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Difficulty: MediumBasic Care and Comfort

An orthopedic unit nurse is updating the care plan for a geriatric client recovering from a right-sided posterior total hip arthroplasty. The client has developed unexpected episodes of nighttime restlessness and loss of bladder control. Which nursing actions are appropriate to ensure optimal hygiene, comfort, and safety? Select all that apply.

  1. Keep an abduction wedge secured between the client's lower extremities while they are lying flat in bedAnswer
  2. B
    Encourage the client to flex their hips beyond 90 degrees when attempting to reach their footwear
  3. Wash the perineal region promptly after voiding accidents and smooth on a protective zinc oxide pasteAnswer
  4. D
    Assign the unit technician to determine the severity of any sacral skin redness during the daily bath
  5. E
    Secure the client's wrists to the bed frame using soft ties immediately when they exhibit restless behaviors
  6. F
    Conclude that the sudden nighttime disorientation is a standard manifestation of the physiological aging process

Answer

The appropriate actions are to keep an abduction wedge between the client's legs and to wash the perineal region promptly while applying a barrier paste.
The appropriate nursing actions address both the surgical restrictions and the basic care needs of the client. Maintaining an abduction wedge is a crucial standard of care following a posterior hip arthroplasty to prevent the leg from crossing the midline (adduction), which could dislocate the new joint. Additionally, for a client experiencing urinary incontinence, promptly washing the area and applying a zinc oxide paste is a fundamental intervention to protect the skin from moisture-associated damage and preserve tissue integrity.

Step-by-Step Solution

1
Analyze the client's surgical history (posterior total hip arthroplasty) to identify positioning restrictions.
Determine that the client must avoid hip flexion greater than 90 degrees, adduction, and internal rotation to prevent joint dislocation.
Post-operative anatomical safety dictates specific positional maintenance.
2
Evaluate the new-onset symptoms (urinary incontinence, nighttime restlessness) to determine basic care and safety needs.
Identify that incontinence requires prompt skin care to prevent breakdown, and acute restlessness requires assessment for underlying causes, not immediate restraints or dismissal as normal aging.
Maintaining physiological integrity and a safe care environment requires addressing acute changes appropriately.
3
Review the delegation principles regarding the unit technician (unlicensed assistive personnel).
Recognize that tasks requiring clinical assessment and evaluation cannot be delegated.
Ensuring safe and effective care requires appropriate scope of practice.

Key Concept

Basic care post-arthroplasty focuses on maintaining joint alignment to prevent dislocation, aggressively managing skin integrity during incontinence, and responding to acute cognitive changes clinically rather than punitively.
Estimated Time:1m 30s
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Topics

Basic Care and Comfort

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