Manual for an Orthopedic Nurse Created by: Lauren Perryman
Manual for an Orthopedic Nurse Created by: Lauren Perryman
Table of Contents iii
Introduction ................................................................................................................... v
Chapter 1 – Setting up the Office on Clinical Days .......................................... 1
1.1 Turning on the computers ........................................................................................... 3
1.1.1 Logging into the computers ............................................................................... 3
1.1.2 Logging into AOA’s imaging program.............................................................. 4
1.1.3 Logging into BOSHA’s imaging database ........................................................ 4
1.1.4 Pulling up informational websites ..................................................................... 4
1.2 Access and pull up daily schedule .............................................................................. 5
1.3 Gathering important forms .......................................................................................... 5
1.4 Gathering Vials for Injections ..................................................................................... 6
1.5 Patient rooms .............................................................................................................. 6
1.5.1 Stocking patient rooms ...................................................................................... 6
1.5.2 Cleaning the patient rooms ................................................................................ 7
Chapter 2 – Procedures on Clinical Days ............................................................. 9
2.1 Types of Patients ....................................................................................................... 11
2.1.1 New Patients .................................................................................................... 11
2.1.2 Follow-up Patients ........................................................................................... 11
2.1.3 Pre-op Patients ................................................................................................. 12
2.1.4 Post-op Patients ................................................................................................ 12
2.1.5 Test Result Patients .......................................................................................... 12
2.2 Rooming Patients ...................................................................................................... 12
2.2.1 Retrieving the Patient ....................................................................................... 13
2.2.2 Recording the Blood Pressure .......................................................................... 13
2.2.3 Recording the Pulse Rate ................................................................................. 14
2.2.4 Taking the Respiration Rate ............................................................................. 14
2.2.5 Gathering Other Relevant Information from the Patient ................................. 15
2.2.6 Proper Attire for Patient ................................................................................... 15
2.2.7 The Light System ............................................................................................. 15
2.3 Injections ................................................................................................................... 16
2.3.1 How to Draw the Injection ............................................................................... 16
2.3.2 Shoulder – Subacromial Space ........................................................................ 16
2.3.3 Shoulder – Glenohumeral Space ...................................................................... 17
2.3.4 Shoulder – Acromioclavicular Joint ................................................................ 17
2.3.5 Elbow – Olecranon Bursitis ............................................................................ 17
2.3.6 Elbow – Lateral Epicondylitis ......................................................................... 17
2.3.7 Elbow – Medial Epicondylitis ......................................................................... 18
2.3.8 Elbow – Cubital Tunnel ................................................................................... 18
2.3.9 Wrist – Carpal Tunnel ...................................................................................... 18
2.3.10 Wrist – Joint ................................................................................................... 18
2.3.11 Wrist – De Qeurvain’s Tenosynovitis ............................................................ 19
2.3.12 Hand – First Metacarpal Space ..................................................................... 19
2.3.13 Hand – Metacarpal – Phalangeal Joint........................................................... 19
2.3.14 Hand – Trigger Finger ................................................................................... 19
iv Manual for an Orthopedic Nurse
2.3.15 Hip – Trochanteric Bursitis ............................................................................ 20
2.3.16 Knee-Joint ...................................................................................................... 20
2.3.17 Ankle – Joint ................................................................................................. 20
2.3.18 Foot – Peroneal Tendonitis ........................................................................... 20
2.3.19 Ganglion Cyst ................................................................................................ 21
2.4 Forms for roomed patients ....................................................................................... 21
2.4.1 Prescription medications forms ........................................................................ 21
2.4.2 Physical therapy forms ..................................................................................... 21
2.4.3 Surgery forms................................................................................................... 21
2.4.4 Imaging forms .................................................................................................. 22
2.5 Durable Medical Equipment ..................................................................................... 22
2.5.1 Wrist Brace ...................................................................................................... 22
2.5.2 Arm Sling ......................................................................................................... 22
2.5.3 Foot Brace ........................................................................................................ 23
Chapter 3 – Procedures on Non-Clinical Days ................................................. 25
3.1 Fielding Calls from Patients...................................................................................... 27
3.2 Fielding Calls from Home Health ............................................................................. 27
3.3 Fielding Calls from Surgery Implant Reps .............................................................. 28
3.4 Fielding Calls from Hospitals ................................................................................... 28
3.4.1 Surgery Department ......................................................................................... 28
3.4.2 Pre-Assessment Department ............................................................................ 28
3.4.3 Hospital Administration Department ............................................................... 29
3.5 Surgical Assists ......................................................................................................... 29
3.6 Scheduling Surgeries ................................................................................................ 29
Index .............................................................................................................................. 31
References ................................................................................................................... 33
Introduction v
Introduction
Dr. Danny Nicholls, D.O. is an orthopedic surgeon at Arlington Orthopedic Associates (AOA).
He requires a least one nurse to assist with managing patients and their needs. In order for the
orthopedic office to run efficiently the nurse must be fully aware of his or her duties and capable
of doing them. This manual will outline all of the duties of an orthopedic nurse working for Dr.
Nicholls.
