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Difficulty: HardBasic Care and Comfort

During morning rounds, a client who underwent a right total hip arthroplasty with a posterior approach the previous day informs the nurse of the need to have a bowel movement. The client is currently restricted to bed rest. Which intervention should the nurse implement to safely facilitate elimination?

  1. A
    Elevate the head of the bed to a high-Fowler's position to promote normal physiological bowel mechanics before placing a standard bedpan.
  2. B
    Instruct the unlicensed assistive personnel (UAP) to place the bedpan and concurrently assess the client's sacral skin for early signs of pressure injuries.
  3. C
    Advise the client that sudden, severe pain in the operated hip during the procedure is a normal expectation due to age-related osteoarthritis and surgical trauma.
  4. Maintain the head of the bed at 30 degrees, ask the client to use an overhead trapeze to lift the pelvis, and slide a fracture bedpan underneath.Answer

Answer

The safest method is to keep the head of the bed at 30 degrees, utilize an overhead trapeze to elevate the client's pelvis, and use a fracture bedpan.
A fracture bedpan is specifically designed with a shallow end that requires minimal pelvic elevation, reducing stress on the hip joint. Concurrently, keeping the head of the bed at 30 degrees ensures the hip angle remains well below the 90-degree flexion limit required for a posterior approach arthroplasty, preventing dislocation.

Step-by-Step Solution

1
Identify the client's surgical procedure and associated safety parameters.
The client had a posterior approach total hip arthroplasty, which strictly requires avoiding hip flexion greater than 90 degrees, leg adduction, and internal rotation.
Recognizing specific surgical precautions is necessary to prevent severe complications like joint dislocation during routine basic care.
2
Evaluate the proposed interventions against the established safety parameters.
High-Fowler's position violates the flexion limit. Delegating a skin assessment violates the nursing scope of practice. Dismissing sudden severe pain ignores a potential joint dislocation.
Each intervention must be systematically ruled out if it poses a physiological or legal risk to the client.
3
Select the intervention that facilitates elimination while strictly maintaining joint alignment.
Using an overhead trapeze with the head of the bed at 30 degrees allows for the placement of a low-profile fracture pan without exceeding 90 degrees of hip flexion.
This method ensures the client's basic comfort and elimination needs are met without compromising the integrity of the surgical site.

Key Concept

Post-Operative Total Hip Arthroplasty Comfort and Precautions
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Topics

Basic Care and Comfort

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