What would be the first action by the nurse for a client with a hip arthroplasty when the affected leg was noted to be rotated outward, pale in coloring, diminishing pulses palpated, skin temperature cool to touch, and shortening in length noted?

Question

1. Ask about changes in pain levels.
2. Call the health care provider.
3. Replace the leg and foot to proper alignment with toes upward.
4. Reinforce proper positioning by putting the abductor pillow in place.

Answer 1

Ask about changes in pain levels.

Rationale: Asking about changes in pain levels will indicate the compromise of bone and tissue alignment. Increased pain and the absence of pain are both caused by pressure on nerves and blood vessels when the hip is misaligned. Assessment is the first action prior to calling the health care provider. Gathering all information prior to notifying the health care provider will allow faster a decision-making process and better communication about the client's current status. Replacing the leg and foot to proper alignment, prior to understanding what mechanism is present in the misalignment, would increase risk for additional damage to the hip. This is not a nursing role and should be performed by health care providers trained to do so. Placing the abductor pillow can also increase harm or risk of potential damage once the leg is misaligned. The shortening of the hip shows that the hip is out of the socket and needs professional replacement by a trained health care provider. Moving the leg should not be done until the health care provider is present.