levels and patient abilities
Types of prostheses : Hydraulic, pneumatic, biofeedback-controlled, myoelectrically controlled, and synchronized
Adjustments of the prosthetic socket are made 6 - 12 months
Special Wheel chairs for amputees - decreased weight in the front - the wheelchair may tip backword when the patient sits.
