# Situation: A 58-year-old man with type 2 diabetes mellitus and severe peripheral arterial disease of the left leg has had a nonhealing ulcer over the left heel for 2 months. Magnetic resonance imaging (MRI) shows osteomyelitis of the calcaneus. On the fifth postoperative day he reports burning, cramping pain in his left foot, rated 7/10. The residual limb dressing is dry, the skin around it is warm and pink, and his vital signs are normal. Which interpretation is correct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630534  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 58-year-old man with type 2 diabetes mellitus and severe peripheral arterial disease of the left leg has had a nonhealing ulcer over the left heel for 2 months. Magnetic resonance imaging (MRI) shows osteomyelitis of the calcaneus.

On the fifth postoperative day he reports burning, cramping pain in his left foot, rated 7/10. The residual limb dressing is dry, the skin around it is warm and pink, and his vital signs are normal. Which interpretation is correct?

## 보기

1. Early wound infection that needs a culture of the incision
2. Residual limb ischemia that needs urgent surgical review
3. Phantom limb pain that needs active pain treatment **✔ 정답**
4. A grief reaction expressed as pain, needing counseling

**정답: 3**

## 해설

Burning or cramping pain felt in the part of the limb that has been removed is phantom limb pain. It has a physical basis, is not imaginary, and is treated with analgesics, gabapentinoids and mirror therapy, while grief and body-image support continue.

## 심화 해설

Naming the sensation
On the fifth day after his above-knee amputation, the client feels burning, cramping pain in his left foot, a foot that no longer exists. Pain perceived in the amputated part is phantom limb pain. It must be separated from phantom sensation, which is a nonpainful feeling that the limb is still there, such as tingling or itching, and from residual limb pain, which is felt in the remaining limb itself. Phantom limb pain has a physical basis in the nervous system and is real; it is not imaginary or purely emotional.

Why it happens
After amputation, the cut nerves and the spinal cord and brain regions that once received input from the foot keep generating signals. The brain's map of the body still includes the foot, and abnormal activity in this map is felt as pain in the missing part. Severe pain before surgery is associated with a higher risk. Phantom pain is common early after amputation and often lessens over time, but it can persist.

Ruling out the other interpretations
The nurse checks the other possibilities before concluding. The residual limb dressing is dry, the skin is warm and pink, and the vital signs are normal. A dry dressing and normal vital signs make wound infection unlikely; infection would bring redness, swelling, drainage, fever, or a rising heart rate. Warm, pink skin makes ischemia of the residual limb unlikely; ischemia would bring pallor or mottling, coolness, and pain in the residual limb itself. A grief reaction is part of adjusting to amputation, but labeling the pain as grief dismisses a real pain that needs treatment.

| Finding | Points away from |
| --- | --- |
| Dry dressing | Wound infection |
| Warm, pink skin | Residual limb ischemia |
| Normal vital signs | Systemic infection |
| Pain felt in the missing foot | Residual limb pain |

Treatment and nursing care
Phantom limb pain is treated actively. Options include analgesics, gabapentinoids for its neuropathic character, and mirror therapy, in which the client watches the reflection of the intact limb moving to retrain the brain's map. The nurse assesses the pain with the same scale used for other pain (here 7/10), believes the report, gives ordered drugs, and evaluates the response. Grief and body-image support continue alongside pain treatment, not instead of it.

Exam takeaway
Key point Pain felt in the amputated part is phantom limb pain: real, physical, and treated actively with analgesics, gabapentinoids, and mirror therapy.

## 임상 시나리오

Phantom Limb Pain After AmputationA real pain that needs treatment
Burning or cramping pain felt in the removed part of the limb is phantom limb pain. It has a physical basis in the nervous system.

A dry dressing, warm pink skin, and normal vital signs make infection and ischemia unlikely.

Treat the pain with analgesics, gabapentinoids, and mirror therapy, and reassess it. Continue grief and body-image support.

CautionDo not dismiss the pain as imaginary or as grief alone. Believe the client's report and treat it like any other pain.

## 핵심 개념

- **Phantom limb pain** — Pain felt in a part of the limb that has been amputated, caused by changes in the nervous system.
- **Phantom sensation** — A nonpainful feeling, such as tingling or itching, that the amputated limb is still present.
- **Mirror therapy** — A treatment in which the client watches a mirror image of the intact limb moving to reduce phantom pain.
- **Residual limb pain** — Pain located in the remaining part of the limb, often from the incision, infection, or ischemia.

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