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Difficulty: HardAccident, Error, and Injury Prevention

A surgical unit nurse is preparing to transfer a client who is 48 hours post-operative following a right total hip arthroplasty (posterior approach) from the hospital bed to a bedside chair. The client is receiving a continuous intravenous infusion of normal saline and exhibits mild confusion today. Which action by the nurse is the priority to prevent injury during this procedure?

  1. Positioning the chair on the client's unaffected left side and guiding the client to keep the right leg extended forward while pivoting.Answer
  2. B
    Elevating the head of the bed to a 90-degree angle and instructing the client to lean the torso forward to gain momentum for standing.
  3. C
    Applying temporary soft wrist restraints to prevent the confused client from grasping and dislodging the intravenous line during the physical movement.
  4. D
    Delegating the transfer to the unlicensed assistive personnel (UAP) to assess the client's weight-bearing tolerance while the nurse updates the care plan.

Answer

Positioning the chair on the client's unaffected left side and guiding the client to keep the right leg extended forward while pivoting.
The correct action directly protects the new hip joint prosthesis by utilizing the client's strong, unaffected side for the pivoting motion. Furthermore, instructing the client to keep the operative leg extended straight forward ensures that the hip joint does not bend beyond a 90-degree angle, which is a critical, universally required precaution to prevent posterior dislocation following this specific surgery.

Step-by-Step Solution

1
Analyze the client's surgical history and required mobility constraints.
The client has a right posterior hip arthroplasty, requiring strict precautions: no hip flexion greater than 90 degrees, no adduction, and no internal rotation.
Identifying procedural contraindications is the first step in preventing injury.
2
Evaluate the safest biomechanical transfer technique for this specific client.
Transferring toward the unaffected (left) side provides stability, while keeping the operative (right) leg extended prevents the hip joint from flexing dangerously during the pivot.
Proper body mechanics and positioning are essential to prevent prosthetic dislocation.
3
Assess the impact of the client's cognitive status on the transfer plan.
Because the client is mildly confused, the registered nurse must directly supervise and assist with the transfer to ensure compliance with precautions, ruling out delegation.
Client confusion increases the risk of impulsive movements that could lead to falls or joint dislocation.

Key Concept

Orthopedic Safety Precautions and Safe Patient Transfer
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Topics

Accident, Error, and Injury Prevention

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