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Difficulty: HardBasic Care and Comfort

An older adult client is recovering on the medical-surgical unit 48 hours following a right above-the-knee amputation. The client's vital signs are stable, and surgical pain is adequately managed with prescribed oral analgesics. To promote optimal physical mobility and prevent a major musculoskeletal complication associated with this procedure, which action should the practical nurse take?

  1. Assist the client into a prone position for 30 minutes three to four times a day.Answer
  2. B
    Keep the residual limb continuously elevated on two pillows while the client is in bed.
  3. C
    Maintain the bed in a high Fowler's position during all waking hours to facilitate deep breathing.
  4. D
    Direct the unlicensed assistive personnel to evaluate the client's ability to independently transfer to a chair.

Answer

Assist the client into a prone position for 30 minutes three to four times a day.
Following an above-the-knee amputation, the client is at an extremely high risk for developing hip flexion contractures, which can prevent the successful use of a prosthesis in the future. Placing the client in a prone position for 20 to 30 minutes several times a day provides full extension of the hip joint. This action effectively stretches the flexor muscles and prevents contracture formation, making it a critical basic care and comfort intervention to ensure optimal long-term mobility.

Step-by-Step Solution

1
Analyze the client's postoperative timeframe and the specific surgical procedure.
The client is exactly 48 hours post right above-the-knee amputation.
The postoperative timeframe is critical because nursing interventions for the first 24 hours (such as edema control) differ entirely from those required on subsequent days (such as contracture prevention).
2
Identify the primary mobility complication associated with this specific procedure.
Hip flexion contracture is a major risk that can severely impair future ambulation and prosthetic fitting.
Understanding the primary complication guides the selection of the correct preventive positioning strategy.
3
Evaluate the proposed nursing interventions against the goal of preventing hip flexion.
Prone positioning physically extends the hip joint, directly counteracting flexion, whereas continuous pillow elevation or prolonged sitting exacerbates flexion.
This ensures the selected action is clinically correct, safe, and remains within the practical nurse's scope of practice.

Key Concept

Postoperative Positioning and Contracture Prevention for Amputations
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Topics

Basic Care and Comfort

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