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Difficulty: MediumBasic Care and Comfort

A licensed practical nurse is assigned to care for a client recovering from a right total hip arthroplasty (posterior approach) performed yesterday. The client requires assistance with hygiene, mobility, and comfort. Which actions are appropriate for the nurse to include in the plan of care? Select all that apply.

  1. Maintain an abduction wedge or pillow between the client's lower extremities while resting in bed.Answer
  2. Suspend the client's heels off the mattress surface using soft pillows.Answer
  3. C
    Roll the client onto the right operative hip to provide back care and relieve pressure.
  4. D
    Assign the unlicensed assistive personnel to evaluate the skin condition beneath the compression stockings.
  5. Slide a low-profile fracture pan under the client for elimination needs.Answer
  6. F
    Position the upper half of the hospital bed strictly upright at a 90-degree angle during mealtime.

Answer

The correct interventions are maintaining an abduction wedge between the legs, suspending the heels off the mattress, and using a low-profile fracture pan.
Appropriate basic care for a client recovering from a posterior total hip arthroplasty includes measures that maintain proper alignment and prevent pressure injuries. An abduction wedge prevents dangerous leg crossing (adduction). Suspending heels protects vulnerable skin from pressure ulcers. Using a fracture pan minimizes lifting and prevents the hip from flexing dangerously to 90 degrees or beyond.

Step-by-Step Solution

1
Identify the surgical procedure and its specific post-operative precautions.
The client had a right total hip arthroplasty using a posterior approach, which requires avoiding hip flexion of 90 degrees or greater, adduction (crossing the midline), and internal rotation.
Understanding joint precautions is essential to prevent dislocation of the prosthesis.
2
Evaluate each intervention against basic care principles and hip precautions.
Abduction wedges prevent adduction. Heel suspension prevents pressure ulcers. Fracture pans prevent excessive hip flexion. However, side-lying on the operative side and 90-degree bed elevation violate positioning precautions.
Applying knowledge of safe positioning ensures client safety and promotes comfort.
3
Determine if delegated tasks fall within the legal scope of practice.
Evaluating skin integrity is an assessment task that cannot be delegated to unlicensed assistive personnel.
Nurses must adhere to the scope of practice guidelines for safe delegation.

Key Concept

Postoperative Basic Care and Precautions for Total Hip Arthroplasty
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Topics

Basic Care and Comfort

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