What should every orthopaedic nurse know?

They'll likely run a fever, it doesn't mean they're septic, it just means body is going into inflammatory healing mode, so don't freak out about it.

With ALIFs ice chips the whole first day because you don't want to risk a paralytic ileus with little to no bowel sounds. At temps of 99 I reinforce IBE use before giving them tylenol

Learn proper positioning of you spine and joint replacement patients. Know what the common precautions are. Know you will give crazy amounts of narcotics and that is OK. I always tell my new grads that bone pain is one of the worse pains the body can experience so don't make them suffer. Pulmonary toileting is essential and don't push them quicker than their gut can handle or you will regret it.

Most of all - have fun!!

Good luck

Penni
Orthopaedic Nurse Practitioner

Penni, you are so right with the crazy amount of narcotics! I've already noticed that. Advice/thoughts about managing pain for patients who come in on a baseline of lots of narcotics... Whether or not they tell you it's the case? I get worried about respiratory failure when Im giving so much!

If they're used to a lot of narcotics, then a lot of narcotics aren't going to put them into respiratory failure.

Right, but if you have no idea what they take, how do you determine what's gonna be too much? Just follow VS's?

I don't start my new grad ortho position for two more weeks, but I have been providing conscious sedation in outpatient surgery for several months... We follow vitals and the patients report of level of pain. You can usually tell by these if they have hx of narc use. I find it also helps when asking the patient about any history of narc use, to explain that it is simply so that we can provide the appropriate amount of pain control. At that point, they usually are pretty open about EVERYTHING they've ever taken.
There should be a policy in place at your facility or the docs order stating the max you can go. Whenever giving narcs though, you need to closely monitor VS for respiratory depression. The first sign we see of this in outpatient surgery is chest wall rigidity, once that happens someone breaks out the narcan (and I've only seen that happen once, and it was the first time my facility had to in over 5 years).

That most patients undergoing a big surgery will have most of the following and it's okay...
1) Fever 2) Pain 3) Trouble Peeing and Pooping 4) Itchyness 5) Minor Lung Issues (atelectisis, effusions, etc) 6) Nausea 7) And a bit of a breakdown at some point.

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.