Preparing the office is the first thing that should be done at the beginning of each day in order to
prepare for the arrival of patients. Chapter one will outline everything that should be done prior
to the arrival of the first patient.
Clinical days are fast-paced and require the nurse to stay alert and be ready for any situation that
might happen. Chapter two of this manual will go into detail about the duties and requirements
that Dr. Nicholls will expect of his nurse. Because clinical days involve a lot of interaction with
patients and their needs will be various, chapter t two has a lot more material in it than the other
two chapters.
The days that Dr. Nicholls does surgery are non-clinical days and chapter three of this manual
will outline the requirements of his orthopedic nurse for these days. Non-clinical days involve
fielding calls from many sources and being able to represent Dr. Nicholls in an appropriate
manner.
Refer to the manual often and read the chapters carefully.
Chapter one – Setting up the Office on
Clinical Days
Setting up the Office on Clinical Days 3
Setting up the office is the first thing that should be done
in the morning. Arrive at the office thirty minutes before
the first patient is scheduled to arrive so that you have
plenty of time to set everything up. Because the nurse’s
station is the hub of activity in the office, everything
needs to be in its proper place before the first patient
arrives. Refer to Figure 1.1 for the layout of the nurse’s
station.
Setting up the office includes:
Turning on the computers and opening programs
Accessing the schedule
Setting out all the script pads and important forms
Setting out vials of injectable solutions
Setting up patient rooms
1.1 Turning on the Computers
The first thing you should do in the morning is turn on both of the computers at the nurse’s
station. You will have a personal computer and there will be a diagnostic computer. Your
personal computer has access to the schedule and will do other basic functions. The diagnostic
computer has programs installed on it that will access AOA’s imaging database along with
Baylor Orthopedic and Spine Hospital at Arlington’s (BOSHA) imaging database. The
diagnostic computer will also be able to access the schedule as well. You must log into both
AOA’s imaging database and BOSHA’s imaging database in the morning so that it will be
accessible for Dr. Nicholls throughout the day.
1.1.1 Logging into the Computers
Follow these instructions for logging into AOA’s computers:
1. Turn on the computer.
2. A dialog box will appear, asking for your username and password. Type in the personal
username and password assigned to you and press enter.
3. If the system displays “Access denied” you may have typed your username or password
incorrectly. Try again.
4. If you are repeatedly denied access even though you are typing your password correctly,
call the Help Desk at ext. 5308.
Figure 1.1: Diagram of nurse’s
station. A = Diagnostic Computer.
B = Personal Computer.
4 Manual for an Orthopedic Nurse
1.1.2 Logging into AOA’s Imaging Program
Follow these instructions for logging into AOA’s imaging program:
1. On the diagnostic computer’s desktop, find the icon labeled “E-film.”
2. Click on the icon.
3. A dialog box will appear, prompting you for your username and password. Type in the
general username and password assigned to you and press enter.
4. If the system displays “Access denied” you may have typed your username or password
incorrectly. Try again.
5. If you are repeatedly denied access even though you are typing your password correctly,
call the Help Desk at ext. 5308.
1.1.3 Logging into BOSHA’s Imaging Database
Follow these instructions for logging into BOSHA’s imaging database:
1. On the diagnostic computer, open your web browser (Internet Explorer or Mozilla).
2. Find the icon on the desktop labeled “VPN Portal.”
3. A dialog box will appear, prompting you for your username and password. Type in the
username and password you assigned to you and press enter.
4. After logging in, the default work list is displayed.
1.1.4 Pulling up Informational Websites
External medical websites will be used throughout the day for various purposes. Post-operative
patients will need packets that explain how to take care of their surgery-site. Dr. Nicholls might
also want to print off packets for patients that have questions about their alternative options. Pull
up the following websites on the diagnostic computer so that they are easily accessible
throughout the day:
Http://www.aaos.org
Http://www.webmd.com
Http://www. methodisthealthsystem.org
Http://baylorhealth.com
1. After going to http://baylorhealth.com find the tab at the top of the page titled
“Physicians and Locations” and click on it.
2. Click on “Find a Location.”
3. Click on “See All Facilities.”
4. Under the heading “Baylor Affiliates, Leases & Joint Ventures” find “Baylor
Orthopedic and Spine Hospital at Arlington” and click on it.
Setting up the Office on Clinical Days 5
1.2 Access and Pull up Daily Schedule
Maintaining and monitoring the schedule is important. Because the day revolves around what
patient is going to be seen and when, you must make sure that a patient that will require at least a
thirty minute appointment isn’t in a fifteen-minute timeslot, or vice versa. Section 2.1 in this
manual will describe the types of patients that can be seen and how long an appointment for each
should be.
Once you have looked over the schedule and made any necessary changes to it you need to print
it off and tape it to the counter of the nurse’s station so that it is easily accessible. Follow these
instructions to access and print off the daily schedule:
1. On the personal computer, find the icon labeled “ANITA” on the desktop and click on it.
2. A menu will appear. Find and click on “schedule.”
3. The schedule for the current day should appear. If it does not appear, use the interactive
tools to navigate to the current day.
