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Difficulty: MediumBasic Care and Comfort

During morning care at a rehabilitation center, a practical nurse is providing care for a resident who underwent a right above-the-knee amputation three days ago. To prevent the development of a hip flexion contracture, which positioning strategy is most appropriate for the nurse to implement?

  1. Assist the resident into a prone position for 20 to 30 minutes several times a day.Answer
  2. B
    Elevate the residual limb continuously on a pillow while the resident rests in bed.
  3. C
    Maintain the head of the bed in a high-Fowler's position throughout the daytime hours.
  4. D
    Encourage the resident to sit in a bedside chair for prolonged periods to build physical endurance.

Answer

The most appropriate strategy is to assist the resident into a prone position for 20 to 30 minutes several times a day.
Placing a client in the prone position for 20 to 30 minutes three to four times a day is a critical basic care intervention following a lower extremity amputation. This position fully extends the hip joint, safely stretching the flexor muscles and preventing the development of a flexion contracture, which would otherwise impede the future fitting and use of a prosthesis.

Step-by-Step Solution

1
Identify the primary mobility and comfort risk associated with the client's postoperative time frame.
Three days after an above-the-knee amputation, the priority concern is preventing hip flexion contractures.
Contractures severely limit mobility rehabilitation and the future ability to effectively use a prosthetic limb.
2
Determine the physiological effect of various positions on the hip joint.
Sitting, elevating the limb, and high-Fowler's positions all cause hip flexion. Prone positioning causes hip extension.
Extending the hip stretches the flexor muscles, directly counteracting the tendency for those muscles to shorten and permanently contract.
3
Select the nursing intervention that promotes therapeutic hip extension.
Placing the client in a prone position for 20 to 30 minutes multiple times daily is the correct intervention.
This specific positioning strategy is the standard of basic care to prevent joint complications in amputation recovery.

Key Concept

Post-amputation Positioning and Contracture Prevention
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Topics

Basic Care and Comfort

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