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Difficulty: Very hardBasic Care and Comfort

A practical nurse is providing care for a client who is 72 hours post-operative following a right above-the-knee amputation. The client reports a dull, aching discomfort in the right hip and requests that the head of the bed be raised to 60 degrees with a thick pillow placed under the residual limb. Which action is most appropriate for the nurse to take?

  1. A
    Provide the requested pillow and raise the head of the bed to promote venous return and relieve the reported hip discomfort.
  2. B
    Raise the head of the bed to 60 degrees, but explain that the residual limb must remain flat on the mattress to prevent swelling.
  3. Acknowledge the discomfort, keep the bed flat, and assist the client into a prone position to stretch the hip flexor muscles.Answer
  4. D
    Ask the client why they want to elevate the limb when they were previously instructed about the importance of proper joint alignment.

Answer

The most appropriate action is to acknowledge the discomfort, maintain a flat bed position, and assist the client into a prone position to stretch the hip flexor muscles.
Following an above-the-knee amputation, the residual limb should not be elevated on a pillow after the first 24 hours due to the high risk of developing a hip flexion contracture. Furthermore, raising the head of the bed flexes the hip joint significantly. The prone position is the optimal nursing intervention, as it fully extends the hip joint, stretches the flexor muscles, prevents contractures, and alleviates aching caused by prolonged flexion.

Step-by-Step Solution

1
Analyze the client's postoperative timeline and positioning request.
The client is 72 hours post-operative from an above-the-knee amputation (AKA) and is requesting both limb elevation and a high-Fowler's position.
Identifying the time since surgery is critical, as positioning guidelines change significantly after the first 24 hours to prevent complications.
2
Evaluate the physiological impact of the requested positions on the residual limb and hip joint.
Both elevating the limb on a pillow and raising the head of the bed to 60 degrees will cause prolonged flexion of the hip joint.
Continuous hip flexion after an AKA leads to shortening of the flexor muscles, resulting in a permanent hip flexion contracture that impairs future prosthesis use.
3
Select the most appropriate nursing intervention within the practical nurse's scope of practice.
The nurse must gently deny the unsafe request, explain the rationale to reinforce teaching, and assist the client into a prone position.
The prone position fully extends the hip joint, counteracting the flexed positions typical of sitting or resting in bed, and safely addresses the aching discomfort caused by muscle tension.

Key Concept

Prevention of hip flexion contractures following an above-the-knee amputation
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Topics

Basic Care and Comfort

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