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Question

Difficulty: MediumReduction of Risk Potential

A 72-year-old client is recovering in the surgical unit 12 hours after undergoing a right total hip arthroplasty using a posterior surgical approach. The client reports mild discomfort and requests assistance with repositioning. To reduce the risk of a post-operative prosthesis dislocation, which action should the nurse implement?

  1. Secure an abduction wedge between the client's lower extremities while resting in a supine position.Answer
  2. B
    Elevate the head of the bed to a high-Fowler's position when assisting the client with meals.
  3. C
    Turn the client onto the unaffected side and allow the operative leg to drape across the body's midline.
  4. D
    Place a trochanter roll along the outer aspect of the operative thigh to promote internal rotation.

Answer

The nurse should secure an abduction wedge between the client's lower extremities while the client is resting in a supine position.
Following a posterior approach total hip arthroplasty, the hip is highly susceptible to posterior dislocation. Securing an abduction wedge or pillow between the client's legs while they are supine prevents adduction (crossing the legs) and helps maintain the leg in a neutral position. This provides crucial stabilization for the new joint and significantly reduces the risk of dislocation.

Step-by-Step Solution

1
Identify the surgical procedure and its specific post-operative physiological risks.
The client underwent a right total hip arthroplasty via a posterior approach. The primary structural risk post-operatively is posterior joint dislocation.
Understanding the specific surgical approach dictates which anatomical positions and movements must be strictly avoided to protect the new joint.
2
Recall the standard hip precautions required for a posterior surgical approach.
Hip precautions for a posterior approach include avoiding hip flexion greater than 90 degrees, avoiding adduction of the operative leg across the body's midline, and avoiding internal rotation of the leg.
These specific movements place excessive mechanical stress on the posterior aspect of the newly implanted joint capsule, potentially forcing the femoral head out of the acetabulum.
3
Evaluate the given nursing interventions against the established precautions to select the safest action.
Utilizing an abduction wedge directly prevents adduction and maintains the leg in a safe, neutral alignment.
The other interventions involve contraindicated movements (high flexion, adduction, internal rotation) that directly violate hip precautions and increase the risk of injury.

Key Concept

Post-operative positioning and hip precautions following a posterior total hip arthroplasty
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Topics

Reduction of Risk Potential

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