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Question

Difficulty: HardBasic Care and Comfort

An older adult client is recovering on the orthopedic unit on the first postoperative day following a right total hip arthroplasty via a posterior approach. When assisting the client with morning hygiene and bed repositioning, which action by the practical nurse is most appropriate?

  1. A
    Elevating the head of the bed to a full 90-degree angle while the client consumes their morning meal
  2. B
    Positioning a firm pillow directly underneath the right knee to decrease tension on the surgical incision
  3. Maintaining an abduction wedge between the client's legs while turning them onto their left sideAnswer
  4. D
    Flexing the client's right hip past 90 degrees to adequately access and wash the lower leg and foot

Answer

Maintaining an abduction wedge between the client's legs while turning them onto their left side is the most appropriate action.
Following a total hip arthroplasty via a posterior approach, the client is at high risk for hip dislocation if the hip is adducted, internally rotated, or flexed beyond 90 degrees. Using an abduction wedge between the legs prevents adduction and internal rotation, especially when turning the client onto their non-operative (left) side, thereby maintaining proper joint alignment and safety during basic care.

Step-by-Step Solution

1
Identify the surgical procedure and the specific approach used.
The client had a right total hip arthroplasty using a posterior approach.
Different surgical approaches have distinct postoperative positioning restrictions that dictate basic care.
2
Recall the positioning precautions specific to a posterior approach total hip arthroplasty.
To prevent prosthesis dislocation, the client must avoid hip flexion greater than 90 degrees, avoid adduction (crossing the legs over the midline), and avoid internal rotation.
Basic care and comfort measures must be adapted to adhere strictly to these physical safety limits.
3
Evaluate each nursing action against the identified precautions.
Elevating the bed to 90 degrees and flexing the hip past 90 degrees to wash the foot both violate the flexion precaution. Placing a pillow under the knee poses a circulatory risk (deep vein thrombosis). Using an abduction wedge while turning maintains proper alignment and prevents adduction.
This confirms that using the abduction wedge is the only safe and appropriate action among the choices.

Key Concept

Postoperative positioning and mobility precautions for total hip arthroplasty (posterior approach)
Estimated Time:1m 0s
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Topics

Basic Care and Comfort

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