A patient is being discharged 4 days after hip arthroplasty using the posterior approach. Which patient action requires intervention by the nurse?
A. The patient uses crutches with a swing-to gait.
B. The patient sits straight up on the edge of the bed.
C. the patient bends over the sink while brushing teeth.
D. The patient leans forward to pull on shoes and socks
The Correct Answer and Explanation is:
The correct answer is D. The patient leans forward to pull on shoes and socks.
Explanation:
After a hip arthroplasty using the posterior approach, certain precautions are crucial to prevent dislocation of the new hip joint and ensure proper healing. The posterior approach involves incisions and manipulations near the posterior hip capsule, which means specific movements should be avoided to prevent dislocation.
Option D requires intervention because leaning forward to pull on shoes and socks can pose a risk of hip dislocation. This action involves significant hip flexion, which exceeds the recommended limit for patients who have undergone a posterior hip replacement. Typically, patients are advised to avoid hip flexion greater than 90 degrees to prevent dislocation. Leaning forward often causes the hip to flex beyond this angle, especially when bending at the waist, increasing the risk of dislocating the new joint.
Option A is correct and does not require intervention. Using crutches with a swing-to gait is appropriate post-hip arthroplasty as it helps the patient move safely and effectively while minimizing stress on the healing hip joint.
Option B is also acceptable. Sitting straight up on the edge of the bed is generally considered safe and might actually promote better posture and less risk of complications. It is important, however, that the patient avoids excessive hip flexion when getting in and out of bed.
Option C involves bending over the sink while brushing teeth. This is generally permissible as long as the patient maintains proper hip precautions and does not bend excessively. A slight forward bend while brushing teeth typically does not pose a risk of dislocation if done within safe limits.
In summary, the primary concern in post-arthroplasty care is avoiding excessive hip flexion and ensuring movements do not jeopardize the stability of the new hip joint. Thus, leaning forward to pull on shoes and socks is a behavior that requires nursing intervention to prevent potential dislocation and complications.