A client is recovering from total hip arthroplasty. What intervention should the nurse prioritize to prevent skin breakdown?

Choice A rationale Monitoring for signs of infection is a standard postoperative nursing action that involves assessing the incision for erythema, warmth, edema, and purulent drainage. While vital for detecting complications like surgical site infections, it is not the primary intervention for preventing skin breakdown. Skin breakdown is more directly related to mechanical forces such as pressure, friction, and shear rather than the inflammatory or bacterial processes associated with a localized incisional infection. Choice B rationale Administering anticoagulants such as heparin or enoxaparin is essential for preventing deep vein thrombosis and pulmonary embolism following major orthopedic surgery. These medications modify the coagulation cascade to inhibit thrombus formation during periods of immobility. However, anticoagulation therapy does not directly address the risk of pressure ulcers or skin integrity. Preventing skin breakdown requires physical interventions that redistribute pressure and manage the microclimate of the skin surface during the recovery phase. Choice C rationale Maintaining hip abduction using pillows or an abduction wedge is the priority intervention to ensure proper joint alignment and prevent prosthesis dislocation. In terms of skin integrity, properly aligned pillows also help in distributing weight and preventing the knees or ankles from rubbing together, which reduces the risk of pressure injury. Maintaining the prescribed position ensures that the soft tissues around the surgical site are not subjected to unnecessary tension or compressive forces during repositioning. Choice D rationale Encouraging early ambulation is a critical component of postoperative recovery that helps prevent many complications, including pneumonia and venous stasis. While moving the patient helps relieve pressure on the skin over bony prominences, the specific priority in the immediate post-arthroplasty period is maintaining the stability of the new joint. Ambulation must be balanced with the need for strict alignment protocols to ensure the surgical repair remains intact while the surrounding musculature and skin heal.