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Difficulty: HardBasic Care and Comfort

A nurse is planning basic care and comfort measures for a geriatric client who is recovering from a right total hip arthroplasty utilizing a posterior surgical approach. The client reports sacral discomfort from prolonged bed rest, and the nurse must reposition them while mitigating the risk of complications. Which action is the most appropriate?

  1. A
    Elevate the head of the bed to a high-Fowler's position to shift pressure away from the sacrum and promote respiratory expansion.
  2. B
    Instruct an Unlicensed Assistive Personnel (UAP) to independently turn the client and evaluate the sacral skin for signs of non-blanchable erythema.
  3. C
    Apply bilateral soft wrist restraints prior to turning to ensure the client does not reach down and contaminate the surgical incision.
  4. Assist the client to roll onto the unoperated left side while maintaining a foam abductor wedge securely between the lower extremities.Answer

Answer

The most appropriate action is to assist the client to roll onto their unoperated left side while maintaining a foam abductor wedge securely between their lower extremities.
The correct action safely addresses the client's sacral discomfort by offloading pressure onto the unoperated side. Critically, the continuous use of the abductor wedge prevents the affected leg from crossing the midline (adduction) or turning inward (internal rotation), which are the primary mechanisms that cause posterior hip dislocation.

Step-by-Step Solution

1
Identify the client's surgical procedure and the associated anatomical precautions.
The client had a right total hip arthroplasty via a posterior approach, which requires strict avoidance of hip flexion greater than 90 degrees, hip adduction (crossing the midline), and internal rotation.
These specific movements can force the femoral head out of the acetabular cup, causing posterior dislocation of the new joint.
2
Evaluate the nursing goal.
The goal is to provide basic comfort and relieve sacral pressure while strictly adhering to orthopedic precautions.
Immobility increases the risk of pressure injuries, necessitating safe repositioning.
3
Analyze the proposed interventions against safety and scope of practice guidelines.
High-Fowler's position violates the hip flexion precaution. Delegating skin assessment violates the UAP scope of practice. Using restraints violates the principle of least restrictive interventions.
Nursing actions must simultaneously address comfort, surgical safety, and ethical/legal standards.
4
Select the intervention that safely achieves the comfort goal.
Turning to the unoperated side safely offloads sacral pressure, while the continuous use of an abductor wedge prevents the dangerous adduction and internal rotation of the affected limb.
This comprehensively addresses basic care needs without compromising the surgical site.

Key Concept

Post-operative positioning precautions for posterior total hip arthroplasty (avoiding >90 degree flexion, adduction, and internal rotation).
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Topics

Basic Care and Comfort

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