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Question

Difficulty: MediumBasic Care and Comfort

During morning rounds, the practical nurse is assisting a client who recently had a right total hip replacement via a posterior approach. The client requires help with bathing and changing positions in bed. Which action should the nurse take to ensure safe positioning and comfort?

  1. Maintain an abduction wedge between the lower extremities when turning the client.Answer
  2. B
    Adjust the head of the bed to a 90-degree angle while the client eats breakfast.
  3. C
    Help the client cross their right ankle over their left leg to relieve back pressure.
  4. D
    Instruct the client to lean forward past their knees to wash their lower legs.

Answer

The nurse should maintain an abduction wedge between the lower extremities when turning the client to prevent adduction and potential hip dislocation.
Following a total hip arthroplasty with a posterior approach, it is critical to prevent adduction (crossing the legs across the body's midline) and hyperflexion of the affected hip to avoid dislocating the new prosthesis. Using an abduction wedge or placing pillows between the legs keeps the hips properly aligned in slight abduction when the client is resting or being turned, ensuring joint safety and comfort.

Step-by-Step Solution

1
Identify the surgical procedure and its specific postoperative precautions.
The client had a right total hip replacement via a posterior approach.
Different surgical approaches have different mobility restrictions to prevent prosthesis dislocation.
2
Recall the positioning restrictions for a posterior approach hip replacement.
Restrictions include avoiding hip flexion greater than 90 degrees, avoiding hip adduction (crossing the midline), and avoiding internal rotation.
These movements place stress on the posterior joint capsule and can pop the femoral head out of the acetabulum.
3
Evaluate the nursing actions against these restrictions.
Using an abduction wedge prevents adduction. The other actions promote extreme flexion or adduction.
Basic care must incorporate these safety parameters to prevent severe complications while promoting hygiene and comfort.

Key Concept

Postoperative Positioning and Precautions
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Topics

Basic Care and Comfort

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