Orthopaedics at The Bon Secours Cork Margaret Sheehan

Orthopaedics at The Bon Secours, Cork Margaret Sheehan Velthuysen CNM 1

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 - CNM 2, 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 ØReview of existing co-morbidities e. g. Cardiac, Diabetes, Renal, Resp. ØAnaesthetic complications – ASA ØRisk of Infection and delayed wound healing e. g. poor nutrition, acute or chronic infections, skin status, poor hygiene ØVenous Thromboembolism ØMedication Management ØPost 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 ØXarelto – 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. 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