Before the Stitches & Staples Come Out
- Educate on positioning in bed and sitting. No pillows under knees.
- Promote stretching in prone position if tolerable (no low back pain).
- Provide sitting support for wheelchair – residual limb supports.
- Educate on precautions (non-weightbearing on residual limb).
- Educate on the purpose of dressing and bandage is to absorb moisture and protect the healing wound.
- Cover and teach protection of residual limb during showers from water contact.
- Remind staff to assist with daily dressing changes.
- Practice transfers onto commode/toilet and shower chairs/benches.
- Advocate for the timing of Rx and pain management.
- Prevent and manage pain and phantom limb pain (diary, breathing, distraction, mirror therapy).
- Strengthen non-involved muscles (shoulder, upper extremities, etc.)
- Provide psychosocial support and resources for support groups.
- Prevent infection control – educate others including staff to wash hands or wear gloves when coming into contact with healing site.
- Promote healthy diet, smoking/alcohol/recreational drug cessation.
After the Stitches & Staples Come Out
- Depends on MD – approximately 3 weeks after surgery.
- Begin desensitization (massage, tapping, rubbing).
- Encourage daily washing with soap and water, patting dry.
- Introduce A/E including hand-mirror, long handle sponge, reacher.
- Teach scar massage.
- Emotional support.
- Assisting with ADLs and IADLs (including cooking, driving, lifting, transport of wheelchair and equipment).
- Assisting with wound care in all phases of rehabilitation.
- Helping with desensitization.
Figure 8 Wrapping
Phantom Limb Pain Causes
- Being too tired
- Putting too much pressure on the stump or parts of the arm or leg that are still there
- Changes in the weather
- An artificial limb that does not fit properly
- Poor blood flow
- Swelling in the part of the arm or leg that is still there