1. Orthopaedics at The Bon Secours, Cork
Margaret Sheehan Velthuysen CNM1

2. 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

3. 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

4. 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

5. 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

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

7. Thank You
References:
National Institute for Health and Clinical Excellence (NICE) Clinical Guideline 65 (2008), The Management of Inadvertent Perioperative Hypothermia in Adults Infection
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)
Health Protection Scotland Surgical Site Prevention Bundle