Question

The nurse is caring for a client with an above-the-knee amputation (AKA). To prevent contractures, the nurse should: A. Place the client in a prone position 15-30 minutes twice a day B. Keep the foot of the bed elevated on shock blocks C. Place trochanter rolls on either side of the affected leg D. Keep the client's leg elevated on two pillows

Short answer

Answer: Place the client in a prone position 15-30 minutes twice a day.

Step-by-step solution

Understand the problem

First, it's essential to understand the problem the nurse is trying to address. Contractures are the abnormal shortening of muscles or tendons around a joint, leading to decreased range of motion. After an above-the-knee amputation, patients are at risk of developing contractures, which might affect their rehabilitation and function.

Analyze each option

Now, we'll evaluate each option to determine the best option for preventing contractures in a client with an above-the-knee amputation. A. Place the client in a prone position 15-30 minutes twice a day: By positioning a patient in a prone position (lying on the stomach), you are promoting hip extension and reducing the risk of hip flexion contractures. B. Keep the foot of the bed elevated on shock blocks: This may help with general leg swelling but does not address the prevention of contractures specifically. C. Place trochanter rolls on either side of the affected leg: Trochanter rolls are used to prevent external rotation of the leg and maintain proper alignment. Although alignment is important, it does not directly prevent contractures in an AKA client. D. Keep the client's leg elevated on two pillows: While this might help with leg swelling, it can actually promote hip flexion contractures by keeping the hip joint in a flexed position.

Determine the correct answer

Based on analyzing each option, the correct answer is: A. Place the client in a prone position 15-30 minutes twice a day. This is the most effective method among the given options to prevent contractures in a client with an above-the-knee amputation.

Key concepts

Preventing Contractures

Contractures refer to the permanent tightening of tissues around joints, which limits motion and can be particularly concerning after surgeries such as an above-the-knee amputation (AKA). To prevent this, nurses must implement strategies that encourage joint flexibility and muscle strength. One such strategy is positioning the client in a prone position regularly.

When a client is positioned prone, lying flat on their stomach, this encourages the extension of the hip joint. Spending 15-30 minutes twice a day in this position stretches the hip flexors, which are at high risk of shortening post-amputation. It's crucial to start this intervention early and to maintain a consistent schedule to effectively prevent contractures.

Incorporated into overall care, this prevention measure can significantly enhance the patient's rehabilitation outcomes by maintaining a range of motion and facilitating the eventual use of a prosthesis.

Above-the-Knee Amputation Care

Proper care following an AKA includes several components focused on wound healing, pain management, and prevention of complications, such as contractures and infections.

Firstly, it's essential to maintain a clean and dry environment around the surgical site to promote healing. Regular dressing changes and monitoring for signs of infection are fundamental nursing responsibilities. Addressing pain efficiently with medication and non-pharmacological interventions contributes to comfort and facilitates participation in preventative and rehabilitative measures.

Physical Therapy

Engagement with physical therapy is also vital, not only for building strength but also for adapting to limb loss, learning balance, and preparing for a prosthesis.

Emotional Support

In addition to physical care, emotional support and education should not be overlooked, as an amputation can have significant psychological impacts. A multidisciplinary approach, including input from physical therapists, occupational therapists, psychologists, and support groups, can provide a holistic recovery plan.

Nursing Interventions

Nursing interventions are critical in guiding a patient through recovery and rehabilitation after an AKA. They include a broad range of activities directed at improving a patient's overall well-being and preventing post-operative complications.

Assessment and Monitoring

Nurses must frequently assess the amputation site for signs of healing or infection, monitor pain levels, and adjust care as needed.

Education

Teaching is another crucial intervention. Patients and their caregivers need to understand care routines, the importance of prone positioning to prevent contractures, and how to recognize complications early.

These interventions contribute significantly to a smoother recovery and lessened risk of long-term disability. By concentrating on individualized care plans that prioritize these aspects, nurses make a decisive impact on their patients' post-surgery quality of life.