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Difficulty: HardErgonomics and Safe Use of Equipment

While managing the care of a client who is two days postoperative following a right total hip arthroplasty (posterior approach), the practical nurse prepares for a bed-to-chair transfer. The client has become agitated, is attempting to climb over the bed rails, and reports unmanaged pain. An as-needed intravenous (IV) push opioid is listed on the medication administration record. Which action represents the safest integration of equipment use and clinical guidelines?

  1. A
    Administer the prescribed IV push opioid to calm the client's agitation prior to performing a manual pivot transfer with a gait belt.
  2. B
    Raise the head of the hospital bed to a 90-degree angle to assist the client into a full sitting position before pivoting them to the chair.
  3. C
    Apply bilateral soft wrist safety devices to prevent the client from climbing over the rails, then prepare the bedside chair for later use.
  4. Secure an abduction pillow between the client's lower extremities and utilize a mechanical lift device with the assistance of a second staff member to complete the transfer.Answer

Answer

The safest action is to secure an abduction pillow between the client's lower extremities and utilize a mechanical lift device with the assistance of a second staff member to complete the transfer.
The correct action integrates proper ergonomic principles by using a mechanical lift for an agitated client, preventing staff injury. It also utilizes the correct safety equipment (an abduction pillow) to adhere strictly to posterior total hip precautions, preventing joint adduction and subsequent dislocation.

Step-by-Step Solution

1
Evaluate the client's mobility status, cognitive state, and surgical precautions.
The client is agitated and restricted by posterior total hip precautions, making a manual transfer unsafe.
Agitation unpredictably shifts the client's center of gravity, risking falls and musculoskeletal injury to the nurse if a manual lift is attempted.
2
Select the appropriate transfer equipment based on the assessment.
A mechanical lift device is chosen to eliminate the need for manual lifting of an unpredictable client.
Mechanical lifts are the standard of care in ergonomics to prevent workplace injuries when a client cannot reliably assist with a transfer.
3
Implement specific postoperative positioning equipment during the transfer.
An abduction pillow is secured between the client's legs before and during the lift.
The abduction pillow prevents adduction and internal rotation, which are the primary causes of prosthesis dislocation following a posterior approach hip arthroplasty.

Key Concept

Ergonomics and Safe Patient Handling
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Topics

Ergonomics and Safe Use of Equipment

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