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Question

Difficulty: MediumBasic Care and Comfort

A nurse is providing morning care for an older adult client who is 2 days post-operative following a right total hip arthroplasty (posterior approach). Which nursing action is most appropriate?

  1. Place an abductor pillow between the client's lower extremities when turning them onto their unaffected side.Answer
  2. B
    Elevate the head of the bed to a 90-degree angle while the client is eating meals.
  3. C
    Delegate the evaluation of the client's sacral skin integrity to the unlicensed assistive personnel (UAP) during the bed bath.
  4. D
    Reassure the client that their new-onset confusion this morning is a normal and expected part of the aging process.

Answer

The nurse should maintain the client's hip in an abducted position by using an abductor pillow when turning the client onto their unaffected side.
Following a posterior approach total hip arthroplasty, the client is at a high risk for prosthetic dislocation if the operative hip is adducted (moved across the midline), internally rotated, or flexed beyond 90 degrees. Placing an abductor pillow between the client's lower extremities effectively prevents adduction, especially during movement and turning, thereby maintaining proper anatomical alignment and joint stability.

Step-by-Step Solution

1
Identify the specific surgical procedure and its associated risks.
The client underwent a right total hip arthroplasty using a posterior approach.
Different surgical approaches dictate specific post-operative movement precautions to ensure joint stability.
2
Recall the necessary positioning restrictions for a posterior hip approach.
The client must strictly avoid hip flexion greater than 90 degrees, hip adduction (crossing the midline), and internal rotation.
These specific movements can lever the prosthetic head out of the acetabulum, leading to a painful and dangerous dislocation.
3
Evaluate each nursing action against safety guidelines and the scope of practice.
Using an abductor pillow aligns with safety precautions. Elevating the head of the bed to 90 degrees violates positioning rules, delegating assessment violates scope of practice, and dismissing confusion ignores a potential pathological issue.
Ensures the selected intervention promotes basic care and comfort while actively preventing post-operative complications.

Key Concept

Post-operative positioning and mobility precautions for total hip arthroplasty
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Topics

Basic Care and Comfort

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