ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

S: “mejo Acute Pain Report pain is 1. Document location 1. Aids in evaluating After 12 hours of
kumikirot kirot relieved or and intensity of pain need for and nursing
yung sugat controlled. (scale of 0–10). effectiveness of intervention, goal
ko” Appear relaxed 2. Investigate changes interventions.
and able to rest in pain 2. Changes may was met as
O: Amputated and sleep characteristics— indicate developing manifested by:
left leg appropriately. numbness and complications,
Verbalize tingling. such as necrosis or Patient reports pain
understanding 3. Elevate affected infection. is relieved and
Restless controlled.
of phantom part by raising foot
pain and of bed slightly or 3. Lessens edema
(+) Facial Grimace methods to using a pillow or formation by Patient is relaxed
provide relief. sling for upper-limb enhancing venous and able to rest and
BP = 140 / amputation. return; reduces sleep appropriately.
70mmHg muscle fatigue and
skin or tissue Patient is able to
Pulse:110 bpm 4. Provide or promote pressure. Note: verbalizes the
general comfort After initial 24 understanding of
measures (e.g., hours and in phantom pain and
frequent turn- ing, absence of edema, methods to provide
back rub) and residual limb may relief.
diversional be extended and
activities. kept flat.
Encourage use of
stress management 4. Refocuses
techniques, such as attention, promotes
deep-breathing relaxation, may
exer- cises, enhance coping
visualization and abilities, and may
guided imagery, decrease
and Therapeutic occurrence of
Touch. phantom-limb pain.

5. Investigate reports 5. May indicate

of progressive or
poorly localized
pain unrelieved by
analgesics.
6. Acknowledge reality
of residual limb pain
and phantom pain
and that various
modalities will be
tried for pain relief.
6. Residual limb pain
7. Collaborative
Administer
medications, as
indicated, such as
the following:
developing
compartment
syndrome,
especially following
traumatic injury.
(Refer to CP:
Fractures; ND: risk
for Peripheral
Neurovascular
Dysfunction.)
is believed to come
from injuries to
nerves at the
amputation site. At
the ends of these
injured nerve fi
neuromas send out
pain impulses in a
random fashion, or
when trapped as in
excessive
compression by
other tissues such
as muscle, or in
the development of
the infectious
 Opioid analgesics,
for example,
morphine sulfate
(Astramorph, MS
Contin), Fentanyl
patch; combination
agents: oxycodone
with acetaminophen
(Percocet); and
anti-inflammatory
agents, for
example,
acetaminophen
(Tylenol) and
ibuprofen (Motrin)
Antidepressants, for
example,
amitriptyline (Elavil),
nortripty- line
(Pamelor), and
duloxetine
(Cymbalta);
antiseizure drugs,
for example,
carbamazepine
(Tegretol),
gabapentin
(Neurontin), and
pregabalin (Lyrica);
sedatives/anti-
anxiety agents, for
example, diazepam In acute postamputation
(Valium) and pain, opioid analgesics are
alprazolam (Xanax); the mainstay of pain
and local/regional management to reduce
anesthetics, for pain and muscle spasms.
example, nova-
caine (Marcaine)
and ropivacaine
(Naropin)
8. Instruct in, and
monitor use of,
patient-controlled
analgesia (PCA).
9. Refer to
interdisciplinary
providers as
appropriate—pain
management
specialist, physical
therapist,
prosthetist,
orthopedic surgeon,
and neurosurgeon.
10. Discuss and
monitor use of
transcutaneous
electrical nerve
stimulation (TENS)
of the residual limb.
process. In
contrast, phantom
pain is thought to
originate in the part
of the brain that
controlled the limb
before it was
amputated. So the
client experiences
pain and sensation
as if the limb were
still in place.
7. Phantom pain is
often described as
crushing, grinding,
or burning. It can
occur immediately
or may not start for
several weeks.
Note: Phantom
pain is not well
relieved by
traditional pain
medications.
8. Many medications
and routes of
administration may
be used.
9. As surgical pain
subsides, other
medications will be
added to manage
more long-term
conditions; for
example,
antidepressants
and antiseizure
medications
appear to help with
neurotic pain
associated with
phantom pain and
sensations.
10. PCA provides for
continuous and
timely drug
administration,
preventing
fluctuations in pain
level and muscle
tension and
 spasms associated
with surgical
procedures.

11. A multidisciplinary
approach is
required, and many
therapy modalities
may be needed
both in the acute
and the long-term
management of
pain.

For some
individuals, a
TENS unit may
help to treat
retractable
phantom limb pain,
especially in
combination with
medica- tions for
neuropathic pain.
Note: Stimulation
of the intact
(opposite) limb is
often more
effective. Indeed,
an increase in
phantom pain has
occassionally been
reported when
TENS unit has
been applied to
residual limb.