What should every orthopaedic nurse know?

wooh, BSN, RN · Jun 26, 2012

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 on what every orthopedics nurse should know? What should I really focus on?
Thanks in advance for your responses!

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.

pcawiz · Jul 1, 2012

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

penniv · Jul 10, 2012

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

GonnaBSN · Sep 24, 2012

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!

wooh, BSN, RN · Sep 24, 2012

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

GonnaBSN · Sep 24, 2012

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?

fromtheseaRN, BSN, RN · Sep 27, 2012

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).

ipaharpoon · Jan 15, 2013

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.

SaoirseRN · Jan 15, 2013

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.

mmc51264, BSN, MSN, RN · Jan 28, 2013

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.

Studentray · Jan 31, 2013

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.