A client has just returned to a nursing unit after below the knee amputation of the right leg. The nurse places the client in which of the following most appropriate positions?

1. A

   Supine with the stump flat on the bed

2. B

   Supine with the stump elevated

3. C

   Reverse Trendelenburg position

4. D

   Prone

Appeared in: AIIMS Bhatinda NO - 2019

Explanation

• In the first 24 hours after a below-the-knee amputation, the priority is to control swelling (edema).
• Placing the client in a supine position with the stump elevated on pillows uses gravity to help drain excess fluid from the limb.
• This reduction in swelling helps decrease pain, promotes healing, and reduces tension on the surgical incision.
• This position is only recommended for the first 24 hours due to the risk of developing contractures.

Why Other Options Were Wrong

• Option A: While keeping the stump flat is crucial for preventing contractures, it is not the priority in the immediate 24-hour post-operative period when edema is the primary concern.
• Option C: The Reverse Trendelenburg position involves tilting the entire bed so the head is higher than the feet. It does not specifically target edema in the lower limb and is used for other medical conditions.
• Option D: The prone position is not used immediately after surgery. Placing a patient on their fresh surgical site would be painful and could compromise the wound.

Related Visual

Clinical Relevance

• Nursing practice connection: Safe nursing care depends on performing Post-operative care and positioning for a client with a below-the-knee amputation in the correct sequence, documenting the action clearly, and monitoring for the expected response.
• A nurse's understanding of the phased approach to amputation positioning is critical for preventing complications. Incorrect positioning can lead to either uncontrolled edema or permanent contractures, both of which severely impact patient recovery and rehabilitation potential.
• Patient education is a key nursing role. The nurse must explain to the patient and family why the position is changing after 24 hours, emphasizing the shift in priority from swelling to preventing joint stiffness.
• What if? If it were 48 hours post-op, the answer would change. The priority would be contracture prevention, making 'Supine with the stump flat' the best answer, supplemented with periods of 'Prone' positioning.

How to Approach the Question

• First, identify the key elements in the question: 'below the knee amputation' and 'just returned to a nursing unit'. This establishes the procedure and the specific timeframe (immediate post-op).
• Recall the two major, competing risks after amputation: edema (swelling) and contractures (joint stiffness).
• Remember that the priority changes with time. In the first 24 hours, the primary goal is managing acute swelling.
• Evaluate the options based on this immediate goal. Elevation (Option B) is the only choice that directly addresses edema by using gravity.
• Consider why the other options are incorrect for this specific timeframe. Flat positioning (A) doesn't help with swelling. Reverse Trendelenburg (C) is for other conditions. Prone positioning (D) is for later, to prevent contractures.

Concept Tested & Keywords

• Concept Tested: Post-operative care and positioning for a client with a below-the-knee amputation.
• Stem keywords: below the knee amputation, postoperative, nursing unit, position
• Lead-in keywords: most appropriate
• Clinical cues: The phrase 'just returned' indicates the immediate postoperative period, which is critical for determining the correct action.

Question ID

QBfMKIRwidbve8YKwz9-Lt

Copy ID

Reference Book

E6 Nursing Fundamentals Taylor p. 332-334