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Difficulty: MediumBasic Care and Comfort

A client is receiving care on a surgical unit 48 hours after undergoing a right below-the-knee amputation. To prevent postoperative complications and promote optimal long-term mobility, which of the following positioning measures should the practical nurse (PN) implement?

  1. Assist the client to lie in a prone position for 20 to 30 minutes several times a day.Answer
  2. B
    Elevate the right residual limb on a soft pillow while the client is resting in bed.
  3. C
    Maintain the client in a continuous semi-Fowler's position to decrease incisional tension.
  4. D
    Encourage the client to sit upright in a bedside chair for the majority of the day.

Answer

Assist the client to lie in a prone position for 20 to 30 minutes several times a day.
Following a lower extremity amputation, the prevention of hip flexion contractures is a primary positioning goal. Assisting the client into a prone position (lying on the abdomen) for 20 to 30 minutes, three to four times a day, actively stretches the hip flexor muscles and prevents them from shortening.

Step-by-Step Solution

1
Identify the surgical procedure and the postoperative timeframe.
The client had a below-the-knee amputation 48 hours ago.
Positioning protocols for amputations change significantly after the first 24 hours to transition from edema control to contracture prevention.
2
Determine the primary musculoskeletal complication associated with lower extremity amputations.
Hip flexion contractures are a major risk because the flexor muscles tend to shorten if the limb is kept in a bent position.
Understanding the risk of muscle shortening guides the selection of the correct preventive positioning measure.
3
Evaluate the given positioning options against the goal of preventing contractures.
Prone positioning extends and stretches the hip flexors, whereas elevating the limb on a pillow, sitting in a chair, and semi-Fowler's positioning all promote continuous hip flexion.
Selecting the intervention that directly counteracts muscle shortening ensures evidence-based basic care and protects the client's ability to use a future prosthesis.

Key Concept

Prevention of Hip Flexion Contractures Following Amputation
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Topics

Basic Care and Comfort

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