In: Nursing
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Encourage him to perform prescribes exercises. | To prevent stump trauma. |
Provide stump care on a routine basis: inspect the area, cleanse and dry thoroughly, and rewrap stump with an elastic bandage or air splint, or apply a stump shrinker (heavy stockinette sock), for “delayed” prosthesis. | Provides an opportunity to evaluate healing and note complications (unless covered by immediate prosthesis). Wrapping stump controls edema and helps form stump into a conical shape to facilitate the fitting of the prosthesis. |
Measure circumference periodically | Measurement is done to estimate shrinkage to ensure proper fit of sock and prosthesis. |
Rewrap stump immediately with an elastic bandage, elevate if “immediate or early” cast is accidentally dislodged. Prepare for reapplication of the cast. | Edema will occur rapidly, and rehabilitation can be delayed |
Assist with specified ROM exercises for both the affected and unaffected limbs beginning early in the postoperative stage. | Prevents contracture deformities, which can develop rapidly and could delay prosthesis usage. |
Encourage active and isometric exercises for the upper torso and unaffected limbs. | Increases muscle strength to facilitate transfers and ambulation and promote mobility and more normal lifestyle. |
Maintain knee extension. | To prevent hamstring muscle contractures. |
Provide trochanter rolls as indicated. | Prevents external rotation of lower-limb stump |
Instruct patient to lie in the prone position as tolerated at least twice a day with a pillow under the abdomen and lower-extremity stump. | Strengthens extensor muscles and prevents flexion contracture of the hip, which can begin to develop within 24 hr of sustained malpositioning. |
Caution against keeping the pillow under a lower-extremity stump or allowing BKA limb to hang dependently over the side of bed or chair. | Use of pillows can cause permanent flexion contracture of the hip; a dependent position of stump impairs venous return and may increase edema formation. |
Demonstrate and assist with transfer techniques and use of mobility aids like trapeze, crutches, or walker. | Facilitates self-care and patient’s independence. Proper transfer techniques prevent shearing abrasions and dermal injury related to “scooting.” |
Assist with ambulation. | Reduces the potential for injury. Ambulation after lower-limb amputation depends on the timing of prosthesis placement. |
Instruct patient in stump-conditioning exercises. | Hardens the stump by toughening the skin and altering feedback of resected nerves to facilitate the use of the prosthesis. |
Refer to the rehabilitation team. | Provides for the creation of exercise and activity program to meet individual needs and strengths, and identifies mobility functional aids to promote independence. Early use of a temporary prosthesis promotes activity and enhances general well-being and positive outlook. Note: Vocational counseling and retraining also may be indicated. |
Provide foam or flotation mattress. | Reduces pressure on skin and tissues that can impair circulation, potentiating the risk of tissue ischemia and breakdown. |