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Difficulty: Very hardBasic Care and Comfort

A practical nurse is assisting a client with morning hygiene and lower body dressing on the second postoperative day following a right total hip arthroplasty using a posterior approach. Which action by the nurse demonstrates the correct application of basic care and positioning principles?

  1. Using a long-handled dressing stick and sock aid to help the client put on pants and footwear while ensuring the client's hips remain slightly higher than the knees.Answer
  2. B
    Elevating the head of the bed to a 90-degree angle so the client can comfortably sit up and wash their upper body from a bedside basin.
  3. C
    Assisting the client into a left side-lying position with a thin blanket placed between the ankles to allow access for washing the back and buttocks.
  4. D
    Guiding the client to slightly internally rotate the right leg toward the body's midline while washing the lower extremities to reduce muscle tension.

Answer

The correct action is utilizing assistive devices like a long-handled stick and sock aid while keeping the hips slightly higher than the knees, which prevents dangerous hip flexion.
For a client recovering from a posterior approach total hip arthroplasty, it is critical to prevent hip flexion greater than 90 degrees. Using long-handled assistive devices allows the client to dress the lower body without bending at the waist. Keeping the hips slightly higher than the knees (such as by using a raised toilet seat or wedge cushion) further ensures the hip angle remains safely obtuse, preventing posterior dislocation of the prosthesis.

Step-by-Step Solution

1
Identify the surgical approach and associated anatomical risks.
The client had a right total hip arthroplasty via a posterior approach.
The surgical approach determines the specific movement precautions needed to prevent joint dislocation.
2
Recall the specific posterior hip precautions.
The client must avoid hip flexion greater than 90 degrees, avoid adduction of the leg across the midline, and avoid internal rotation of the leg.
These specific anatomical movements force the prosthetic femoral head out of the acetabulum posteriorly.
3
Evaluate the nursing actions against these strict precautions.
Only the use of assistive devices with the hips positioned above the knees adheres to all postoperative restrictions.
This prevents the client from bending forward at the waist (flexing the hip > 90 degrees) during the daily activity of dressing.

Key Concept

Postoperative Positioning and Activities of Daily Living (ADLs) for Total Hip Arthroplasty
Estimated Time:1m 30s
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Topics

Basic Care and Comfort

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