4. At the top left of the screen, find and click on “file.”
5. Click on “print.” The schedule will be printed off at the printer next to your personal
computer.
6. Tape the schedule to the counter of the nurse’s station where it is easily seen.
1.3 Gathering Important Forms
There are many different forms that Dr. Nicholls or a patient will need to fill out. Have these
forms ready and organized at the beginning of the day is important. Gather the following forms
and organize them on the counter of the nursing station so that they are easily accessible:
AOA’s physical therapy script pad
All external facilities’ physical therapy script pads
Prescription medication script pad
Patients’ work status forms
Image ordering forms
Patient questionnaire
School excuse notes
Surgery order form
6 Manual for an Orthopedic Nurse
1.4 Gathering Vials for Injections
A patient might need an injection during their appointment. It will be your job to prepare the
injections for Dr. Nicholls to administer. The injections consist of differing amounts of these
three substances:
Marcaine 0.25%
Xylocaine 1.0%
Kenalog 40 mg
Set out these vials on the counter of the nurse’s station so that you have easy access to them
whenever you need them.
1.5 Patient Rooms
Maintaining the patient rooms is your job. You must make sure that they are kept clean and fully
stocked for the convenience of both Dr. Nicholls and the patients. This section will explain
exactly what you need to stock the rooms with and how to clean the rooms once a patient leaves.
1.5.1 Stocking Patient Rooms
Each patient room is to be kept fully stocked. Before the first patient arrives, make sure that all
of the following items are in either the drawers or cabinets of each room:
Freeze spray
Gloves (small, medium, large)
Sterile applicators
Suture removal kits (for stitches and
staples)
Bottled rubbing alcohol
Saline solution
Hydrogen peroxide
Tape (various sizes)
Xeroform
Betadine swabsticks
Neosporin and Bacitracin ointments
Alcohol swabs
Steristrips (all sizes)
Steristrip adhesive
Dressing scissors
All-purpose scissors
Gauze (various sizes)
Sterile gauze
Adaptic dressing
Adhesive Telfa dressings (various
sizes)
Non-adhesive Telfa dressings
(various sizes)
Ace wraps (various sizes)
Cotton padding
Conforming roll gauze
Band-Aids (various sizes)
Soft-cling roll gauze
Coban wrap
Paper shorts (various sizes)
Paper tube tops (various sizes)
Gowns
Towels
Wash cloths
Table paper
Setting up the Office on Clinical Days 7
Paper pillow cases
Chucks
Germicidal wipes
Sharps container
1.5.2. Cleaning the Patient Rooms
Before the first patient arrives, every room should be prepared. Each room should also be
cleaned after each patient leaves. The following should be done to maintain cleanliness in the
patient rooms:
1. Tear off the paper cover on top of the bed.
2. Replace the bed cover with new, clean, paper.
3. Throw the old bed cover away.
4. If the pillow was used, take off the paper pillowcase.
5. Replaced the paper pillowcase with a new, clean, one.
6. Throw the old pillowcase away.
7. Throw any other trash into the trash can.
8. Throw any used syringes, disposable scalpels, stitch/staple removers in the sharps
container.
9. Throw anything with the patient’s bodily fluids on it in the biohazard container.
10. If any bodily fluids were excreted:
a. Put on gloves.
b. Wipe them up with a paper towel.
c. Throw paper towel in the biohazard container or flush down the toilet.
d. Clean surfaces with antibiotic wipes.
Chapter Two – Procedure on Clinical Days
Procedure on Clinical Days 11
Clinical days are fast-paced and require focus. You must be able to interact with the patients in
an appropriate manner while also managing any last-minute schedule changes or fielding calls.
This section will explain the following:
What types of patients Dr. Nicholls sees and how long each of their appointments should
be
The procedure you need to follow when rooming patients
The light system that is used to communicate with the front desk and Dr. Nicholls
The list of forms that some patients should receive after they are roomed
The ingredients of each injection
The different types of durable medical equipment and the specific application of each
2.1 Types of Patients
Dr. Nicholls sees a variety of different ailments but, for scheduling purposes, there are five types
of patients:
New patients
Recheck patients
Pre-op
Post-op
Test results
2.1.1 New Patients
There should be at least five new patients scheduled for every half day of clinic. A half day is
considered the time from the morning until lunch or the time from lunch until the end of the day.
New patients should be allowed a thirty minute appointment. New patients must also fill out
information regarding their current health insurance, billing address, etc. All this information is
on the “New Patient” form that patients need to fill out.
2.1.2 Follow-up Patients
Follow-up patients are patients that have already seen Dr. Nicholls once, and are seeing him
again about the initial complaint. Follow-up patients should already have all of their personal
information on file. Follow-up patients should be in a fifteen minute time slot for an
appointment. Dr. Nicholls will want to know how they are doing since their last appointment.
He will also want to know if the regimen he prescribed them is working.
