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Difficulty: MediumBasic Care and Comfort

A client is recovering on the surgical unit following a right total hip arthroplasty utilizing a posterior approach. The practical nurse is preparing to turn the client to assess the sacral area. Which action represents the safest technique for this client?

  1. A
    Elevate the head of the bed to a 90-degree angle to help the client adjust their weight before turning
  2. B
    Position the right leg in internal rotation to relax the hip muscles while resting supine
  3. Keep an abduction wedge placed between the client's legs while rolling them onto their left sideAnswer
  4. D
    Instruct the client to cross the right ankle over the left leg to create leverage during the turn

Answer

Keep an abduction wedge placed between the client's legs while rolling them onto their left side.
For a client with a posterior approach total hip arthroplasty, the hip must remain in an abducted, neutral position to prevent prosthesis dislocation. Using an abduction wedge between the legs while turning the client onto the unaffected (left) side maintains this alignment and safely prevents the surgical hip from crossing the midline (adducting) or internally rotating.

Step-by-Step Solution

1
Identify the surgical procedure and the associated post-operative precautions.
The client had a right total hip arthroplasty (posterior approach).
Different surgical approaches have specific movement restrictions to prevent prosthesis dislocation.
2
Recall the specific mobility restrictions for a posterior approach total hip arthroplasty.
Precautions include avoiding hip flexion greater than 90 degrees, avoiding adduction (crossing the midline), and avoiding internal rotation of the affected leg.
These specific movements force the newly placed femoral head out of the acetabular cup.
3
Evaluate each nursing action against the identified safety precautions.
Using an abduction wedge prevents adduction. The other actions promote extreme flexion, internal rotation, or adduction.
Basic care must be performed without violating the prescribed positional limitations.
4
Select the action that safely facilitates basic care.
Turning the client onto the unaffected (left) side with an abduction wedge is the safest technique.
This maintains neutral alignment of the operative hip while allowing access to the sacral area.

Key Concept

Postoperative Positioning and Joint Precautions for Total Hip Arthroplasty
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Topics

Basic Care and Comfort

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