Rotations : Orthopaedics

Rotations : Orthopaedics

Orthopaedics refers to post operative care of patients. Conditions you are likely to see (In larger hospitals they may split orthopaedics conditions into separate wards):

You should familiarise yourself with restrictions and post op rehab. As a first year they will not expect you to know all these operations and their restrictions but getting a head start will make you feel more confident and comfortable with normal protocols.

Points to remember:

  • Always read notes
  • Enquire with nursing staff how the patient is getting on/ what there plan for the day is.
  • Ideally you want to mobilise someone when they have minimal pain (normally 1/2 hour after pain relief). If a patient has minimal pain they are less likely to faint (first and second years don’t panic your educators aren’t going to give you complicated patients to begin with!!) Try to liaise with n/s regarding pain medication.
  • Get the nursing staff on your side try to pre arrange a time so that they have a chance to do all there bits (ie washing/meds/d/c).
  • Always checks obs  O2 sats/BP/HR.
  • Weight bearing status. what is the patient’s status are they allowed to weight bear as tolerated (WCBT), partial weight bear (PWB), toe touch weight bear (TWB) or full weight bear (FWB) ?
  • What mobility do the patients use or what do they need? If a patient need to non weight bear (NWB) they will need a frame or EC to do so.
  • The aim is to discharge a patient safely with all the necessary information, advice and safety checks (ie do they have stairs at home? Yes. Then have you assessed that they can get up and down the stairs safely?)

Responsibilities and Expectations

This varies with educators and the opinions below reflect that of their authors and should be taken as a guide. Your initial communication with educators should discuss what is expected of you and you will often get brownie points for asking if there is any specific reading you should do prior to placement to prepare you. As a student it is tough because you don’t know any of the nurses who will always seem busy. Be polite and prepare what you wish to ask so that you don’t forget questions.

 

Year 1:
  • Learn basic anatomy. May be asked to look at an X-ray at look at basic anatomy.
  • May be asked to read patient notes and report back findings. (look for observations are these within normal ranges/what operation/any restrictions)
  • Will often watch how your educator performs assessments.
  • May be asked to perform assessment when feeling more comfortable (ie later in placements)
  • Mobilise patients with supervision (have you check notes/introduced yourself/gained consent/asked nursing staff how the patient has been doing).
  • Asked to carry out a pre operative information visit. show patient how to use EC safely, give information about surgeries. explain transfers for post op.
  • Towards end of placement mobilise patients independently (Day 3/4 post op.)
  • Often asked to perform reflective writing/presentation
Year 2:
  • Asked to perform assessment day 1,2,3 post op (Check obs particularly on day 1 as these can often be variable. Low blood pressure increases the likelihood of the patient feeling unwell. See “Placement Skills” section on how to get a patient out of bed).
  • Provide mobility aids. Day 1 hip and knees will need a zimmer frame.
  • Assessing day 1’s – do they have a nerve block? check dermatomes and myotomes. If they can ‘t lift their leg or feel it they are going to find it hard to walk on it!!
  • Review notes
  • Discuss notes with MDT including doctor in ward round.
  • Write a discharge summary for follow up physio.
  • Assess patient safety on stairs
  • Manage a small case load. organise time and visits to these patients(Timing with pain relief is useful here/who is priority? Who could potentially be discharged?
  • Follow ward round and feedback on your patients.
  • Often asked to perform reflective writing/presentation
Year 3:
  • Asked to perform assessment, treatments and progressions.
  • Explain and analyse X-Rays
  • Clear understanding of all obs and there potential effects
  • Mobilising patients Day 1 with nil supervision.
  • Managing decent caseload
  • Good understanding of conditions.
  • Often they will ask you to perform case study or presentation.
Rotation
So they have let you loose!!! You will be expected to assess, treat and discharge patients however will have good guidance from seniors.
  • Need to assess notes, X-Rays, reports before seeing patient.
  • Attend ward round
  • Attend MDT meetings.
  • Mobilise and discharge up to ten patients daily (Some may be pre-op visits)
  • Prioritise your caseload (When are they going to surgery/ when do they get back? Hospital guidelines normally insist that the patient must be on the ward for 4 hours before discharge. Mobilising a  patient an hour after surgery may not be wise!! Check they have had something to eat, have they been up to the loo? Have they had any complications?)
  • Treat a variety of conditions including complicated Hip/knee replacements.

Resources

  • Normally you chat through some objectives within the first week.   Possible Objectives Click here
  • Example of a Physiotherapy Pre-assessment total knee replacement (TKR)

 

Share Button

Why not check out...

Close
Please support the site
By clicking any of these buttons you help our site to get better