12 Manual for an Orthopedic Nurse
2.1.3 Pre-op Patients
Pre-op patients are patients that already have surgery scheduled for the next day or within the
next few days. Dr. Nicholls likes to make sure that the patient knows what to expect and to go
over any last-minute concerns with the patient. If a brace is to be used following the operation
Dr. Nicholls will go over the guidelines of using it with them and it will be your job to make sure
that they know how to remove and reapply it. Pre-op patients should be scheduled to have a
thirty minute appointment.
2.1.4 Post-op Patients
Post-op patients are patients that just recently had surgery within the last day or two. Dr.
Nicholls will want to know how they are doing and if they are having any adverse reactions to
the pain medications he prescribed them. He will then have them practice their set of exercises
in the room to make sure that they know exactly what to do. Post-op patients should be
scheduled to have a thirty minute appointment.
2.1.5 Test Result Patients
Test result patients are patients that have had imaging done at other facilities and are there to
hear the results of their imaging. Dr. Nicholls will want to know how they have been since they
had their imaging done. If the patient had the imaging done at a facility that is not a part of
AOA, the patient should already have had their imaging results sent to the office. If the patient
did not have this done you need to call the facility immediately and request for the results to be
sent to Dr. Nicholls’s office so that he can discuss them with the patient.
2.2 Rooming Patients
It is your duty to room the patients. To room a patient you will go to the front of the office,
retrieve the patient, and put him or her in the next available room. There are four patient rooms
in the office, each labeled with their corresponding number. In order to maintain efficiency,
using the rooms in a linear fashion will reduce any confusion between you and Dr. Nicholls. In
other words, the first patient goes in room one, the second in room two, and so on.
This section will describe the proper procedures to room patients, how to take their vitals,
information that you should gather, how to make sure the patient is in proper attire, and how to
communicate with the light system.
Procedure on Clinical Days 13
2.2.1 Retrieving the Patient
When the next patient to be seen has arrived, the front desk will alert you via the light system.
When you see this signal you are to follow these instructions:
1. Get the patient’s chart.
2. Skim the chart to make sure all the information is complete.
3. Double check to make sure that the patient’s complaint is something that Dr. Nicholls
sees.
4. Go into the waiting room and call the patient’s name.
5. If the patient’s complaint is not one that Dr. Nicholls sees:
a. Alert the patient of the situation.
b. Advise the patient that if they insist on being seen they will still have to pay for
the appointment.
6. Put the patient in the next available room.
If patients do not have all the information filled out when you go to retrieve them, inform them
that they must fill out the required information before they can be seen.
2.2.2 Recording the Blood Pressure
Once you have put the patient in the appropriate room, the patient’s blood pressure must be
taken. The office has two types of blood pressure machines that you can use. One machine is
digitally read, and the other is manually run and requires the use of a stethoscope.
To operate the digital blood pressure pump:
1. Wrap the sleeve around the patient’s arm with the air tube on the inside bend of the
elbow.
2. Fasten the sleeve with the Velcro straps, keeping careful to leave a small amount of
space.
3. Turn on the digital screen.
4. Pump air into the sleeve.
5. Stop pumping air into the sleeve when you hear the machine beep.
6. Wait for the machine to finish calculating the blood pressure.
7. Read off the results.
The digital blood pressure pump will also give you the pulse rate of the patient. Section 2.2.3
will address taking the pulse.
To operate the manual blood pressure pump:
1. Wrap the sleeve around the patient’s arm with the air tube on the inside bend of the
elbow.
14 Manual for an Orthopedic Nurse
Do NOT use your thumb to take the patient’s pulse. The pulse in your
own thumb will give an inaccurate result.
2. Fasten the sleeve with the Velcro straps, keeping careful to leave a small amount of
space.
3. Place the ear buds of the stethoscope in your ears.
4. Using the stethoscope, find the pulse on the inside bend of the elbow.
5. Pump air into the sleeve.
6. Stop pumping air when you no longer hear the pulse.
7. At this point, look at the gauge and read the number. This is the systolic.
8. Slightly open the valve to slowly release air from the sleeve.
9. When you hear the heartbeat again look at the gauge and read the number. This is the
diastolic.
Once you have successfully taken the blood pressure, record the systolic over diastolic in the
patient’s chart.
2.2.3 Recording the Pulse Rate
After you have taken the patient’s blood pressure you must take the patient’s pulse. If you used
the digital machine to take the blood pressure it will have given you the pulse. If you used the
manual pump, you must manually take the pulse.
The pulse is a measure of heart beats per minute. You can choose to count the number of heart
beats for a full minute, or you can take it for thirty seconds and multiply by two, or you take it
for fifteen seconds and multiply by four. Each method will give an accurate pulse.
Follow these instructions to take the pulse:
1. Place your index finger and middle finger on the radial side of the wrist.
2. Using your two fingers, find the heartbeat.
3. Using a clock or watch with second-hands, count the number of heartbeats.
As stated above, if you counted the number of heartbeats over an interval less than a minute,
multiply appropriately to find the number of heart beats per minute. Record the pulse rate in the
patient’s chart.
