Post op A K Amputation

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    Hey all, I'll be sitting for the NCLEX next week and came upon one of hundreds of "Not sure on this ones". Would like to know correct protocol for post op positioning for a patient w/ above the knee amputation. Med surg text book states "should lie prone 20 to 30 min q3-4 to prevent hip contracture until pt is up and around". Is this so? Most of the actual photographs I've seen in nursing texts didn't depict a pt lying in a prone position. Also the post op hip replacement positioning. My ding dang book did not explicitly state the proper position for this only to discuss the abduction wedge, and that upon discharge pt told it is alright to lie on affected side. Is my book wacked or partially correct. I guess I'm one of those I need the exact exacts kind of person. Any clear ups on these two? Thanx so much in advance :redpinkhe
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    Quote from newtress
    hey all, i'll be sitting for the nclex next week and came upon one of hundreds of "not sure on this ones". would like to know correct protocol for post op positioning for a patient w/ above the knee amputation. med surg text book states "should lie prone 20 to 30 min q3-4 to prevent hip contracture until pt is up and around". is this so? most of the actual photographs i've seen in nursing texts didn't depict a pt lying in a prone position.

    [b]yep, prone 20-30 min tid/qid.
    also when supine, no pillows under legs, hips.


    also the post op hip replacement positioning. my ding dang book did not explicitly state the proper position for this only to discuss the abduction wedge, and that upon discharge pt told it is alright to lie on affected side. is my book wacked or partially correct. i guess i'm one of those i need the exact exacts kind of person. any clear ups on these two? thanx so much in advance :redpinkhe
    yes, laying on affected side is ok.
    and no sitting at 90 deg or > angles...
    don't forget to logroll pt.

    leslie
    newtress likes this.
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    Hey! I had learned in school and as per my med-surge book: "Alternately, the residual limb may be elevated in a pillow for 24hrs or less. Continued use of a pillow for elevation can lead to a flexion contractures....Check the limb periodically to ensure that it lies completely flat on the bed. Pt should avoid positions of flexion such as sitting for a long periods. If the pt is able, lying prone for 30 min q4 times a day, helps prevent contracture" , and remember avoid contractures is very important for this pt, so pt can be able to use a prosthesis and walk.
    Good luck in your test....You can do it!!!!
    newtress likes this.
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    So appreciate the get back.
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    Actually, it's good to keep the stump propped up the first 24 hrs. postop to decrease edema but then you should put it down because of contractures. In 19 years of orthopaedics I've never seen a postop AKA who could tolerate the prone position r/t respiratory issues, but yes, that's the NCLEX answer. Some of the newer hip replacements won't tolerate an ABDUCTED position, actually, but in the NCLEX answers it's still always don't adduct the hip.
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    Wow, my sneaking suspicion was that an ortho nurse would say that a prone position isn't really the real deal. But for state board answer response I'd have to go with the prone position. Quite frustrating to be gearing up for this exam with answer responses that THEY want as opposed to what I would do. Especially the psych questions. Some of the correct responses were so out there and absolutely not what I would do in those situations. Like the safety issue was oddly not in the equation, or what your first intervention would be seemed contradictory. But that's the way they test and I have to go outside of what I know or think to answer the way they think. Geez I almost hope I get an exam that has a lot of pharm questions as they seem to be straight forward on those meds. Now I suddenly sound nervous. I felt so ready, competent and confident last night to take this thing. I know just about everyone felt ready/not ready right before. Glad I'm scheduled for an afternoon to give me time to decompress my head!


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