To prevent external rotation of the hips for a patient immobilized in a body cast, which positioning device should the nurse use?

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2015

Explanation

A trochanter roll is specifically designed to prevent the external rotation of the hips when a patient is lying in a supine position.
It is typically made from a folded blanket or towel and placed along the outer aspect of the thigh.
This placement provides a physical barrier that stops the femur from rolling outward, thereby maintaining neutral hip alignment.
This intervention is crucial for patients who are immobilized or have lost motor control of their lower extremities to prevent hip contractures.

Option A: Hand rolls are placed in the palm to maintain the functional position of the hand, thumb, and fingers. They have no effect on hip alignment.
Option B: An abdominal binder is a wide elastic band wrapped around the torso to support the abdomen. It does not influence hip or leg position.
Option D: A trapeze bar is an overhead device that patients use to lift their upper body. It aids in repositioning and upper body strengthening but does not position the lower limbs.

Clinical Relevance

Nursing practice connection: Use the key finding related to Use of positioning devices for immobilized patients to guide bedside assessment, documentation, and the next nursing action.
Proper positioning is a fundamental nursing responsibility to prevent complications of immobility, including pressure injuries, nerve damage, and joint contractures.
Failure to prevent prolonged external hip rotation can lead to permanent contractures, which can cause pain and significantly impair a patient's ability to walk in the future.
What if? If the patient was also at risk for foot drop, the nurse would need to use an additional device, such as a footboard or positioning boots, to keep the feet in a dorsiflexed position.

How to Approach the Question

First, identify the specific problem the question is asking to solve: preventing 'external rotation of the hips'.
Next, analyze the context: the patient is 'immobilized in a body cast', indicating a need for supportive positioning.
Then, evaluate each option based on its primary function and the body part it targets.
Eliminate options that are clearly incorrect for hip positioning: 'Hand rolls' are for hands, and an 'abdominal binder' is for the abdomen.
Differentiate between the remaining options. A 'trapeze bar' is for patient movement (pulling up), not for passive positioning of the legs.
Conclude that the 'trochanter roll' is the only device listed whose specific purpose is to support the trochanter of the femur and prevent the hip from rotating externally.

Concept Tested & Keywords

Concept Tested: Use of positioning devices for immobilized patients
Stem keywords: prevent external rotation, hips, immobilized, body cast, positioning device
Lead-in keywords: which
Clinical cues: Patient immobilized in a body cast: This context highlights the need for interventions to prevent complications of immobility, such as joint contractures.
Negative lead-in flag: false

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E6 Nursing Fundamentals Potter Perry 12e Part 4 p. 154-156

E6 Nursing Fundamentals Taylor p. 328-330

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