What's Ortho Nursing Like?

Ortho nursing.... mainly "older" pts. I wouldn't compare it to physical therapy... although PT and nursing have to work together. Typically our PT gets the patient up the first time and then gives us the heads up on whether the pt can make it to the BSC or BR, with or without a walker, with assist of 1 or 2...light assist or strong assist.

Lots of pain control. Lots of PCA and pain med pushes.

Have to keep up on the vitals and labs.

Several other health issues that the elderly usually have. Many pts with COPD, heart hx, etc.

I like ortho. Particularly the replacements. Typically clean surgeries that you see the person have a great deal of improvement in a few days. Don't care for the fx hips that come in... particularly when you see and elderly person lose their independence right in front of your eyes. Being told they have to go to a nursing home, even if just for extended therapy, does something to people. Sometimes you can just see the will to live leave right there.

I didn't really choose it, I kind of got plunked into it, but I've stuck with it for over 2 years. It's busy with high turnover. People seldom stay more than 3-4 days for elective hips and knees. Hips are generally over 73 and knees are generally over 50. They can be needy depending on their pain tolerance, they can be resistant to therapy, they can get lazy and not do their incentive spirometers or their in bed PT's or be compliant with their anticoag therapy and end up with DVT's. It's a LOT of education and teaching and reinforcement. The anesthesia/pain meds can make them confused or crazy, especially in the elderly. Back patients are the worst and they're usually younger and needier. Then you'll get an occasional person with "intractable pain" or some BS like that which is apparently drug seeking because they're allergic to motrin, tylenol, morphine, percocet, vicoden and darvocet. And they need Benadryl with their Dilaudid, thank you very much. It can be aggravating, but when people come and they tell you that the surgical pain is far less than the pain that they were living with their degenrated hips/knees day to day, it's rewarding to give them that mobility back. To see the hope in their faces that they'll be able to walk their child down the aisle or attend their grandchild's christening or even just be able to function with family again is great.

I agree the hip fractures are tough, especially when they just fix them and not replace them. They often have a lot of extensive histories and you're treating a lot of stuff. It's a lot of pain management and keeping on top of hemoglobins, bun/creatinines. However, I know our floor is very esteemed amongst other med-surg floors because unlike the other floors, our pts are generally there by choice and not necessity. Joint replacements are elective surgery and it's not like the person who's in with cellulitis or appendicitis or clogged A-V fistulas or anything else like that. We work hard for our Joint Certification and are the bread and butter of med-surg. Not to toot our own horns.