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Difficulty: HardBasic Care and Comfort

During morning rounds, the nurse assesses an older adult client who underwent a right total hip arthroplasty (posterior approach) the previous day. The client demonstrates acute confusion and requires total assistance with hygiene and mobility. Which interventions are appropriate for the nurse to implement? Select all that apply.

  1. Maintain an abduction wedge between the client's lower extremities when turning the client in bed.Answer
  2. B
    Elevate the head of the bed to a 90-degree angle when the client is consuming meals in bed.
  3. C
    Instruct the unlicensed assistive personnel (UAP) to evaluate the skin integrity of the client's sacrum during hygiene care.
  4. Utilize a fracture bedpan for elimination while instructing the client to use an overhead trapeze to lift their pelvis.Answer
  5. E
    Reassure the client's family that the sudden onset of confusion is a normal, expected age-related change in older adults.
  6. Reorient the client frequently and activate a bed alarm to promote safety during confused episodes.Answer

Answer

The appropriate interventions are maintaining an abduction wedge between the lower extremities, utilizing a fracture bedpan with an overhead trapeze, and reorienting the client frequently while using a bed alarm.
Proper care integrates posterior hip precautions (abduction wedges, fracture bedpans) with appropriate safety measures for delirium (reorientation, alarms) while adhering to strict delegation guidelines.

Step-by-Step Solution

1
Analyze the client's surgical history to determine positioning constraints.
The client had a posterior approach total hip arthroplasty, which requires avoiding hip flexion greater than 90 degrees and preventing internal rotation and adduction.
Identifying the specific surgical approach dictates safe basic care and mobility limitations.
2
Evaluate the proposed positioning and hygiene interventions against the surgical precautions.
Using an abduction wedge prevents adduction. Using a fracture bedpan with a trapeze prevents excessive hip flexion. Conversely, sitting at a 90-degree angle for meals violates the hip flexion restriction.
Interventions must promote comfort while adhering strictly to post-operative safety guidelines.
3
Assess the delegation, cognitive, and safety aspects of the remaining options.
Skin evaluation cannot be delegated to a UAP. Sudden confusion indicates a pathological issue (delirium), not normal aging. Bed alarms are a safe, least-restrictive alternative to physical restraints.
Registered nurses must retain assessment responsibilities, investigate acute cognitive changes, and prioritize restraint-free safety measures.

Key Concept

Basic care and comfort for post-operative total hip arthroplasty, encompassing joint precautions, safe delegation, and management of acute delirium.
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Topics

Basic Care and Comfort

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