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Difficulty: HardBasic Care and Comfort

A resident in a rehabilitation facility is recovering from a left above-knee amputation performed 48 hours ago. The individual expresses feelings of stiffness and aching in the remaining hip. What is the most appropriate positioning strategy the practical nurse should utilize to optimize comfort and preserve joint mobility?

  1. Assist the client into a prone position for 20 to 30 minutes several times a day.Answer
  2. B
    Elevate the residual limb continuously on a stack of pillows to reduce edema.
  3. C
    Maintain the client in a high-Fowler's position with the residual limb resting flat.
  4. D
    Encourage the client to sit upright in a bedside chair for the majority of the day.

Answer

The most appropriate strategy is to assist the client into a prone position for 20 to 30 minutes several times a day.
Prone positioning for 20 to 30 minutes, three to four times a day, is a critical nursing intervention for clients recovering from an above-knee amputation. This position actively extends the hip joint, stretching the flexor muscles and preventing the development of hip flexion contractures. Preventing these contractures is essential for the client's future ability to walk and properly fit a prosthesis.

Step-by-Step Solution

1
Analyze the client's postoperative timeframe (48 hours post-amputation) and identify the specific physiological risks associated with this recovery phase.
The initial 24-hour period for edema management has passed, making the prevention of hip flexion contractures the primary mobility priority.
Contractures can severely impair future mobility and prevent successful prosthetic fitting.
2
Evaluate the physiological effects of each positioning option on the hip joint.
Elevation on pillows, high-Fowler's positioning, and prolonged sitting all place the hip joint into a flexed position.
Maintaining the hip in prolonged flexion causes the muscles and ligaments to shorten, leading to contractures.
3
Select the intervention that actively counteracts hip flexion while promoting comfort.
Prone positioning is identified as the correct intervention.
Lying prone forces the hip into extension, stretching the flexor muscles and preserving joint mobility.

Key Concept

Positioning and contracture prevention following lower extremity amputation
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Topics

Basic Care and Comfort

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