What should every orthopaedic nurse know? - page 2

by Jammin' RN 16,171 Views | 17 Comments

Hello to all you fabulous nurses out there! I'm about to start my first job as an orthopaedics nurse in a few weeks! I've been out of school for awhile and I'm studying and brushing up on things. Anyone out there have advice... Read More


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    Congrats!! I start in 2 weeks, a new grad ortho 6 month program. I ahve been working the past 7 months at a rehab facility so I am excited to move up. I give a lot of narcs, on constant poop watch, and proper positioning. And DVT s/s.
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    I am on an orthopedic unit mainly focusing on Knee and Hip Replacement Surgeries. I guess it's very important to maintain pain with narcotic use. Repositioning of the joints, pillow placement, ice packs and transferring patients. Most of the patients are elderly and have dementia so it might be like a long term care facility to you. Lots of administration of antibiotics such as ancef (cefazolin). Make sure you know how to do a neurovascular assessment (Circulation (pulse, color), Warmth of the limb, Movement of the limb and Sensation if they can feel you). Learn about compartment syndrome - numbness, tingling, excruciating pain that doesn't go away after narcotics, repositioning or ice packs. If that happens contact the surgeon, they may need an emergency fasciotomy to relieve pressure and prevent necrosis of the tissue. Most patients are allowed to full weight bear after their surgeries, it's important to ambulate as soon as possible. There are some dressing changes, stable removals, and CODEs from overdose.
    VVCN2012 likes this.
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    Also patients maybe on blood thinners to reduce the chance of post op complications from surgery such as: Pulmonary embolism, Deep vein thrombosis, and stroke. You make have to teach patients how to administer their own fragmin (Dalteparin) injections post op because they're usually discharged within days if they're stable enough. Teach about deep breathing, incentive spirometry, leg and arm exercises (Wiggling fingers), and the importance of managing pain.
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    Quote from SaoirseRN
    Know that patients will try to be brave, and that the pain WILL quickly go out of control if you don't get on it when it's just "a little sore".

    I give all my joint patients the same spiel when I first see them post op:

    You will have pain; pain is an expected part of having surgery.

    What we don't want is to let that pain get out of control. You may be nervous about taking pain medicine, but you will need it so your body can heal.

    If you are having pain, you can't rest. If you can't rest, you don't heal.

    I want you to tell me as soon as you start to feel uncomfortable, not when you are really hurting. If we take care of the pain quickly, when it is just irritating and not intolerable, you will end up needing a lot less medicine and be much more comfortable.

    If you let it go too long, it is really hard to catch up, and you will need a lot more medicine to get there.

    Trust me. Get that analgesic on board as soon as the spinal wears off and they start feeling uncomfortable. Wait until it hurts and 9 times out of 10 you are playing catch up all afternoon.
    Funny i give the same spiel it works about 99% of the time their is always one who thinks they can do without the help but they soon come round.
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    Congrats!! I just started as a new grad on an ortho unit 7 months ago and absolutely love it!! I agree that narcs are a focus point, and it is absolutely important to start early with the pain medications even if the patients only begin to feel a little discomfort. Especially if the patient's spine/fem block wear off earlier than anticipated (for the knee replacements). I always tell my patients that as soon as they start to feel any discomfort that is nagging to start taking their PO pain meds. What I look for to check to make sure you aren't giving your patient too many pain meds is their respiratory rate, if they respond and wake up from sleeping when you attempt to wake them and their vital signs. Many times I try to give the patient their PO pain meds and only use the IV pain meds for break through pain. Also if they patient is tolerating the dose ordered with very little relief don't hesitate to talk with the doctors about adjusting the dose to help the patient.

    Another thing I've learned is that you have to be attentive to your neurovascular checks, especially if you work the night shift. It's awkward at first waking patients up multiple times in the night for their various antibiotics and anti-embolism medications, neurovascular checks, and with many patients their 6am synthroid. But because neurovascular changes can happen quickly you have to catch them early as to prevent any complications for your patient. Know the signs and symptoms for a PE, DVT, foot drop, etc. and remember that not every patient is the same... Signs and symptoms will vary patient to patient.

    You will love working on an ortho unit!! Good luck!! )

    You will love orthopedic nursing
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    Someone posted about giving lots of Ancef. It reminded me of something funny one of our ortho surgeons said to me once. He asked me if I knew the other name for Ancef. I'm a little slow to get the docs' attempts at humor sometimes and was like, "Cefazolin?" He said, "Orthocillin." He proceeded to explain the joke but I got it
    tots24 and mmc51264 like this.
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    Re: Bone pain from traumatic fx
    (Speaking only from my own experience, having had fx and then ORIF), bone pain is much reduced once the fracture is reduced and aligned.
    The fresh trauma with dislocation and swelling is very painful, and I agree with penniv (keep on top of the analgesia for these patients)
  8. 1
    Several things I've learned on my ortho floor (lots about hips/knee replacements)...

    -Bedside commodes and shallow bedpans for hip precautions patients!

    -FALLS precautions! Set bed alarms, especially on male patients who will try to get OOB without help

    -Nerve blocks--epidurals and perineurals--as per anesthesia or pain team. Make sure they are in place and not leaking! If they are leaking or infected, call anesthesia or pain team. I see a lot of sciatic and femoral perineurals on my floor. Sometimes interscalene. Frequently check the extremities for any loss of sensation (numbness/tingling is normal) and loss of motor activity.

    -Neurovasc checks

    -Try to get the foley D/C'ed as soon as possible (if you don't have a POD # 1 or POD # 2 d/c order already); some doc's want the foley to stay in as long as the perineurals are in

    -30 min before you D/C a PCA or pain team D/C's a perineural, give PO pain pills

    -Hip/knee replacements will go home/to rehab on coumadin; make sure you're getting a daily PT/INR and communicating the result with the team DAILY so they can adjust dosing; the goal for the INR on coumadin is 2-3 (hold and call doc if over 3); important to go over coumadin teaching and during discharge teaching, the need for weekly blood draws

    -Get cool with PT/OT team, you can work together to coordinate that the patient gets pain meds before they go to the gym and they can get your patient OOB to the chair for breakfast or to the toilet

    -Ortho patients typically if they don't go to rehab will need to go home with services (do they have a lot of stairs? Is there someone to help them with things around the house?) so coordinate with the SW about the patient's needs and disposition

    -Increased temp: encourage IS use first (an ortho resident once told me he doesn't really care about the temp unless it's over 100.4 or something)

    -Knee immobilizer on knee replacement patient's while ambulating or in bed (depending on what MD wants)

    -Continuous passive motion (CPM) machine: look at the degree of flexion prescribed, how much to increase it by each day, how long the patient should wear it and how many times per day; only do what the patient can tolerate though

    Wow that was a lot. Sorry for the information overload!
    VVCN2012 likes this.


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