2.2.4 Taking the Respiration Rate
Once the blood pressure and pulse have been taken you must record the respiration rate of the
patient. Just as with the pulse, respiration is recorded as the amount of breaths per minute. You
can count the number or breaths for a full minute, or you can count for thirty seconds and
multiply by two, or count for fifteen seconds and multiply by four. Each of these methods will
give an accurate respiration rate. Follow these instructions to take the respiration rate:
Procedure on Clinical Days 15
Figure 2.1 – The
light system.
1. Have the patient sit up with his or her back straight.
2. Watch the patient’s chest and record every intake of breath.
As with the blood pressure and pulse, multiply if necessary to reach the number of breaths per
minute. Record the respiration rate in the patient’s chart.
2.2.5 Gathering Other Relevant Information from the Patient
Once you have recorded the blood pressure, pulse, and respiration rate of the patient in the chart,
ask pertinent questions to gather exactly why the patient is there. If the patient is a new patient
inquire as to why they are there to see Dr. Nicholls. Record everything that the patient says
regarding his or her symptoms on the patient’s chart. Section 2.1 describes the different types of
patients and what kind of information Dr. Nicholls will want to know.
2.2.6 Proper Attire for Patient
Patients that require an X-ray will need the appropriate attire for the X-ray room. The office has
paper shorts and tube tops available for patients’ needs. If you see that a patient is wearing
clothing over the affected area, inform the patient that he or she will have to change prior to
getting an X-ray. If the X-ray is to be done anywhere on the waist down, provide them with a
pair of paper shorts to change into. If the X-ray is to be done on the torso, men can take their
shirt off and women can wear a paper tube top that you provide them with. Section 2.2.7 will
explain how patients are to use the light system to communicate that they are done with imaging.
2.2.7 The Light System
The light system is a square block of four different buttons. Each
button is a different color and signifies a different thing. Pressing a
button will cause it to light up with its color and pressing it again
causes the light to turn off. Figure 2.1 shows a picture of the light
system.
When a patient is told to go to the X-ray room you will press the red
button. Inform patients that when they are done and have returned to
their room they need to press the red button again to turn it off. This
tells Dr. Nicholls that they are back in the room and ready to be seen.
The yellow button on the light system tells Dr. Nicholls which room has the next patient to be
seen in it.
The green button tells Dr. Nicholls which room has the second patient in line to be seen.
16 Manual for an Orthopedic Nurse
The white button is not used.
2.3 Injections
If Dr. Nicholls wants to give a patient an injection he will tell you the body part and you will
need to mix the ingredients of the injection for him. Each injection site requires its own
ingredients with different size needles. This section will tell you how to draw the syringe and
what to put in each syringe per body part.
Once you have made the injection, place it in the patient’s room so that Dr. Nicholls can use it
when he returns to the room. Sometimes Dr. Nicholls will want different ingredients in the
injection for a specific site. When this happens he will tell you exactly what to put in it.
2.3.1 How to Draw the Injection
Before drawing the injection collect the vials needed, the appropriate size syringe, an alcohol
swab, a 16-gauge needle, and the appropriate size needle for injecting. Follow these instructions
to draw in injection:
1. Swab the top of all vials with an alcohol swab.
2. Attach a 16-gauge needle to the appropriate size syringe.
3. To avoid a vacuum, push the same amount of air that you will be drawing out into each
vial.
4. Draw the correct amount into the syringe from the vial.
5. Detach the 16-gauge needle from the syringe.
6. Attach the appropriate size needle to the syringe.
To set up for the injection in the patient’s room the physician will need:
Topical vacocoolant spray
Betadine swab stick
Alcohol swab
4x4-gauze
Band-Aid
It is sometimes necessary to use a 3 ½-inch needle on an obese patient in order to penetrate the
fatty tissue. If needed, have the 3 ½-inch needle available for Dr. Nicholls at the time of setup.
2.3.2 Shoulder – Subacromial Space
The subacromial shoulder space injection requires the following ingredients in the syringe:
Procedure on Clinical Days 17
3cc Marcaine 0.25 %
3cc Xylocaine 1.0 %
1cc Kenalog 40 mg
Attach a 22-gauge 1 ½-inch needle to the syringe.
