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Difficulty: MediumBasic Care and Comfort

During the second postoperative day following a right below-the-knee amputation, a client requires positioning assistance to prevent musculoskeletal complications. Which action by the practical nurse best supports the client's physical comfort and mobility goals?

  1. A
    Elevate the affected extremity continuously on two pillows to reduce dependent edema.
  2. B
    Place a supportive rolled towel directly underneath the right knee joint while supine.
  3. Assist the individual into a prone position for 20 to 30 minutes several times daily.Answer
  4. D
    Maintain the client in an upright seated position in a bedside chair for the majority of the shift.

Answer

Assist the individual into a prone position for 20 to 30 minutes several times daily.
Following a lower extremity amputation, clients are at high risk for developing flexion contractures of the hip and knee, which can severely interfere with future prosthetic fitting and ambulation. Placing the client in a prone position for 20 to 30 minutes, 3 to 4 times a day, extends the hip and knee joints, stretches the flexor muscles, and prevents contracture formation. This is a critical basic care intervention for these clients.

Step-by-Step Solution

1
Identify the client's postoperative timeframe and surgical procedure (Below-the-knee amputation, 48 hours post-op).
The acute risk of severe edema has decreased (which is highest in the first 24 hours), and the primary risk is now flexion contractures of the hip and knee.
Postoperative priorities for amputations shift from edema control in the immediate postoperative period to contracture prevention thereafter.
2
Evaluate each positioning option for contracture risk.
Continuous elevation, placing items underneath the knee, and prolonged sitting all promote joint flexion.
Joints left in a flexed position for extended periods will adapt and shorten, developing contractures that impair future prosthesis use.
3
Select the intervention that actively extends the vulnerable joints.
The prone positioning strategy is selected.
Lying prone forces the hip and knee joints into extension, stretching the flexor muscles and directly counteracting contracture formation.

Key Concept

Postoperative positioning to prevent flexion contractures following lower extremity amputation.
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Topics

Basic Care and Comfort

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