Nursing management of the surgical orthopaedic patient

Orthopaedic patients can vary from elective to emergency patients, they can be otherwise healthy or require treatment of other more serious comorbidities. Their nursing requirements evolve around the need to provide adequate support and perhaps analgesia. For emergency patients, the orthopaedic element of their condition is often not the first thing to be treated and as nurses we need to know how to nurse these patients during that time. Orthopaedic procedures often require planning to ensure selection of the correct sized instrumentation. Diagnostic such as x-rays or CT are often utilised to help with this. ​

As with all patients, warming provided to the patient is essential. This can be given through a variety of means, including passive and active warming. Different orthopaedic procedures require specific handling in the preparation period, particularly fractures. Some will require careful handling not to displace a fracture whereas other will benefit from some body weight pull when the limb is hung to aid in fracture reduction, knowing the difference between these scenarios is important and will play a part in patient outcomes. Surgical site infections (SSI) are when an infection occurs in the surgical wound or deeper tissues, spaces or organs in the operative area. Infections noted up to a year post operatively when implants have been placed are classed as a SSI. For our orthopaedic patients, depending on the magnitude of infection, this can be devastating if the implants then require removal. The risks for SSI development is multi-factorial and prevention involves the whole team at the practice. As nurses we can play a large part in the prevention of SSI and reduction in risks. ​

Post operatively it is essential to provide adequate analgesia to the orthopaedic patient. Utilising multi-modal analgesia is recognised as the best way to interrupt the pain pathway and different site.​

As the patient goes through their recovery period, different levels of physio will aid in the recovery process. This could start with simple massage and ROM exercises through to more advanced movements and perhaps hydrotherapy for the right patient. In the immediate post operative period this is aimed at reduction in swelling and light weight bearing. As the healing process continues physio techniques are aimed at support of the muscles surrounding the area to reduce muscle wastage and keep joints moving well. Exercises can then be aimed at strengthening the muscles to aid in return of normal function.​

​Pre-operative considerations:​

• Understand the difference between elective orthopaedic conditions and emergency orthopaedic conditions ​
• Be able to recognise the nursing requirements of patients
• Understand the different diagnostic techniques available to aid in surgical planning​
• Understand the urgency of different procedures when planning theatre slots​
• Intra-operative considerations:​
• - Understand the need for patient warming and how this can be accomplished​
• - Be able to recognise the nursing requirements of different orthopaedic conditions in the preparation period​
• - Understand how to manage orthopaedic cases to reduce the risk of surgical site infection​
• Post-operative considerations:​
• - Understand the benefits of multi-modal analgesia for orthopaedic patients​
• - Understand how the application of physiotherapy techniques can aid in the return to normal function in the orthopaedic patient​