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Difficulty: Very hardBasic Care and Comfort

A practical nurse (PN) is caring for a client who underwent a right total hip arthroplasty (posterior approach) 24 hours ago. The client is receiving continuous enteral feeding via a gastrostomy tube and reports significant sacral discomfort from lying supine. The PN determines that the client needs to be repositioned to relieve pressure. Which sequence of actions is the most appropriate for the PN to implement?

  1. Pause the enteral feeding, lower the head of the bed to a flat position, ensure the abductor pillow is secured, logroll the client onto the left side, and then elevate the head of the bed to 30 degrees before resuming the feeding.Answer
  2. B
    Lower the head of the bed to a flat position to maintain spinal alignment, logroll the client onto the left side with the abductor pillow in place, and leave the continuous feeding running to ensure adequate caloric intake.
  3. C
    Maintain the head of the bed at a 30-degree angle to prevent aspiration, temporarily remove the abductor pillow to facilitate easier movement, and assist the client to turn onto the left side.
  4. D
    Elevate the head of the bed to a 90-degree angle to shift the client's body weight from the sacrum to the ischial tuberosities while maintaining optimal aspiration precautions during the feeding.

Answer

The sequence where the nurse pauses the enteral feeding, lowers the bed flat, keeps the abductor pillow secured, logrolls the client to the left side, and elevates the bed to 30 degrees before resuming the feed.
This sequence safely addresses both the client's aspiration risk and postoperative hip precautions. When turning a client to relieve sacral pressure, the bed should be lowered to a flat position to maintain proper body alignment and prevent shearing. Because the client is receiving continuous enteral feeding, the pump must be paused before lowering the head of the bed to prevent regurgitation and aspiration. The abductor pillow must remain securely in place to prevent adduction of the operated leg, which could cause a posterior dislocation. Once the client is safely logrolled to the unoperated side, the head of the bed must be elevated back to at least 30 degrees before the feeding is resumed.

Step-by-Step Solution

1
Identify the client's concurrent positioning risks.
The client has a severe aspiration risk from the enteral feeding and a high dislocation risk from the recent posterior approach total hip arthroplasty.
Recognizing overlapping precautions is essential for planning safe basic care.
2
Determine the physical requirements for a safe turn.
Turning the client requires flattening the bed to maintain proper spinal alignment and reduce shearing forces.
Turning a client with the head of the bed elevated creates poor body mechanics and increases skin friction.
3
Address the aspiration risk prior to movement.
The continuous enteral feeding must be temporarily paused before lowering the head of the bed.
Laying a client flat while formula is actively infusing into the stomach can lead to immediate regurgitation and aspiration into the lungs.
4
Execute the turn while maintaining musculoskeletal precautions.
The abductor pillow is left in place, and the client is logrolled onto the unoperated (left) side.
The abductor pillow prevents the operated leg from crossing the midline (adduction), which is the primary cause of dislocation in posterior hip replacements.
5
Restore aspiration precautions and comfort.
The head of the bed is elevated back to at least 30 degrees, and the feeding is resumed.
Formula can only be safely administered when the upper body is adequately elevated to allow gravity to assist digestion.

Key Concept

Prioritization of basic care interventions involving concurrent aspiration precautions and postoperative mobility restrictions.
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Topics

Basic Care and Comfort

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