A client recovering at home following a left total knee replacement 7 days ago is using a cane to go up and down the stairs under the supervision of the home health nurse. Which client action indicates a need for further instruction? A)Faces forward when going up and down the stairs B)Holds the cane with the right hand C)Leads with left leg, follows next with cane, and finally right leg when going up the stairs D)Places full weight on left leg when going down the stairs

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11ecbb05_cb77_f67e_b433_19a1177f4469_MD0009_00 To provide full support when climbing stairs, clients should hold the cane on the stronger side and move the cane before moving the weaker leg, regardless of the direction of the stairs (Option B). They should also keep 2 points of support on the floor at all times (eg, both feet, cane and foot) and face forward when going up or down the stairs, especially if there is no handrail (Option A). The nurse should instruct the client on the following: When ascending stairs: Step up with the stronger leg first (in this client, the right leg) Move the cane next while bearing weight on the stronger leg Finally, move the weaker leg (in this client, the left leg) When descending stairs: Lead with the cane Bring the weaker leg down next Finally, step down with the stronger leg The nurse may use the mnemonic "up with the good and down with the bad." The cane always moves before the weaker leg. (Option D) Clients are usually hospitalized for 3-4 days following a total knee replacement and can bear full weight by the time of discharge. Early ambulation and weight-bearing helps to hasten recovery and prevent complications (eg, thromboembolism). Educational objective: Clients who have had total knee replacement surgery can typically bear full weight by the time of discharge. To reduce the risk of falls, the client should hold the cane on the stronger side and face forward when going up and down the stairs. To ascend the stairs, the client should first step up with the stronger leg, next bear weight on that leg and move the cane, and finally step up with the weaker leg.

A Client Recovering at Home Following a Left Total Knee