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Difficulty: MediumBasic Care and Comfort

A registered nurse is planning care for a 78-year-old client who is 1 day post-operative following a right total hip arthroplasty (posterior approach). Which basic care and comfort interventions should the nurse include in the client's plan of care? Select all that apply.

  1. Apply an abduction pillow between the client's legs when resting in bed.Answer
  2. Place a raised toilet seat over the commode for elimination needs.Answer
  3. Apply ice packs to the surgical site as a non-pharmacological comfort measure.Answer
  4. D
    Delegate the initial assessment of skin integrity under the compression stockings to the unlicensed assistive personnel (UAP).
  5. E
    Position the client in a low, soft armchair during meals to promote relaxation.
  6. F
    Document the client's acute post-operative confusion as an expected, normal change of aging.

Answer

The correct interventions include applying an abduction pillow, using a raised toilet seat, and applying ice packs to the surgical site.
Appropriate basic care and comfort for a posterior approach total hip arthroplasty focuses on maintaining joint alignment and managing pain. Interventions must prevent adduction (using an abduction pillow) and prevent hip flexion greater than 90 degrees (using a raised toilet seat). Additionally, applying ice is a standard non-pharmacological comfort measure to reduce localized tissue swelling and pain.

Step-by-Step Solution

1
Identify the surgical procedure and approach.
The client had a right total hip arthroplasty via a posterior approach.
The surgical approach determines specific anatomical precautions (avoiding flexion > 90 degrees, adduction, and internal rotation).
2
Evaluate each intervention for adherence to posterior hip precautions and safe care principles.
Abduction pillows and raised toilet seats maintain proper alignment and prevent excessive flexion or adduction. Ice packs safely manage localized pain.
Maintaining joint stability and promoting comfort are primary goals of post-operative basic care.
3
Identify contraindicated actions related to positioning, delegation, and geriatric assessment.
Low chairs violate hip flexion precautions. Delegating initial skin assessment is outside the UAP's scope. Acute confusion is an abnormal pathological finding.
Recognizing unsafe practices prevents complications such as joint dislocation, missed skin breakdown, or failure to rescue a declining client.

Key Concept

Post-Operative Basic Care and Positioning Precautions
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Topics

Basic Care and Comfort

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