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Difficulty: MediumBasic Care and Comfort

A practical nurse is providing basic care for a client who is two days postoperative following a right total hip arthroplasty (posterior approach). Which of the following care and positioning interventions should the nurse include in the client's daily routine? Select all that apply.

  1. Place an abduction wedge between the client's legs while resting in bed.Answer
  2. Provide a raised toilet seat for the client's bowel and bladder elimination needs.Answer
  3. C
    Position the client in a high Fowler's position (90-degree angle) during meal times.
  4. D
    Turn the client onto the right (operative) side to relieve pressure on the sacrum.
  5. E
    Assist the client to put on their shoes by instructing them to bend forward at the waist.
  6. Remind the client to avoid crossing their legs at the ankles or knees while sitting.Answer

Answer

The correct interventions are placing an abduction wedge between the legs, providing a raised toilet seat, and reminding the client not to cross their legs.
Following a posterior approach total hip arthroplasty, the client is at high risk for joint dislocation if the hip is flexed beyond 90 degrees, adducted across the body's midline, or internally rotated. Using an abduction wedge prevents adduction. Providing a raised toilet seat keeps the hip flexion angle safe during elimination. Instructing the client not to cross their legs prevents both adduction and internal rotation. All of these interventions are essential basic care measures to ensure safety and comfort.

Step-by-Step Solution

1
Identify the surgical procedure and the associated anatomical risks.
The client had a total hip arthroplasty using a posterior approach.
Different surgical approaches have different postoperative precautions. The posterior approach requires strict avoidance of severe hip flexion, adduction, and internal rotation.
2
Evaluate each care intervention against posterior hip precautions.
Interventions preventing flexion greater than 90 degrees, adduction, and internal rotation are safe. Interventions causing these movements are contraindicated.
Adhering to strict positioning rules prevents dislocation of the newly placed prosthetic joint.
3
Select the options that promote safety and comfort without violating precautions.
Using an abduction wedge, using a raised toilet seat, and avoiding leg crossing are all necessary protective measures.
These actions integrate essential joint protection into routine daily basic care.

Key Concept

Postoperative Basic Care and Joint Precautions for Total Hip Arthroplasty
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Topics

Basic Care and Comfort

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