2.3.3 Shoulder – Glenohumeral Space
The glenohumeral shoulder space injection requires the following ingredients in the syringe:
1cc Xylocaine 1.0 %
1cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.4 Shoulder – Acromioclavicular Joint
The acromioclavicular shoulder space injection requires the following ingredients in the syringe:
0.5cc Xylocaine 1.0 %
0.5cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.5 Elbow – Olecranon Bursitis
The injection for olecranon bursitis of the elbow requires the following ingredients in the
syringe:
1cc Xylocain 1.0 %
1cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.6 Elbow – Lateral Epicondylitis
The injection for lateral epicondylitis of the elbow requires the following ingredients in the
syringe:
1cc Xylocaine 1.0 %
18 Manual for an Orthopedic Nurse
1cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.7 Elbow – Medial Epicondylitis
The injection for medial epicondylitis of the elbow requires the following ingredients in the
syringe:
1cc Xylocaine 1.0 %
1cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.8 Elbow - Cubital Tunnel
The injection for cubital tunnel of the elbow requires the following ingredients in the syringe:
1cc Xylocaine 1.0 %
1cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.9 Wrist – Carpal Tunnel
The injection for carpal tunnel of the wrist requires the following ingredients in the syringe:
1cc Xylocaine 1.0 %
1cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.10 Wrist – Joint
The injection for the wrist joint requires the following ingredients in the syringe:
0.5cc Xylocaine 1.0 %
1cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
Procedure on Clinical Days 19
2.3.11 Wrist – De Qeurvain’s Tenosynovitis
The injection for De Quervain’s Tenosynovitis requires the following ingredients in the syringe:
0.5cc Xylocain 1.0 %
0.5cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.12 Hand – First Metacarpal Space
The injection for the first metacarpal space of the hand requires the following ingredients in the
syringe:
0.5cc Xylocain 1.0 %
0.5cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.13 Hand – Metacarpal – Phalangeal Joint
The injection for the metacarpal – phalangeal joint of the hand requires the following ingredients
in the syringe:
0.5cc Xylocaine 1.0 %
0.5cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.14 Hand – Trigger Finger
The injection for a trigger finger in the hand requires the following ingredients in the syringe:
0.5cc Xylocain 1.0 %
0.5cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
20 Manual for an Orthopedic Nurse
2.3.15 Hip – Trochanteric Bursitis
The injection for trochanteric bursitis of the hip requires the following ingredients in the syringe:
1cc Xylocaine 1.0 %
1cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.16 Knee-Joint
The injection for a knee joint requires the following ingredients in the syringe:
2cc Marcaine 0.25 %
2cc Xylocaine 1.0 %
1cc Kenalog 40 mg
Attach a 22-gauge, 1 ½-inch needle, to the syringe.
2.3.17 Ankle – Joint
The injection for an ankle joint requires the following ingredients in the syringe:
0.5cc Xylocaine 1.0 %
0.5cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.3.18 Foot – Peroneal Tendonitis
The injection for peroneal tendonitis of the foot requires the following ingredients in the syringe:
0.5cc Xylocaine 1.0 %
0.5cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
Procedure on Clinical Days 21
2.3.19 Ganglion Cyst
The injection for a ganglion cyst on various parts of the body, post-aspiration, requires the
following ingredients in the syringe:
0.5cc Xylocaine 1.0 %
0.5cc Kenalog 40 mg
Attach a 25-gauge, 1 ½-inch needle, to the syringe.
2.4 Forms for roomed patients
After Dr. Nicholls has seen a patient he may want to order one or many of the following:
Prescription medication
Physical therapy
Surgery
Imaging
He will tell you what he wants to order and you need to collect the proper forms.
2.4.1 Prescription medications forms
When Dr. Nicholls wants to order a prescription medication for a patient he will tell you what he
wants to order. You need to write it on the script pad and give it to him to look over. He will
sign it and give it to the patient to fill.
2.4.2 Physical therapy forms
Dr. Nicholls will sometimes want to order physical therapy for a patient. Physical therapy is
usually prescribed for patients who are about to have surgery or as preventative treatment to keep
them from having surgery. If he wants a patient to have surgery he will tell you what regimen he
wants them to follow and you need to fill out the proper forms for the patient and give it to Dr.
Nicholls. He will then discuss it with the patient.
2.4.3 Surgery forms
If the patient and Dr. Nicholls have decided that the patient needs surgery Dr. Nicholls will tell
you to fill out the surgery form for the patient’s chart. You will also need to put together the
22 Manual for an Orthopedic Nurse
Figure 2.2 – The
wrist brace
surgery packet. This will be made on non-clinical days though, and is addressed in Chapter
Three.
2.4.4 Imaging forms
If the patient needs imaging done Dr. Nicholls will tell you what kind of imaging he wants done
and you will find the appropriate form for that specific type of imaging (MRI, EMG nerve
conduction study, CT, etc). You will then fill it out and give it to the patient. Dr. Nicholls will
discuss with the patient where he or she can have the imaging done.
2.5 Durable Medical Equipment
Any kind of brace, sling, cast, etc. is considered to be durable medical equipment (DME). If Dr.
Nicholls sees a patient and says that they need to start wearing durable medical equipment he
will tell you. It will be your job to get the equipment and show the patient how to apply it. This
section will explain the basic kinds of DME and how to apply them. The more heavy-duty
equipment will have instructions in their box that you will need to follow.
2.5.1 Wrist Brace
Retrieve a wrist brace from the supply closet and follow these instructions to
apply the wrist brace:
1. With the straps loosened, insert the hand into the brace. The thumb
should be placed through the thumb hole and the straps should be on
the back of the hand.
2. Starting with the strap farthest away from the hand, pull the straps
through the plastic loop to tighten.
3. Pull the straps over the back of the plastic loop and attach to the
Velcro.
4. Refer to Figure 2.2 for the final product.
Inform the patient that the brace will not prevent or eliminate risk of injury. Also tell the patients
that if they experience any discomfort while using the brace that they should immediately inform
Dr. Nicholls. Give the patients instructions on caring for their brace.
