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Difficulty: MediumBasic Care and Comfort

A client is receiving care on the surgical unit 48 hours after undergoing a right below-the-knee amputation. Which positioning strategy should the nurse implement to prevent the most common musculoskeletal complication associated with this recovery phase?

  1. Assist the client into a prone position for 20 to 30 minutes every 3 to 4 hours.Answer
  2. B
    Keep the residual limb continuously elevated on a pillow while the client is resting.
  3. C
    Maintain the client in a continuous semi-Fowler's position to promote respiratory expansion.
  4. D
    Position a rolled towel directly under the client's right knee joint for support.

Answer

The nurse should assist the client into a prone position for 20 to 30 minutes every 3 to 4 hours to stretch the hip flexors and prevent contractures.
After 24 hours following a lower extremity amputation, preventing flexion contractures becomes a primary nursing priority. Assisting the client into a prone position for 20 to 30 minutes several times a day fully extends the hip joint. This stretching of the flexor muscles is essential to maintain full range of motion, which is strictly required for successful ambulation with a prosthesis.

Step-by-Step Solution

1
Identify the timeframe and procedure in the clinical scenario.
The client is 48 hours post-operative from a right below-the-knee amputation.
Timing is critical, as positioning guidelines change significantly after the first 24 hours of recovery.
2
Recall the major musculoskeletal complications associated with this specific timeframe.
Flexion contractures of the hip and knee are the most common and debilitating complications that interfere with future prosthetic use.
Prolonged flexion of joints above the amputation site leads to permanent muscle shortening.
3
Evaluate the positioning options against the primary goal of contracture prevention.
Prone positioning extends the hip joint, whereas elevating the limb, sitting in semi-Fowler's, or placing a roll under the knee all promote joint flexion.
Joint extension is necessary to counteract the tendency of muscles to contract when left in a flexed position.

Key Concept

Prevention of flexion contractures following lower extremity amputation
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Topics

Basic Care and Comfort

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