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Difficulty: Very hardBasic Care and Comfort

A practical nurse is caring for a client who is 36 hours postoperative following a right above-the-knee amputation. The client has a history of dysphagia and is receiving continuous enteral nutrition via a nasogastric tube. The nursing care plan includes interventions to prevent hip flexion contractures. Which action is most appropriate for the practical nurse to implement?

  1. Pause the continuous enteral feeding, wait 30 to 45 minutes, and then assist the client into a flat prone position for 20 to 30 minutes.Answer
  2. B
    Immediately assist the client into a flat prone position and then pause the continuous enteral feeding.
  3. C
    Maintain the head of the bed at 45 degrees and elevate the right residual limb on a soft pillow.
  4. D
    Position the client supine with the head of the bed elevated 30 degrees and place a rolled towel under the right knee.

Answer

The most appropriate action is to pause the continuous enteral feeding, wait 30 to 45 minutes, and then assist the client into a flat prone position for 20 to 30 minutes.
The correct action demonstrates safe synthesis of two critical basic care protocols. To prevent hip flexion contractures following an above-the-knee amputation, the client should lie prone for 20 to 30 minutes multiple times a day. However, because the client is receiving continuous enteral feedings, laying them flat immediately poses a severe aspiration risk. The nurse must first pause the feeding and wait 30 to 45 minutes to allow for gastric emptying before safely lowering the head of the bed and turning the client prone.

Step-by-Step Solution

1
Identify the primary positioning requirement for a client post-above-the-knee amputation.
The client should be placed in a prone position for 20 to 30 minutes several times a day to prevent hip flexion contractures. Elevating the limb on pillows after 24 hours is contraindicated.
Prolonged hip flexion leads to contractures, which can severely impede future prosthesis fitting and mobility.
2
Identify the safety requirements for a client receiving continuous enteral nutrition.
The head of the bed must remain elevated at least 30 to 45 degrees during the feeding and for 30 to 45 minutes after pausing the feeding.
Maintaining elevation prevents regurgitation and aspiration of gastric contents into the lungs.
3
Synthesize the conflicting requirements to determine the safest sequence of actions.
The feeding must be paused and sufficient time allowed for gastric emptying before the client can be safely laid flat for the required prone positioning.
Airway protection (preventing aspiration) takes immediate priority, but contracture prevention must still be implemented safely.

Key Concept

Synthesizing postoperative contracture prevention positioning with aspiration precautions for enteral feedings.
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Topics

Basic Care and Comfort

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