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by maunikam maunikam (New) New


I'm starting my preceptorship in the Surgical/Orthopedics unit soon. Any good advice from those experienced RNs in Ortho?

Double-Helix, BSN, RN

Specializes in PICU, Sedation/Radiology, PACU. Has 10 years experience.

In Ortho, you'll see a lot of post-operative patients. Knee and hip replacements will be common, as well as shoulder repairs. For equipment, expect to see internal fixators, CPM machines, and traction. It would probably be helpful for you to brush up on the use of these devices as well as different types of traction. With hip replacements, there are certain ways that the patient has to move, roll, get out of bed, etc. and types of movement that they need to avoid (such as not crossing the legs). You should definitely know how to safely transfer and move a patient who is post-hip replacement.

As far as general surgical care, you'll want to know some basics about wound care, surgical site care, post-operative ambulation schedules, incentive spirometry, etc. Don't be afraid to ask questions. If it's a slow day, ask if it's possible to go to the OR and observe an ortho surgery.

Well, you shouldn't see a lot of internal fixators, because they are internal however; you will see some external fixators or ex-fix for short. They are rods that brace pins that have been placed in bone for reduction. Chances are, they will be in a significant amount of pain from the manipulation of their fracture and reduction during surgery.

Good luck!

have a good handle on clotting studies and anticoagulation meds-- many ortho patients are on prophylactic anticoagulation. know the difference between a heparin and warfarin, what usual dose ranges are, and what labs tell you what about each. be prepared to teach the patient about his anticoagulation, and do not call it "blood thinners" even if you hear someone else do it.

Thank you for all the insight on equipment, procedures and anticoagulants. I brushed up on most of all the different types of surgeries and positioning. What limits certain post op patients have like hip replacement surgeries not bending 90 degrees, crossing legs, turning toes inward...things like that. I'm on day 3 of my preceptorship and love it!