After joint replacement and amputation, most of what protects the patient is not a drug — it is where the limb is put, and positioning is teaching, which belongs to the RN. Drive a hip through its range under posterior and then anterior precautions and watch which movements pop the prosthesis out, fix eight bedside positions, and finish by deciding who on the unit may legally do what.
Which surgical approach did your patient have?
Hip flexion angle
−20° extension30°120° flexion
Leg across the midline?
Rotation of the operative leg
And one more
Eight bedside callsKnee replacement, amputation, lumbar fusion and assistive devices. In every one of them the correct answer is a position, not a medication.
What do you do?
The assignment boardSix tasks on the orthopaedic unit. Assign each to the lowest level of staff who may legally and safely perform it. The dividing line is not difficulty — it is whether the task requires assessment, teaching, evaluation or nursing judgement.
The hip, live
Safe position
Why that position
0 correct of 8
Make a call on the leftThe rule and the reason land here.
Assistive devices, tested every year. Crutch handgrips are set so the elbows flex 20 to 30 degrees, with 2 to 3 finger widths (about 5 cm) between the axilla and the crutch pad — weight rests on the hands, never in the armpit, or the patient earns a radial nerve palsy. A cane is held on the strong side and advanced together with the weak leg. On stairs, up with the good, down with the bad.
The delegation rule
0 correct of 6
Assign a task on the leftThe rule behind the assignment lands here.
The single sentence to remember. Assessment, teaching, evaluation, nursing judgement and any unstable patient stay with the RN. Everything routine, predictable and already taught, on a stable patient, may be delegated — and the person you delegate to reports the findings back to you, because the accountability does not transfer with the task.