The practical nurse (PN) is assisting a client who is performing peritoneal dialysis catheter self-care before being discharged home. Which behavior indicates that the client needs additional teaching?

Choice A reason: Positioning the client supine and flat is not specifically aimed at preventing phantom pain. Phantom pain is a common issue after amputations, and its management typically involves medications, therapies, and psychological support rather than positioning. Keeping the client supine and flat may not address the immediate concerns of bleeding and swelling, which are critical in the initial postoperative period.
Choice B reason: Turning the client prone every 2 hours to prevent hip flexion contractures is an important intervention to prevent contractures after a below-the-knee amputation. However, this is not the immediate priority immediately following surgery. The primary concern in the immediate postoperative period is to manage bleeding, swelling, and ensuring proper healing of the residual limb.
Choice C reason: Elevating the residual limb on pillows to prevent bleeding and swelling is the most crucial intervention immediately after a below-the-knee amputation. Elevation helps reduce edema, promote venous return, and minimize the risk of postoperative bleeding. Proper elevation also supports the healing process of the surgical site. This intervention addresses the immediate needs of the client and helps prevent complications in the critical early stages after surgery.
Choice D reason: Positioning the residual limb below the heart to promote healing for prosthetic fitting is not recommended in the immediate postoperative period. Keeping the limb elevated is more beneficial to reduce swelling and manage bleeding. The focus in the immediate phase is to ensure proper healing and prevent complications, with considerations for prosthetic fitting coming later in the rehabilitation process.

Choice A reason: Placing the client in the left lateral recumbent position with the right leg supported in proper alignment is not the best choice for reducing swelling and promoting comfort in a client with a fractured right tibia and fibula. While supporting the leg in proper alignment is important, the left lateral recumbent position does not provide optimal elevation of the affected limb. Elevation is crucial to reduce swelling and promote venous return, which can help decrease edema and discomfort.
Choice B reason: Placing the client in the dorsal recumbent position with the right leg elevated on two pillows is the most appropriate choice. This position allows the right leg to be elevated above the level of the heart, which helps reduce swelling by promoting venous return and lymphatic drainage. Elevation also decreases the hydrostatic pressure in the lower extremity, which can help minimize edema and improve comfort. This position ensures that the leg is properly supported and aligned, which is essential for optimal healing.
Choice C reason: Placing the client in the supine position with a footboard and a trochanter roll to the right leg is not the best choice for reducing swelling. While using a footboard and a trochanter roll can help maintain proper alignment and prevent external rotation of the leg, it does not provide the necessary elevation to reduce swelling. Elevation is a key component in managing edema and promoting comfort in clients with fractures.
Choice D reason: Placing the client in the right lateral position with a pillow between the legs is not an appropriate choice for reducing swelling in a client with a fractured right tibia and fibula. The right lateral position does not allow for proper elevation of the affected limb, which is essential for reducing swelling and promoting venous return. Additionally, this position may place pressure on the injured leg, causing discomfort and potentially compromising the healing process.