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Difficulty: HardBasic Care and Comfort

A client is receiving care on the surgical unit on the first postoperative day following a right total hip arthroplasty utilizing a posterior approach. The practical nurse is preparing to perform perineal care and change the soiled bottom bed linens. Which action should the nurse take to safely complete this task?

  1. Secure an abduction pillow between the client's legs and gently roll the client onto their left, unoperated side.Answer
  2. B
    Raise the head of the bed to a high-Fowler's position and encourage the client to lean forward to assist with washing.
  3. C
    Instruct the client to flex the right knee and internally rotate the leg to expose the perineal area while remaining supine.
  4. D
    Remove the abduction wedge and logroll the client as a single unit onto their right, operated side.

Answer

Secure an abduction pillow between the client's legs and gently roll the client onto their left, unoperated side.
Following a total hip arthroplasty utilizing a posterior approach, the client is at a high risk for joint dislocation if the hip is flexed beyond 90 degrees, adducted across the midline, or internally rotated. Securing an abduction pillow between the client's legs before rolling them onto the unoperated (left) side ensures that the legs remain safely abducted and in a neutral anatomical alignment throughout the basic care procedure.

Step-by-Step Solution

1
Identify the surgical procedure and approach.
The client had a right total hip arthroplasty via a posterior approach.
The surgical approach determines the specific movement precautions required to prevent joint dislocation.
2
Recall the contraindications for a posterior approach hip arthroplasty.
Hip flexion greater than 90 degrees, adduction of the leg past the body's midline, and internal rotation are strictly contraindicated.
These specific movements place stress on the posterior joint capsule and can mechanically force the newly implanted femoral head out of the socket.
3
Evaluate the proposed basic care interventions against these surgical precautions.
Rolling the client onto the unoperated side with an abduction pillow in place prevents adduction and internal rotation, ensuring the joint remains completely stable during the bed bath and linen change.
This is the safest clinical method to access the client's posterior and perineal areas for routine hygiene without compromising the integrity of the surgical site.

Key Concept

Postoperative Positioning and Precautions for Total Hip Arthroplasty
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Topics

Basic Care and Comfort

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