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Difficulty: MediumBasic Care and Comfort

A nurse is providing care for a client who is 1 day postoperative following a right total hip arthroplasty with a posterior approach. Which nursing action is most appropriate when assisting the client with basic care and mobility?

  1. Maintaining an abduction wedge between the client's legs while turning them in bed.Answer
  2. B
    Elevating the head of the bed to 90 degrees to assist the client with eating meals.
  3. C
    Instructing the client to bend forward at the waist when applying their socks and shoes.
  4. D
    Delegating the client's first postoperative transfer from the bed to the chair to an unlicensed assistive personnel (UAP).

Answer

Maintaining an abduction wedge between the client's legs while turning them in bed.
Following a total hip arthroplasty (posterior approach), it is critical to prevent the affected leg from crossing the midline of the body (adduction). Utilizing an abduction wedge or pillow between the client's legs when turning them prevents this contraindicated movement and maintains the hip in proper alignment, greatly reducing the risk of joint dislocation.

Step-by-Step Solution

1
Identify the surgical procedure and its specific postoperative movement restrictions.
A total hip arthroplasty using a posterior approach requires avoiding hip flexion greater than 90 degrees, adduction (crossing the legs), and internal rotation.
These specific movements place excessive stress on the posterior joint capsule and can cause the new prosthetic head to dislocate.
2
Evaluate each nursing intervention to determine if it violates these movement precautions or safe nursing practice.
Elevating the head of the bed to 90 degrees and bending to put on socks both violate the flexion precaution. Delegating the first transfer violates the RN scope of practice.
Only actions that maintain proper anatomical alignment and adhere to delegation principles are appropriate.
3
Select the intervention that promotes safety and comfort while preventing dislocation.
Using an abduction wedge keeps the legs apart during turns.
This directly prevents adduction, securing the hip joint in a safe, neutral position.

Key Concept

Postoperative Positioning and Mobility for Total Hip Arthroplasty (Posterior Approach)
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Topics

Basic Care and Comfort

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