Total Joint Reconstruction Nursing Considerations

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

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

Revisions Plan for a longer surgery

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

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

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

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

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

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

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