Orthopaedics at The Bon Secours, Cork Margaret Sheehan Velthuysen CNM1

Orthopaedic Unit – The Team Consultants Mr David Mulcahy – Hip and knee arthroplasty, foot surgery Mr Kieran Barry – Hip and knee arthroplasty Mr Pat Fleming – Shoulder and upper limb surgery Mr Stephen Brennan – Hip and Knee arthroplasty, lower limb surgery Nursing Ward and Theatre - CNM2, CNM 1’s, Staff Nurses, BSc Nursing Students, Healthcare Assistants Physiotherapy, Pharmacy, Pastoral Care, Dietician, Clinical Nurse Specialists, Infection Prevention & Control team, Occupational Therapy and Supporting Allied Professionals

Pre procedure Assessment and Workup Assessing patient ‘Risk for poor outcome’ - Early identification Review of existing co-morbidities e.g. Cardiac, Diabetes, Renal, Resp. Anaesthetic complications – ASA Risk of Infection and delayed wound healing e.g. poor nutrition, acute or chronic infections, skin status, poor hygiene Venous Thromboembolism Medication Management Post discharge support

Wound Care Dressing changes Subcuticular suture Removal of Clips Care of wound instructions in Discharge Letter and in Hip/Knee Replacement Booklet If patient presents febrile, wound ooze, redness, cellulitis – contact Orthopaedic surgeon

Managing Pain, Swelling and Bruising Discharge prescription for Analgesia – usually 2 week supply Regular analgesic medication Reduce swelling – Ice packs and rest Don’t overdo it! Anticoagulation Xarelto – Hip Arthroplasty 35 days Knee Arthroplasty 14 days

Avoiding Constipation Use of opiate analgesia and reduced mobility Adequate hydration Balanced diet which includes fibre Mobility Laxatives as necessary – ‘Avoiding Constipation’ information sheet

Thank You References: National Institute for Health and Clinical Excellence (NICE) Clinical Guideline 65 (2008), The Management of Inadvertent Perioperative Hypothermia in Adults Infection www.nice.org.uk/nicemedia/live/11962/40432/40432.pdf Preventing Surgical Site Infections Key Recommendation for Practice Developed by the Joint Royal College of Surgeons in Ireland/Royal College of Physicians of Ireland Working Group on Prevention of Surgical Site Infection (2012) http://www.hpsc.ie Health Protection Scotland Surgical Site Prevention Bundle www.hps.scot.nhs.uk/haiic/ic/ssipreventionbundle.aspx