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Difficulty: Very hardBasic Care and Comfort

During afternoon rounds on a rehabilitation unit, a practical nurse observes a client who is 72 hours post-transfemoral amputation of the right leg. The client is resting with the head of the bed elevated to 90 degrees, and the right residual limb is supported on two stacked pillows. The client states, 'My right hip feels extremely tight and stiff.' Which action should the practical nurse implement?

  1. A
    Maintain the pillows beneath the residual limb but lower the head of the bed to a flat position to reduce hip flexion.
  2. Remove the pillows from beneath the residual limb and assist the client into a prone position.Answer
  3. C
    Replace the pillows with a trochanter roll positioned along the outer aspect of the right thigh while maintaining the 90-degree head elevation.
  4. D
    Lower the head of the bed to a semi-Fowler's position and place a rolled towel beneath the right thigh to relieve joint tension.

Answer

The practical nurse should remove the pillows from beneath the residual limb and assist the client into a prone position.
Following a transfemoral amputation, preventing a hip flexion contracture is a primary nursing priority. After the initial 24 to 48 hours, the residual limb should never be elevated on pillows, and sitting in high-Fowler's position should be minimized. Removing the pillows and assisting the client into a prone position actively stretches the shortened hip flexor muscles, preventing contracture formation and ensuring the client can eventually be fitted for a prosthesis.

Step-by-Step Solution

1
Evaluate the postoperative timeframe.
The client is 72 hours post-transfemoral (above-the-knee) amputation.
Post-amputation positioning guidelines change drastically after the first 24 to 48 hours.
2
Analyze the mechanical effects of the client's current position.
Sitting at 90 degrees with the limb on pillows forces the hip joint into extreme and prolonged flexion.
Prolonged hip flexion rapidly leads to debilitating flexion contractures, making future prosthetic fitting impossible.
3
Interpret the client's symptom of 'tight and stiff' hip.
The stiffness is a physiological warning sign that the hip flexor muscles are shortening due to the improper positioning.
Connecting patient symptoms to physical alignment allows the nurse to prioritize structural correction over secondary interventions.
4
Select the appropriate therapeutic positioning intervention.
Remove all elevation under the limb and place the client flat or prone.
The prone position (usually implemented for 20-30 minutes, 3 to 4 times daily) actively extends and stretches the hip flexor muscles, countering the risk of contracture.

Key Concept

Post-operative positioning to prevent hip flexion contractures following transfemoral amputation
Estimated Time:1m 30s
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Topics

Basic Care and Comfort

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