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QUESTION IMAGE

a nurse is repositioning a client who has quadriplegia and is in the su…

Question

a nurse is repositioning a client who has quadriplegia and is in the supine position. which of the following actions should the nurse take to prevent client musculoskeletal injury?

  • support the clients head with a pillow that maintains cervical flexion.
  • position the clients shoulders off the pillow for internal rotation
  • place the clients arms at their sides to keep their elbows extended
  • internally rotate the clients hips by using a trochanter roll.

Explanation:

Brief Explanations

To prevent musculoskeletal injury in a quadriplegic client in supine position:

  • Option 1: Supporting the head with a pillow to maintain cervical flexion is incorrect as it can cause strain; neutral alignment is better.
  • Option 2: Positioning shoulders off the pillow for internal rotation is incorrect as internal rotation can lead to contractures; external rotation or proper support is needed.
  • Option 3: Placing arms at the sides to keep elbows extended is incorrect as it can cause elbow flexion contractures; arms should be supported in a slightly flexed position.
  • Option 4: Using a trochanter roll to internally rotate the hips is incorrect. Trochanter rolls are used to prevent external rotation of the hips (to maintain neutral or slight internal rotation? Wait, no—actually, trochanter rolls are placed along the outer thigh to prevent external rotation of the hips, which is important for alignment. Wait, maybe I made a mistake earlier. Wait, let's re - evaluate. Wait, for a quadriplegic client, to prevent musculoskeletal injury:

Wait, maybe the correct option is none of the above? No, let's re - check. Wait, the options:
Wait, the first option: "Support the client’s head with a pillow that maintains cervical flexion"—cervical flexion for a quadriplegic (who may have spinal cord injury) is bad, should be neutral.
Second: "Position the client’s shoulders off the pillow for internal rotation"—internal rotation of shoulders can cause contractures, should be external rotation or supported in neutral.
Third: "Place the client’s arms at their sides to keep their elbows extended"—elbows extended at sides can lead to flexion contractures, should be supported in slight flexion.
Fourth: "Internally rotate the client’s hips by using a trochanter roll"—trochanter rolls are used to prevent external rotation of the hips (to keep them in neutral or slight internal rotation? Wait, actually, trochanter rolls are placed against the outer aspect of the thighs to prevent the hips from externally rotating. So if we use a trochanter roll, we are preventing external rotation, which means we are promoting internal rotation (relative to external rotation). Wait, maybe this is the correct action. Wait, no—let's think about musculoskeletal care for paralyzed patients. To prevent hip external rotation (which can lead to contractures and misalignment), trochanter rolls are placed along the outer thighs, which helps to keep the hips in a neutral or slightly internally rotated position. So using a trochanter roll to internally rotate the hips (or prevent external rotation) is a correct action. Wait, but the other options:
Wait, maybe I messed up the first three. Let's re - check each option:

  1. Supporting head with pillow for cervical flexion: Bad, causes strain.
  2. Shoulders off pillow for internal rotation: Internal rotation of shoulders is bad, causes contractures.
  3. Arms at sides, elbows extended: Bad, causes elbow flexion contractures.
  4. Internally rotate hips with trochanter roll: Trochanter rolls are used to prevent external rotation, which is equivalent to promoting internal rotation (or maintaining neutral). So this is the correct action among the given options. Wait, but maybe the correct answer is the fourth option? Wait, no—wait, trochanter rolls are placed to prevent external rotation of the hips. So when you place a trochanter roll along the outer thigh, it pushes the thigh inward, preventing external rotation, which means the hip is in a neutral or slightly internally rotated position. So this action helps to maintain proper hip alignment and pr…

Answer:

D. Internally rotate the client’s hips by using a trochanter roll. (Assuming the options are labeled A, B, C, D in order, with D being the fourth option)