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Difficulty: MediumBasic Care and Comfort

A nurse is planning positioning and mobility interventions for a client who is recovering from a right total hip arthroplasty with a posterior approach. Which of the following actions should the nurse include in the client's plan of care?

  1. A
    Elevate the head of the bed to a 90-degree angle while the client is eating meals.
  2. B
    Delegate the daily evaluation of the client's skin integrity to the unlicensed assistive personnel (UAP).
  3. Place an abduction pillow between the client's legs when turning them to the unaffected side.Answer
  4. D
    Apply soft wrist restraints at night to ensure the client does not inadvertently cross their legs.

Answer

The correct action is to place an abduction pillow between the client's legs when turning them to the unaffected side.
An abduction pillow or wedge keeps the legs slightly apart and prevents the operative leg from crossing the midline of the body (adduction). This is a critical intervention for basic care and mobility after a posterior total hip arthroplasty to prevent prosthesis dislocation.

Step-by-Step Solution

1
Identify the surgical procedure and its specific mobility precautions.
The client had a total hip arthroplasty utilizing a posterior approach.
Different surgical approaches dictate different post-operative movement restrictions to ensure joint stability.
2
Determine the contraindicated movements for a posterior hip approach.
Hip flexion greater than 90 degrees, adduction across the midline, and internal rotation are contraindicated.
These specific movements force the head of the femur backward and can cause it to dislocate from the acetabulum.
3
Evaluate the nursing interventions in the options against these restrictions and general safety guidelines.
Using an abduction pillow safely prevents adduction. Conversely, elevating the head to 90 degrees violates the flexion restriction. Delegating assessment and using restraints inappropriately violate safety and scope of practice guidelines.
This ensures the selected intervention promotes basic care, comfort, and safety without risking prosthesis dislocation.

Key Concept

Following a posterior total hip arthroplasty, the nurse must prevent hip flexion greater than 90 degrees, internal rotation, and adduction to maintain joint stability.
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Topics

Basic Care and Comfort

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