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Difficulty: MediumReduction of Risk Potential

A 68-year-old client with severe osteoarthritis arrives on the orthopedic unit after undergoing a right total hip arthroplasty using a posterior surgical approach. The client is drowsy but responsive, with stable vital signs. Which action must the nurse prioritize to prevent dislocation of the new joint prosthesis?

  1. Place an abductor wedge pillow between the client's legs while the client is supine.Answer
  2. B
    Elevate the head of the bed to a 90-degree angle during meal times.
  3. C
    Turn the client onto the unaffected left side with both legs resting together.
  4. D
    Delegate the client's initial out-of-bed transfer to the unlicensed assistive personnel.

Answer

The nurse must prioritize placing an abductor wedge pillow between the client's legs while the client is supine.
Placing an abductor wedge pillow between the legs is essential because it actively prevents adduction of the operative hip across the body's midline. Following a posterior approach total hip arthroplasty, avoiding adduction, internal rotation, and extreme flexion (greater than 90 degrees) is critical to reduce the risk of the prosthesis dislocating from the newly formed acetabulum.

Step-by-Step Solution

1
Identify the surgical procedure and its specific postoperative risks.
The client had a total hip arthroplasty via a posterior approach, which carries a high risk of joint dislocation if proper alignment is not maintained.
Understanding the surgical approach determines which specific movements are contraindicated in the postoperative period.
2
Recall the standard posterior hip precautions used to reduce the risk of dislocation.
The client must avoid hip flexion greater than 90 degrees, adduction of the leg across the body's midline, and internal rotation of the hip.
These specific movements place excessive mechanical stress on the posterior capsule, potentially forcing the femoral head out of the acetabulum.
3
Evaluate the given interventions against these strict precautions.
Placing an abductor wedge actively prevents adduction. The other options violate positional precautions or represent an unsafe delegation of initial mobility.
Selecting the intervention that directly aligns with established hip precautions actively reduces the physiological risk of joint dislocation.

Key Concept

Reduction of Risk Potential: Posterior Hip Precautions
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Topics

Reduction of Risk Potential

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