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Difficulty: HardBasic Care and Comfort

A resident in a rehabilitation facility requires assistance with elimination. The resident underwent a right-sided total hip arthroplasty using a posterior surgical approach two days ago. When positioning this resident to use a fracture bedpan, which action by the practical nurse is most appropriate?

  1. Instruct the resident to use an overhead trapeze bar to lift the buttocks straight up while keeping the right leg slightly abducted.Answer
  2. B
    Elevate the head of the bed to a high-Fowler's position of 80 to 90 degrees to facilitate gravity for easier bowel elimination.
  3. C
    Turn the resident onto their left side while allowing the right leg to naturally cross over the midline to slide the pan underneath.
  4. D
    Slide a standard, deep-rimmed bedpan under the resident to provide maximum sacral support and prevent spillage.

Answer

The most appropriate action is to instruct the resident to use an overhead trapeze bar to lift the buttocks straight up while keeping the right leg slightly abducted.
For a posterior approach total hip arthroplasty, the hip must not be flexed beyond 90 degrees, and adduction or internal rotation must be completely avoided to prevent prosthesis dislocation. Using an overhead trapeze bar allows the client to lift their pelvis straight up without flexing the hip or rolling, while slight abduction maintains safe joint alignment for the placement of a fracture pan.

Step-by-Step Solution

1
Identify the specific surgical procedure and its associated precautions.
The client had a posterior total hip arthroplasty. Precautions include avoiding hip flexion greater than 90 degrees, avoiding adduction (crossing midline), and avoiding internal rotation.
Understanding the anatomical limitations post-surgery is essential to prevent prosthetic dislocation during routine basic care.
2
Evaluate the demands of placing a bedpan against the required post-operative precautions.
Using a bedpan normally requires lifting the pelvis or rolling the client, both of which can compromise hip alignment if performed incorrectly.
Basic care tasks must be adapted to fit within the safety parameters of the client's current physiological state.
3
Select the intervention that achieves the care goal without violating joint precautions.
Using an overhead trapeze bar with the leg abducted allows vertical lifting without dangerous flexion or adduction.
This action promotes client independence and comfort while strictly adhering to posterior hip precautions.

Key Concept

Maintenance of post-operative positioning precautions during basic care and comfort procedures.
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Topics

Basic Care and Comfort

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