1. Total Joint Reconstruction
Nursing Considerations

2. What Is the Plan? Age, weight, allergies Diagnosis and procedure
Laterality
Previous surgery
Type of joint
Revision
Cell saver for hip revision
Type and screen for hips, blood consent
Previous xrays available
Nerve blocks

3. Room Set Up? Meds Beds Equipment Implants Local, abx irrigation
Hip: hip vice, peg board,
Knee: alvarado
Equipment
Electrocautery
Tourniquet
Cellsaver
Cement mixer foot pedal
X ray viewing
Implants
Have all implants available

4. Revisions
Plan for a longer surgery

5. Nerve Block
May be performed prior to surgery to help with post-op pain

6. Risk for Infection Limit traffic Togas Total joint attire
Limit people in room
Check integrity of wrapping on trays
Infection is devastating to a patient
Multiple surgeries, increase hospital stay
I&D, revision, explant, fusion

7. Assessment Verify consent
Verify laterality with H&P, x rays & with patient
Verify site marking
Labs, EKG
Skin integrity
Rash, abrasions at surgery site
ROM
Pain

8. Positioning Hip Knee Shoulder Be careful with joints while moving
Lateral with hip vice or peg board
Patient position can affect placement of implants
Supine for anterior approach
Knee
Supine with alvarado knee holder
Place tourniquet
Shoulder
Beach chair or lateral on fracture table
Be careful with joints while moving

9. Intra op Monitor blood loss Suction Lap sponges Monitor field
Bone cement
Methyl methacrylate
Room temp
Keep time

10. Implants Verify implants before opening Handle gently Document
Reference/reorder number
Lot number
Serial number
Expiration date
Description
Size

11. Post Op Pain Immobilization
Hip: abduction pillow for posterior approach
Knee: knee immobilizer, cold pad