NCLEX Basic Care and Comfort

Correct! Phantom limb pain is a real, neurological phenomenon caused by persistent activation of the neural pathways that previously served the amputated limb. The somatosensory cortex retains the body map of the missing limb. It is not psychological and requires real treatment. Approximately 80% of amputees experience phantom limb pain.

Clinical pearl: Clinical Pearl: Phantom limb pain treatments: MIRROR BOX THERAPY — the client watches the reflection of the intact limb moving, creating a visual illusion of the phantom limb moving painlessly. Shown to reduce cortical reorganization and pain. MEDICATIONS — gabapentin, pregabalin (neuropathic pain agents), tricyclic antidepressants, SNRI antidepressants. SPINAL CORD STIMULATION — for refractory cases. PSYCHOLOGICAL — CBT and mindfulness reduce suffering component. Mirror therapy is a simple bedside intervention the nurse can introduce.

Correct! Cool, pale skin, numbness, and tingling in the traction extremity are signs of neurovascular compromise — possible compartment syndrome or vascular injury. This is a surgical emergency requiring immediate provider notification. The 5 Ps — pain, pallor, pulselessness, paresthesia, and paralysis — guide neurovascular assessment in traction and casted extremities.

Clinical pearl: Clinical Pearl: Traction principles: weights must hang freely (resting on the floor or bed eliminates the traction force), ropes must be in pulley grooves, countertraction provided by the client's own body weight (head of bed may be elevated slightly on the traction side), ensure linens and equipment do not obstruct the traction line, and perform neurovascular checks every 1 to 2 hours. Never remove traction weights without a provider order.

Correct! While the analgesic is being obtained, the nurse should implement multiple non-pharmacological measures: positioning, temperature application if ordered, and therapeutic presence. Sitting with the client communicates empathy and reduces the psychological distress of waiting in pain. These measures do not replace the analgesic but bridge the gap while it is being prepared.

Clinical pearl: Clinical Pearl: The concept of "comfort bundling" — combining multiple non-pharmacological comfort measures simultaneously to achieve greater relief than any single measure alone: position the client optimally + adjust lighting and noise + apply appropriate temperature therapy + provide therapeutic presence + use distraction (music, conversation) + relaxation breathing. The combined effect is greater than each measure alone and demonstrates comprehensive nursing care.