Applying Prosthetics and Orthotics
Key Points
- Prosthetics replace lost limb function, while orthotics support or correct body part alignment/function.
- Device placement must follow therapist instructions and care-plan timing.
- Skin irritation and pressure injury are major risks and require active monitoring.
Pathophysiology
Prosthetic and orthotic devices redistribute load and guide movement to improve function, stability, and alignment. Incorrect placement can create abnormal pressure points, friction, and impaired circulation, leading to skin breakdown or pain.
Older adults and residents with fragile skin are at higher risk for device-related irritation. Protective sleeves and proper padding reduce shear and displacement risk in prosthetic use.
Safe device support preserves mobility and participation while preventing avoidable tissue injury.
Classification
- Prosthetics: Artificial limb attachments replacing lost or nonfunctional limb components.
- Orthotics: Braces/splints/supports for alignment, correction, and controlled movement.
- Supportive accessories: Sleeves, padding, and thin clothing interfaces to protect skin.
- Wear schedule control: Care-plan specified duration and removal intervals.
Nursing Assessment
NCLEX Focus
Priority questions ask which findings indicate unsafe fit and what action is required before continued device use.
- Verify order/instructions for device type, side, placement, and wear schedule.
- Inspect skin before and after application for redness, pressure, abrasion, or pain.
- Assess comfort and ask resident about pressure spots or instability.
- Report uncertainty or poor fit immediately to supervising nurse before use.
Nursing Interventions
- Apply prosthetic/orthotic exactly as instructed by therapist and care plan.
- Use protective sleeve/padding interface as ordered before attachment.
- Confirm secure but non-constrictive fit and reassess after initial movement.
- Remove or adjust per ordered schedule to allow skin checks and pressure relief.
- Escalate unresolved discomfort, skin changes, or fit problems promptly.
Device-Fit Injury Risk
Incorrect prosthetic or orthotic placement can cause pressure injury, gait instability, and functional decline.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| analgesics | Device-related pain contexts | Pain relief should not replace correction of poor fit or pressure source. |
| anti-inflammatory-medications | Joint-support contexts | Persistent swelling or pain despite medication warrants device reassessment and nurse notification. |
Clinical Judgment Application
Clinical Scenario
A resident reports sharp pressure at the stump after prosthetic placement and refuses ambulation.
Recognize Cues: Localized pain and functional refusal after application. Analyze Cues: Likely fit/interface issue with risk of skin injury. Prioritize Hypotheses: Immediate priority is preventing tissue damage and fall risk. Generate Solutions: Remove device per policy, inspect skin, verify sleeve placement, and notify nurse. Take Action: Document findings and hold ambulation until reassessment. Evaluate Outcomes: Device is re-fitted and resident resumes safe mobility with reduced discomfort.
Related Concepts
- assisting-with-ambulation - Device fit directly affects walking safety and gait quality.
- assisting-clients-to-transfer - Transfer method may require adaptation for prosthetic/orthotic users.
- moving-and-positioning-clients - Positioning supports skin protection when devices are removed.
- body-mechanics-and-safe-equipment-use - Safe assist mechanics reduce injury during device application and mobility.
- documenting-and-reporting-data - Accurate recording of fit, tolerance, and skin findings supports team follow-up.
Self-Check
- What signs indicate prosthetic or orthotic fit is unsafe?
- Why is a protective interface important for many prosthetic applications?
- When should CNA device application be paused and escalated to the nurse?