Implentation of the Self-Care Theory in pain control in patientes with amputation

Abstract

INTRODUCTION:

Lower limb amputation is a painful procedure with significant physical and emotional repercussions. It is a therapeutic last resort when the condition is not congenital. Its causes include vascular, traumatic, oncological, metabolic, and infectious factors. The Rehabilitation Nurse Specialist's role is to provide comprehensive and specialized care during the pre-prosthetic and prosthetic stages, with an emphasis on pain management.

OBJECTIVE:

To perform specialized rehabilitation nursing interventions for a person with a left transfemoral amputation using Dorothea's self-care theory.

METHODOLOGY:

The Nursing Care Process (NCP) was used to develop the case study, developing each stage (assessment, diagnosis, planning, execution, and evaluation) using Dorothea Orem's Self-Care Theory. Data were collected through the application of an assessment instrument in the Physical Therapy service, where the patient was approached, obtaining subjective (anamnesis) and objective (through physical examination) data, and validated through informed consent. Nursing care plans (PLACE) were developed using the PES format for the nursing diagnoses, and specialized rehabilitation nursing interventions were carried out through home visits to ensure better pain control during the pre-prosthetic and prosthetic stages.

RESULTS:

Male with a left transfemoral amputation of metabolic origin due to diabetic foot (03/2019); with a BMI of 33.4 and obesity type I. He presented with a decreased range of motion on the Daniels MPI score of 3/5, and use of walking aids with crutches and a wheelchair. A VAS score of 6/10, moderate pain, and presence of phantom pain; TINIT II with moderate risk of falls, decreased ability to perform activities of daily living (ADL), with a Barthel index of 70 points, and mild dependency.

DISCUSSION AND CONCLUSIONS:

The combination of these therapies significantly reduced pain in the amputee patient. Warm compresses improved circulation and relaxed residual muscles, decreasing hypersensitivity and discomfort prior to physical therapy. Mirror therapy helped restructure brain perception, decreasing phantom pain, while Jacobson muscle relaxation reduced tension and anxiety, improving pain control. Sensory stimulation using the Rood technique contributed to desensitization of the stump, improving tolerance to tactile stimuli. These interventions favored patient adaptation and significantly reduced pain perception.