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OBJECTIVES

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At the end of this chapter, all students are expected to:

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  1. Prioritize all management activities according to the patient's condition and the environmental situation.

    1. Differentiate between early and late postsurgical status.

    2. Handle the residual limb to enhance healing and decrease postsurgical pain.

    3. Gather appropriate data accurately throughout the program.

  2. Implement a program of intervention appropriate to the goals and the patient's status.

    1. Teach proper positioning.

    2. Describe and demonstrate proper residual limb bandaging and care.

    3. Implement an appropriate program of exercises and mobility training.

    4. Develop an appropriate client education program.

  3. Exhibit an understanding of the psychosocial and economical effects of amputation on clients of different ages.

    1. Respond appropriately to patient and family.

    2. Provide guidance and support throughout the program.

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Physical Therapy students are expected to:

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  1. Establish an appropriate physical therapy diagnosis for each person.

    1. Develop and implement a plan of care for the postsurgical period of any lower extremity amputee.

    2. Select appropriate information from the history and system review.

    3. Select, prioritize, and implement appropriate tests and measures in the early and late postsurgical periods

    4. Evaluate data on an ongoing basis to adapt the plan of care as needed.

  2. Develop an examination plan throughout the postsurgical period.

  3. Evaluate the examination data to

    1. Establish a physical therapy diagnosis

    2. Establish a plan of care

    3. Establish functional outcomes

    4. Implement the plan with any simulated client

  4. Take responsibility for making appropriate referrals for effective continuation of care throughout the postsurgical (preprosthetic) program.

    1. In the early postsurgical period, plan for discharge and continuation of care from the onset of treatment.

    2. In the later postsurgical period, ensure proper referral for prosthetic fitting and training using appropriate community resources.

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CASE STUDIES

Janice Simmons, 63 years old, underwent a left transtibial amputation yesterday secondary to diabetic gangrene. She had an ulcer on the plantar surface of the first metatarsal that did not heal despite wound care and special shoes.

John Adams, 72 years old, underwent a right transfemoral amputation yesterday secondary to arteriosclerosis. He had a long history of arteriosclerosis with intermittent claudication and rest pain. He had a femoral-popliteal bypass 2 years ago.

Richard Canto, a 20-year-old member of the U.S. Army. While in a firefight in Iraq, he was hit in the left side with fragments from a roadside bomb. Evacuated quickly, he was sent to Germany and then to Walter Reed Medical Center, where attempts to save the leg failed. It was amputated at a transtibial level 1 week ago. The wound was left open because of potential infection. Yesterday, the incision was closed, and he was fitted with an immediate postoperative prosthesis without the pylon and foot.

Linda Bean, a 10-year-old, underwent a right transfemoral amputation yesterday secondary to IIB osteogenic sarcoma of the proximal tibia. The tumor by type and location was not suitable for excision, and reconstruction and amputation was considered the best treatment alternative.

Case Study Activities

All Students

  1. Compare and contrast the ...

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