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Difficulty: HardBasic Care and Comfort

An older adult client is 24 hours postoperative following a right total hip arthroplasty using a posterior approach. The client suddenly exhibits acute confusion, severe restlessness, and reports urgent bladder fullness. The client is currently prescribed strict bed rest. Which action is most appropriate for the practical nurse (PN) to take to safely assist this client with elimination?

  1. Place an abduction wedge between the client's legs and assist the client to roll onto the unaffected left side to position a fracture pan.Answer
  2. B
    Elevate the head of the bed to a 90-degree angle and slide a standard high-back bedpan underneath the client to promote bladder emptying.
  3. C
    Apply physical wrist restraints prior to placing the bedpan to prevent the confused client from touching the surgical dressing.
  4. D
    Document the acute confusion as an expected age-related response to anesthesia and delay elimination until the registered nurse evaluates.

Answer

The practical nurse should use a fracture pan and roll the client onto the unaffected side while maintaining leg abduction with a wedge.
Following a total hip arthroplasty with a posterior approach, it is critical to prevent hip flexion greater than 90 degrees, adduction across the midline, and internal rotation. A fracture pan is required for elimination because its flat end slips easily under the buttocks, minimizing how much the client must be lifted or flexed. Rolling the client onto the unaffected side with an abduction wedge securely in place keeps the operative leg in a safe, neutral position during the procedure, effectively addressing the client's immediate elimination need while ensuring the surgical joint remains stable.

Step-by-Step Solution

1
Acknowledge the client's basic care need and physiological state.
Identify the immediate need to relieve bladder fullness safely.
Urinary retention and bladder distention can directly cause or exacerbate acute confusion and restlessness in older adult clients.
2
Select the appropriate elimination equipment for the client's surgical status.
Choose a fracture pan rather than a standard bedpan.
A fracture pan has a low profile that slides easily under the buttocks, preventing the need to excessively lift the hips or bend the lower back.
3
Execute safe positioning techniques based on surgical precautions.
Place an abduction wedge between the legs and roll the client toward the unaffected (left) side.
For a posterior total hip arthroplasty, maintaining abduction prevents the operative leg from crossing the midline, significantly reducing the risk of posterior hip dislocation during the basic care procedure.

Key Concept

Basic Elimination Care and Postoperative Positioning Precautions
Estimated Time:1m 30s
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Topics

Basic Care and Comfort

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