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Question

Difficulty: MediumReduction of Risk Potential

A nurse is developing a plan of care for an older adult client who is 12 hours postoperative following a right total hip arthroplasty (posterior approach). Which of the following nursing actions will effectively reduce the client's risk for post-surgical complications? Select all that apply.

  1. Maintain the right leg in an abducted position using a specialty wedge pillow.Answer
  2. B
    Elevate the head of the bed to a high-Fowler's position during meal times.
  3. C
    Assign the unlicensed assistive personnel (UAP) to perform the neurovascular checks of the right leg.
  4. Monitor the surgical site drain output and ensure the device maintains continuous closed suction.Answer
  5. E
    Document new-onset acute confusion as an expected age-related response to general anesthesia.
  6. Administer the prescribed prophylactic subcutaneous enoxaparin at the scheduled time.Answer

Answer

The correct actions include maintaining the leg in an abducted position, monitoring the surgical site drain for continuous suction, and administering prophylactic subcutaneous anticoagulants.
Maintaining leg abduction with a specialty pillow prevents internal rotation and adduction, which are the primary causes of posterior hip prosthesis dislocation. Monitoring surgical drains ensures early detection of postoperative hemorrhage and prevents hematoma formation that could compromise wound healing. Administering prophylactic anticoagulants reduces the high risk of deep vein thrombosis (DVT) and pulmonary embolism commonly associated with major lower extremity orthopedic surgery.

Step-by-Step Solution

1
Identify the surgical procedure and its specific risk factors.
The client had a total hip arthroplasty (posterior approach), which carries high risks for prosthesis dislocation, deep vein thrombosis (DVT), hemorrhage, and altered mental status related to hypoxia or infection.
Understanding the specific postoperative risks dictates which preventive measures must be included in the care plan.
2
Evaluate each intervention for its impact on mitigating postoperative risks.
Leg abduction, drain monitoring, and anticoagulant administration directly prevent dislocation, hematoma, and DVT.
These interventions are evidence-based practices that actively reduce physiological risk.
3
Identify contraindicated actions based on client positioning, delegation rules, and lifespan considerations.
High-Fowler's position causes dangerous hip flexion. UAP delegation for assessments is unsafe. Dismissing confusion as normal ignores potential life-threatening complications.
Eliminating actions that introduce new risks is a core component of the reduction of risk potential.

Key Concept

Postoperative Risk Reduction and Positioning (Total Hip Arthroplasty)
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Topics

Reduction of Risk Potential

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