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Question

Difficulty: EasyReduction of Risk Potential

A nurse is caring for a client who is recovering from a right total hip arthroplasty using a posterior approach. Which of the following nursing actions should the nurse implement to reduce the client's risk for hip dislocation? Select all that apply.

  1. Place an abduction pillow between the client's legs while resting in bed.Answer
  2. Ensure the client's operative leg remains in a neutral position to prevent internal rotation.Answer
  3. Instruct the client to use an elevated toilet seat when using the restroom.Answer
  4. D
    Assist the client to sit in a low, soft armchair when out of bed.
  5. E
    Allow the client to cross their legs at the ankles to reduce lower extremity edema.

Answer

The correct actions are placing an abduction pillow between the legs, ensuring the operative leg remains in a neutral position, and instructing the client to use an elevated toilet seat.
Following a posterior approach total hip arthroplasty, the client is at high risk for joint dislocation if the hip is flexed past 90 degrees, adducted across the body's midline, or internally rotated. Using an abduction pillow effectively prevents adduction. Maintaining a neutral leg position prevents internal rotation. Instructing the client to use an elevated toilet seat prevents the hips from flexing more than 90 degrees when sitting down. Implementing all three of these actions directly reduces the risk of the surgical joint dislocating.

Step-by-Step Solution

1
Analyze the surgical procedure and the specific risk involved.
The client had a posterior approach total hip arthroplasty, which carries a high risk for posterior hip dislocation if specific movement precautions are not followed.
Understanding the mechanism of injury allows for the identification of safe versus unsafe positioning.
2
Identify the specific movements that cause posterior hip dislocation.
The movements to strictly avoid are hip flexion greater than 90 degrees, adduction (crossing the midline), and internal rotation.
These positions place excessive stress on the posterior surgical joint capsule, potentially popping the prosthesis out of place.
3
Evaluate each nursing action against the identified movement precautions.
Using an abduction pillow prevents adduction, a neutral leg position prevents internal rotation, and an elevated toilet seat prevents excessive flexion. Low chairs and crossing legs violate these rules.
Selecting only the interventions that avoid flexion >90 degrees, adduction, and internal rotation ensures the risk for dislocation is effectively minimized.

Key Concept

Postoperative hip precautions for posterior arthroplasty to prevent dislocation
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Topics

Reduction of Risk Potential

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