A nurse is providing discharge teaching about circumcision care to a parent of a newborn. Which of the following statements by the parent indicates an understanding of the teaching?

A. Instructing the client to bend at the waist is incorrect because hip flexion beyond 90 degrees is contraindicated after total hip arthroplasty due to risk of dislocation.

B. Keeping the client’s heels elevated while in bed is correct. This helps prevent pressure ulcers, which are a common postoperative complication due to decreased mobility.

C. Massaging the affected leg is contraindicated because it can dislodge a thrombus and lead to complications such as a pulmonary embolism.

D. Maintaining adduction of the affected hip is incorrect because it increases the risk of hip dislocation. The hip should be kept in abduction using a pillow or abduction device.

Rationale for correct choices

• Osteomyelitis: The client has an open fracture, which increases the risk of infection in the bone due to direct exposure to pathogens. The rising temperature (36.8 → 38.9°C) and elevated heart rate indicate a possible inflammatory response, making monitoring for osteomyelitis essential. Early detection allows prompt initiation of antibiotics and prevents chronic bone infection.

• Fat embolism syndrome: The client sustained a long-bone fracture (right femur), which is a known risk factor for fat embolism syndrome. Signs such as tachycardia, tachypnea, and decreased oxygen saturation (96% → 94%) may indicate early fat emboli. Prompt recognition and supportive interventions, including oxygen therapy and monitoring respiratory status, are critical.

Rationale for incorrect choices

• Deep vein thrombosis (DVT): While immobility and trauma increase the risk of DVT, there is no evidence of unilateral leg swelling, redness, or pain reported in this client. Although preventive measures are important, current findings suggest infection and respiratory complications are more immediate risks.

• Compartment syndrome: Compartment syndrome typically presents with severe pain unrelieved by medication, tense swelling, and neurovascular compromise in the affected limb. The client’s report and vital signs do not indicate these specific signs, so it is not the most immediate concern at this time.