2.5.2 Arm Sling
Retrieve an arm sling from the supply closet and follow these instructions to apply the arm sling:
1. Place the arm in the sling pouch.
Procedure on Clinical Days 23
Figure 2.3 – The arm sling.
2. Pull the strap over the opposite shoulder.
3. Pull the strap through the double rings and secure.
4. Adjust the shoulder strap as necessary to ensure a
comfortable fit.
5. Refer to Figure 2.3 for the final product.
Inform the patient that the sling will not prevent or
eliminate the risk of injury. Also tell the patients that if
they experience any discomfort while using the sling that
they should immediately inform Dr. Nicholls. Give the patients instructions for caring for their
brace.
2.5.3 Foot Brace
Retrieve a foot brace from the supply closet and follow these instructions to apply the foot brace:
1. Loosen the straps and remove the liner and ankle cuff from the boot.
2. Place foot in liner.
3. Fasten the foot flaps on the liner first, making sure they are snug.
4. Wrap and fasten the leg portion of the liner, again making sure that it is snug from bottom
to top.
5. Trim the liner if necessary to get the best fit.
6. Spread the uprights using both hands and have the patient step into boot.
7. Align the uprights with the midline of the ankle.
8. Secure the boot straps, starting at the foot and working up the leg.
9. To inflate the air liner, turn in inflate/deflate knob clockwise.
10. Press and release the air bulb several times until liner is providing comfortable cushion
and support.
Chapter Three – Procedures on Non-
Clinical Days
Procedure on Non-Clinical Days 27
The days that Dr. Nicholls does surgery are non-clinical days. No patients will be seen in the
office on these days and you will be required to work at your desk. Non-clinical days are slower
and less varied than clinical days. You might find yourself doing the same thing multiple times
throughout the day for different patients. Your duties will include:
Fielding calls from patients
Fielding calls from home health
Fielding calls from surgery implant reps
Fielding calls from hospitals
Fielding calls from drug reps
Scheduling surgeries
Putting together surgery packets
This section will explain all these duties and provide you with the necessary information to
perform them.
3.1 Fielding Calls from Patients
Patients will call for many reasons. It will be your job to field these calls and advise patients.
Usually, you can use your best judgment to advise them. If you believe it is something that they
should see Dr. Nicholls for you can tell them to call the scheduling desk at 817-375-5200. It is
not your job to schedule patients. There is a central scheduling desk that is in charge of
scheduling. On occasion you can try to squeeze somebody in if it is an emergency, but you will
not do the majority of scheduling.
If patients that Dr. Nicholls has already seen call with any complaints, you need to record this in
their chart along with the date they called.
3.2 Fielding Calls from Home Health
Home health companies will call for multiple reasons. They will call about a patient of Dr.
Nicholls’s that they are taking care of or they will call asking for business. If they are calling
about a patient, record whatever they say in the patient’s chart. If they are asking for Dr.
Nicholls to see the patient, tell them to have the patient call the scheduling desk at 817-375-5200.
If a home health business calls asking for business, it is illegal to give them any patients’
information. Tell them that they can come to the office and leave some business cards. If Dr.
Nicholls sees a patient that he feels could use their business he will give the patient their card.
28 Manual for an Orthopedic Nurse
3.3 Fielding Calls from Surgery Implant Reps
Dr. Nicholls will sometimes use surgical implants in surgery as anchors or clamps. In order for
him to use the implant at least one representative from the company must be present at surgery.
It is their job to bring the implant for Dr. Nicholls to use. They must also observe and make sure
he uses it correctly.
Surgery implant reps will call asking to verify when and where they are supposed to be for
surgery. You must give them accurate information as to when and where they are supposed to
be. They might also need to verify what it is they are supposed to bring.
If a surgery implant rep calls asking for business tell them that they can call the scheduling desk
at 817-375-5200 and make an appointment to talk to Dr. Nicholls about it. Inform Dr. Nicholls
also of anything that you think he might want to hear.
3.4 Fielding Calls from Hospitals
Different departments of hospitals will call for various reasons. This section will inform you of
the different departments you can expect to hear from and what information to give them.
3.4.1 Surgery Department
Sometimes the surgery department will call wanting to move a surgery either earlier or later,
depending on how the day is going. Sometimes if they have scheduled an emergency surgery for
the next day they will call saying that they need to move a surgery that they have scheduled with
Dr. Nicholls because they have run out of operating room space.
They will also have questions pertaining to a case. They will call asking about the implantation
that they will be using wanting to know how necessary it is. Do your best to answer all their
questions in an appropriate and efficient manner.
3.4.2 Pre-Assessment Department
Patients will go to the hospital a few days before surgery to have testing done. If the hospital
finds anything abnormal they will call and report it. For example, if the EKG testing was
abnormal the anesthesiologist will not put them to sleep until the patient has seen a cardiologist.
It is your duty to call the patients and inform them of any abnormalities in their lab results and
tell them what to do next. They must get clearance from a secondary source before they can
have surgery.
