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Difficulty: MediumBasic Care and Comfort

A practical nurse is providing care for a client who is 1 day postoperative following a right total hip arthroplasty using a posterior approach. The nurse is preparing to turn the client onto their unoperated left side for back care. Which action is essential for the nurse to implement to ensure client safety and comfort during this position change?

  1. Place an abduction wedge or pillow between the client's legs before turningAnswer
  2. B
    Flex the client's right hip to a 100-degree angle to ease the turning process
  3. C
    Allow the client's right leg to cross over the midline of the bed while turning
  4. D
    Elevate the head of the bed to a high-Fowler's position before initiating the turn

Answer

The nurse must place an abduction wedge or pillow between the client's legs before turning to maintain proper alignment and prevent adduction.
The correct answer maintains the client's hip in an abducted, neutral position. Following a posterior approach total hip arthroplasty, the primary goals of positioning are to prevent adduction (crossing the legs), internal rotation, and hip flexion greater than 90 degrees. Using an abduction wedge or pillow between the legs before and during a turn ensures the operative leg cannot cross the midline, thereby preventing a painful and serious surgical dislocation.

Step-by-Step Solution

1
Identify the surgical procedure and its associated positional restrictions.
The client had a right total hip arthroplasty (posterior approach), which requires strict precautions to prevent dislocation.
Understanding the specific surgical approach dictates the safe parameters for basic care and movement.
2
Recall the three primary positional movements to avoid after a posterior hip arthroplasty.
The client must avoid hip flexion greater than 90 degrees, adduction (crossing the midline), and internal rotation of the affected leg.
These movements place stress on the posterior surgical capsule and can pop the femoral head out of the acetabulum.
3
Select the nursing intervention that actively prevents these contraindicated movements during a lateral turn.
Placing an abduction wedge keeps the legs apart, preventing adduction and maintaining neutral alignment during the turn.
An abduction pillow physically blocks the operative leg from crossing the midline of the body.

Key Concept

Proper positioning and joint precautions following a total hip arthroplasty are essential basic care measures to prevent postoperative dislocation.
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Topics

Basic Care and Comfort

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