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Difficulty: HardBasic Care and Comfort

A practical nurse receives shift report for a client who underwent a right above-the-knee amputation 48 hours ago. To promote optimal physical mobility and prevent a major musculoskeletal complication associated with this surgery, which positioning intervention should the nurse implement?

  1. A
    Elevate the right residual limb continuously on a firm pillow to minimize dependent edema.
  2. B
    Maintain the client in a high-Fowler's position when resting in bed.
  3. Assist the client into a prone position for 20 to 30 minutes several times a day.Answer
  4. D
    Transfer the client to a bedside chair for 4-hour intervals to increase activity tolerance.

Answer

The correct intervention is to assist the client into a prone position for 20 to 30 minutes several times a day to prevent hip flexion contractures.
After an above-the-knee amputation, preventing hip flexion contractures is a primary basic care goal. Placing the client in a prone position for 20 to 30 minutes three to four times a day actively stretches the hip flexor muscles and prevents contracture formation. This extension is absolutely essential for the client's future ability to use a prosthesis and ambulate effectively.

Step-by-Step Solution

1
Analyze the client's postoperative timeline.
The client is 48 hours post-amputation.
Care protocols for amputations change significantly after the first 24 hours, particularly regarding limb elevation.
2
Identify the major musculoskeletal complication associated with above-the-knee amputations.
Hip flexion contracture is a severe complication that impedes future ambulation and prosthetic fitting.
Anticipating this complication allows the nurse to prioritize preventive positioning measures.
3
Evaluate the physiological impact of each positioning option.
Elevation, high-Fowler's, and prolonged sitting all promote hip flexion. Prone positioning promotes hip extension.
To prevent a flexion contracture, the joint must be periodically extended.
4
Select the intervention that actively prevents the complication.
Assisting the client to lie prone for 20-30 minutes stretches the hip flexors.
This is the evidence-based standard of care for contracture prevention in amputation clients.

Key Concept

Prevention of hip flexion contractures following lower extremity amputation
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Topics

Basic Care and Comfort

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