Procedure on Non-Clinical Days 29
3.4.3 Hospital Administration Department
The hospital administration will call if a patient owes more money towards their surgery than
they have the ability to pay. The administration will want to know if the surgery is absolutely
necessary or not. If it is absolutely necessary you need to tell that that it is and why. If it is not
absolutely necessary you need to tell them. The hospital will then deal with the patient
themselves. Typically, they will call back to cancel the surgery until the time when the patient
has the money and can reschedule.
3.5 Surgical Assists
Dr. Nicholls will want a surgical assist to help him out with some surgeries. It is your duty to
call and find ones to help him. He will always need a surgical assist for the following
procedures:
Total joint replacements
ACL reconstruction
Larger patients
If he wants a surgical assist for any surgeries outside of this list he will inform you of this and
you will need to find him a surgical assist.
3.6 Scheduling Surgeries
After Dr. Nicholls and a patient have decided that the patient will have surgery Dr. Nicholls will
fill out the pink sheet to order surgery. The next thing you should do is fill out the pre-cert form
on the personal computer. After you fill it all out, print out three copies and follow these
instructions:
1. Take one copy of the pre-cert form to AOA’s pre-cert department.
2. Print out the patient’s insurance and demographic information.
3. Fax a copy of the pre-cert form, the insurance and demographic information to the pre-
cert department of the facility where the surgery will be performed.
4. File the copy that was faxed in the patient’s chart.
5. Save the third copy for the surgery packet.
Dr. Nicholls needs a surgery packet to take with him to every surgery. It is your job to put
together the surgery packet. It includes the following from top to bottom:
Follow-up post-op appointment card.
The surgery pre-cert form
The Patient’s Medical History
The dictation from the initial office visit
30 Manual for an Orthopedic Nurse
The last dictation prior to surgery
The MRI report
A copy of the X-ray
A copy of MRI images
The hospital agency consent form
The hospital’s history and physical form
It is your job to put together the surgery packet forms for him to take to surgery. Put the third
pre-cert form in his surgery packet. Retrieve the patients’ medical history, Dr. Nicholls’s initial
and last dictations, and the MRI report from the patients chart and make copies. Place the copies
in the surgery packet. Print out a copy of the X-ray and relevant MRI images from the
diagnostic computer and put them in the surgery packet. Have the hospital fax their consent
form and their history and physical form to the office and put them in the surgery pack also.
Once this is all together, staple the patients’ follow-up post-op appointment card to the front of
the surgery packet.
Index 31
Index
A acromioclavicular, 17
ANITA, 5
ankle joint, 20
arm sling, 22
attire, 12, 15
B blood pressure, 13, 14, 15
BOSHA, iii, 3, 4
C carpal tunnel, 18
cubital tunnel, 18
D De Quervain’s, 19
diagnostic computer, 3, 4, 30
drug reps, 27
durable medical equipment, 11, 22
F first metacarpal space, 19
Follow-up patients, 11
foot brace, 23
G ganglion cyst, 21
glenohumeral, 17
H home health, 27
hospital administration, 29
hospitals, 27, 28
I imaging, iii, 3, 4, 12, 15, 22
injection, 6, 11, 16, 17, 18, 19, 20, 21
K knee joint, 20
L lateral epicondylitis, 17
light system, 11, 12, 13, 15
M medial epicondylitis, 18
metacarpal – phalangeal, 19
N new patients, 11
O olecranon bursitis, 17
P peroneal tendonitis, 20
personal computer, 3, 5, 29
physical therapy, 5, 21
Post-op patients, 12
Pre-op patients, 12
prescription medication, 21
pulse, 13, 14, 15
R respiration, 14, 15
S schedule, iii, 3, 5, 11, 27
subacromial, 16
surgery department, 28
surgery form, 21
surgery packet, 22, 29, 30
surgical assist, 29
32 Manual for an Orthopedic Nurse
surgical implants, 28
T Test result patients, 12
trigger finger, 19
trochanteric bursitis, 20
V vials, 3, 6, 16
W websites, iii, 4
wrist brace, 22
wrist joint, 18
References 33
References
Mark. (2008, December 19). Cough medicine ingredient could treat prostate cancer. Retrieved
April 2011, from MedicineWorld.Org: http://medicineworld.org/news/ent-news.html
Nisarg. (2011, April 5). Why Be a Doctor? Retrieved April 2011, from UConn Welcome Mat:
http://uconnwelcomemat.wordpress.com/2011/04/05/why-be-a-doctor/
Ontario Schools of Medicine. (n.d.). Retrieved April 2011, from Regional Education: School of
Medicine at Queen's University, Kingston, Ontario:
http://meds.queensu.ca/regionaled/links/ontario_schools_of_medicine
Personal Injury at Work. (n.d.). Retrieved April 2011, from Personal Injury Work:
http://personalinjurywork.com/
ProLite Wrist Brace 8" Deluxe. (n.d.). Retrieved April 2011, from Doc Ortho:
http://www.docortho.com/fla-professional-wrist-brace-8-deluxe.html
Rubenstein, A. H., & Dunlop, R. G. (n.d.). PENN Medicine. Retrieved April 2011, from Making
History: The Campaign for PENN: http://www.makinghistory.upenn.edu/penn_medicine