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Difficulty: MediumBasic Care and Comfort

During the night shift, an older adult client who underwent a right total hip arthroplasty (posterior approach) 24 hours ago becomes acutely agitated. The client attempts to climb over the side rails and repeatedly insists on walking to the bathroom to have a bowel movement. Which action represents the most appropriate nursing intervention?

  1. A
    Secure the client to the bed using a soft waist restraint to prevent an accidental fall and subsequent surgical injury.
  2. B
    Assist the client to sit on a standard bedside commode with their hips flexed slightly forward at a 110-degree angle.
  3. Provide a fracture pan for elimination while keeping the right leg in an abducted, neutral position.Answer
  4. D
    Direct the unlicensed assistive personnel (UAP) to assess the client's abdomen for distention and bowel sounds.

Answer

Provide a fracture pan for elimination while keeping the right leg in an abducted, neutral position.
Providing a fracture pan with the leg abducted safely addresses the client's urgent physiological need to eliminate, which is the root cause of the agitation. The fracture pan minimizes the need for lifting or rolling, and maintaining abduction prevents adduction and internal rotation, protecting the newly constructed hip joint from dislocation.

Step-by-Step Solution

1
Identify the underlying cause of the client's acute agitation.
The client is communicating an urgent need to have a bowel movement.
Addressing basic physiological needs is the first step in managing acute confusion and agitation in older adults.
2
Determine the physical limitations and contraindications based on the client's surgical history.
A posterior approach total hip arthroplasty requires strict avoidance of hip flexion greater than 90 degrees, adduction (crossing the midline), and internal rotation.
Violating these precautions can cause posterior dislocation of the newly placed prosthetic joint.
3
Evaluate the proposed nursing interventions against safety guidelines.
Using a standard commode risks excessive hip flexion. Delegating assessment is out of UAP scope. Applying restraints ignores the physiological need and violates restraint protocols.
Evidence-based practice requires utilizing the least restrictive, safest method to meet client needs.
4
Select the intervention that meets the elimination need while maintaining surgical safety.
Using a fracture pan (which requires minimal lifting) and maintaining leg abduction ensures safe elimination.
This action directly resolves the cause of agitation without compromising the integrity of the surgical site.

Key Concept

Post-operative positioning precautions and safe elimination practices following a total hip arthroplasty.
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Topics

Basic Care and Comfort

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