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Difficulty: Very hardBasic Care and Comfort

The healthcare team is managing the recovery of a client who underwent a left total knee arthroplasty the previous day. The client is receiving continuous epidural analgesia and requires assistance with daily activities. Which interventions are appropriate for the practical nurse to incorporate into the client's basic care routine? Select all that apply.

  1. Place a rolled towel or small blanket under the client's left ankle to suspend the heel.Answer
  2. B
    Position a supportive pillow directly beneath the left popliteal space to alleviate joint tension.
  3. C
    Instruct unlicensed assistive personnel (UAP) to perform the client's first out-of-bed transfer to the bedside recliner.
  4. Apply intermittent cold therapy packs to the surgical joint for 20 minutes at a time.Answer
  5. Utilize a fracture pan rather than a standard bedpan when assisting the client with elimination in bed.Answer
  6. F
    Continue routine hygiene care without reporting a borderline blood pressure of 96/58 mm Hg, assuming it is an expected effect of the epidural.

Answer

The correct interventions include suspending the heel with a rolled towel, applying intermittent cold therapy, and utilizing a fracture pan for elimination.
The correct interventions focus on preventing joint contractures by maintaining knee extension through heel suspension, utilizing intermittent cold therapy to manage local edema, and using a fracture pan to minimize painful hip and knee flexion. These actions directly support comfort and physiological integrity without risking joint deformities or compromising safety.

Step-by-Step Solution

1
Analyze the surgical procedure (total knee arthroplasty) to determine specific positioning requirements.
The knee must be kept in full extension to prevent contractures. Placing anything behind the knee is contraindicated, but suspending the heel is appropriate.
Flexion contractures permanently impair mobility and surgical success.
2
Evaluate the impact of continuous epidural analgesia on basic care and mobility.
Epidural analgesia affects motor function, sensory perception, and sympathetic tone (blood pressure).
These physiological changes increase the risk for orthostatic hypotension and falls during initial transfers.
3
Differentiate between tasks appropriate for the LPN versus those requiring RN assessment or those that can be delegated to UAP.
Initial transfers for complex patients cannot be delegated to UAP. Reporting borderline vital signs is a required LPN action.
Operating strictly within the LPN scope of practice ensures client safety.
4
Select the basic care options that promote comfort, prevent complications, and adhere to safety standards.
Cold therapy, fracture pans, and heel suspension are selected as safe, effective basic care measures.
These interventions directly address the client's postoperative physiological needs.

Key Concept

Postoperative Basic Care and Positioning Precautions
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Topics

Basic Care and Comfort

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