A client who underwent a left posterior total hip arthroplasty 24 hours ago is currently receiving continuous enteral nutrition via a nasogastric tube. The client experiences an episode of bowel incontinence and requires immediate perineal care alongside a full bed linen change. Which specific sequence of actions represents the safest method for the practical nurse to complete this care?
- AMaintain the head of the bed at a 30-degree angle to prevent aspiration, place two regular pillows between the knees, and gently roll the client onto their left side.
- BPause the continuous feeding, elevate the head of the bed to 45 degrees, and instruct the client to use the overhead trapeze bar to lift their pelvis off the mattress.
- Stop the enteral feeding pump, lower the bed to a flat position, secure an abduction wedge between the client's legs, and roll them onto their right side.Answer
- DLeave the feeding infusion running, lower the head of the bed temporarily to 15 degrees, and utilize a friction-reducing slide sheet to turn the client laterally.
Answer
The safest method is to first pause the enteral feeding, lower the head of the bed flat, secure an abduction wedge between the legs, and turn the client onto their unaffected (right) side.
This sequence comprehensively addresses multiple conflicting physiological safety requirements. First, pausing the feeding allows the bed to be safely lowered without risking pulmonary aspiration. Second, lowering the bed to a flat position prevents shearing forces on the sacrum and prevents dangerous hip flexion during the turn. Finally, securing an abduction wedge and rolling the client onto their unaffected right side maintains strict posterior hip precautions, preventing joint dislocation and avoiding direct pressure on the fresh surgical incision.
Step-by-Step Solution
Key Concept
Integrating safe positioning protocols for post-operative posterior total hip arthroplasty with aspiration precautions for enteral feeding during basic hygiene care.