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Question

Difficulty: HardBasic Care and Comfort

While providing morning hygiene and comfort measures for an individual recovering from a recent right posterior total hip arthroplasty, the practical nurse (PN) needs to change the soiled bottom bed linens. Which specific technique must the PN utilize to complete this task safely?

  1. A
    Remove the inter-leg foam wedge temporarily to wash the inner thighs and perineal area thoroughly.
  2. B
    Position the client in a high Fowler's position to allow them to assist by pulling on the overhead trapeze.
  3. Secure an abduction device between the thighs and turn the client as a single unit onto their left lateral side.Answer
  4. D
    Gently rotate the client's right leg inward toward the midline when positioning them for the bedpan.

Answer

The correct action is to secure an abduction device between the thighs and turn the client as a single unit onto their left lateral side.
Following a posterior total hip arthroplasty, the client is at high risk for hip dislocation if the joint is subjected to adduction, internal rotation, or flexion greater than 90 degrees. Placing an abduction wedge or pillow between the legs prevents the affected leg from crossing the midline (adduction) while the client is safely turned onto their unoperated side to facilitate linen changes and back care.

Step-by-Step Solution

1
Identify the client's surgical procedure and associated anatomical risks.
The client had a right posterior total hip arthroplasty, which carries a high risk of dislocation if specific joint movements are permitted.
Understanding surgical precautions is essential before initiating basic care and hygiene interventions.
2
Determine the specific movement restrictions for a posterior surgical approach.
The affected hip must not be flexed beyond 90 degrees, internally rotated, or adducted across the body's midline.
These specific positions force the femoral head out of the newly implanted acetabular cup.
3
Evaluate each proposed hygiene technique against the strict movement restrictions.
Raising the bed causes excessive flexion, removing the wedge causes adduction, and inward rotation is directly contraindicated. Only using an abduction device while turning maintains safety.
Basic care interventions must be fundamentally modified to strictly adhere to postoperative joint precautions.

Key Concept

Postoperative Positioning and Joint Precautions
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Topics

Basic Care and Comfort

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