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Question

Difficulty: MediumBasic Care and Comfort

An 81-year-old client is on the surgical unit for their first postoperative day following a right total hip arthroplasty via a posterior approach. The client requires help with morning hygiene, meals, and general comfort measures. Which action by the nurse demonstrates the safest and most appropriate care?

  1. A
    Elevate the head of the bed to a full 90-degree upright angle to promote optimal digestion while the client eats breakfast.
  2. B
    Direct the unlicensed assistive personnel (UAP) to assess the integrity of the skin under the client's heels during the bed bath.
  3. Maintain a foam abduction wedge between the client's legs while assisting them with washing their lower extremities.Answer
  4. D
    Apply bilateral soft wrist restraints to ensure the client does not reach for or dislodge their surgical dressing.

Answer

The correct action is to maintain a foam abduction wedge between the client's legs while assisting them with washing their lower extremities.
Maintaining an abduction wedge between the legs prevents adduction and internal rotation of the affected hip, which are critical precautions to prevent prosthesis dislocation following a posterior approach total hip arthroplasty. Assisting with hygiene while maintaining this alignment promotes basic care, comfort, and safety.

Step-by-Step Solution

1
Identify the client's surgical procedure and the associated anatomical risks.
The client underwent a right total hip arthroplasty via a posterior approach.
Understanding the specific surgical approach dictates the movement precautions required to prevent the prosthetic joint from dislocating.
2
Evaluate each nursing intervention against posterior hip precautions and general safety guidelines.
Flexing the hip to 90 degrees is contraindicated. Delegating assessment is out of the UAP's scope of practice. Applying restraints without less-restrictive alternatives violates safety protocols. Only maintaining an abduction wedge adheres to surgical precautions.
Nursing actions must prioritize evidence-based safety, adhere to surgical precautions, and align with the nurse's legal scope of practice.
3
Select the intervention that safely promotes basic care and comfort.
Maintaining the abduction wedge during hygiene is the correct action.
This directly facilitates necessary hygiene (comfort) while preventing adduction and internal rotation of the affected limb (safety).

Key Concept

Posterior Approach Total Hip Arthroplasty Precautions
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Topics

Basic Care and Comfort

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