Post-operative Day to Day management

Post-operative Day to Day management


Pain Management: 
Most patients will require opioid infusion in the form of Patient Controlled Analgesia (PCA) or Nurse Controlled Analgesia.  
Pain assessment is performed hourly with patient pain scores recorded at this time. This is done using a visual analogue scale or tools such as Wong Baker faces.
NOTE: Pain that is out of proportion to the surgery performed is reported immediately, as this may indicate the presence of Compartment Syndrome which is a medical emergency.
Neurovascular Observations:
Neurovascular observations at HillsClinic are performed every 30 minutes on return to the ward for the first 4 hours. They are then performed hourly for the next 24 hours, and then four hourly until stable. If there be any concern regarding a patient's neurovascular status,  the treating surgeon is notified immediately.
At this time assessment of the footplate or toe slings for poor fit or any areas of pressures also done.
Positioning of the limb:
Whilst elevation is important, the position of both lower limbs is also something to concentrate on in the postoperative stage. The patient rests in bed with the leg in full extension, with the knee cap pointing to the ceiling.
Physiotherapy / activity:
As soon as the patient is able to manage, we encourage independence. This may involve handling the frame, moving from bed to wheelchair, showering etc. Independence practiced at this time will make management latter much easier. Patient is trained when comfortable transferring from chair to toilet, bed to chair and chair to bed with minimal assistance. 
Pin site care
Pin site care is to be performed on Days 1, 2 and 3 and then once a week.
Toe slings
The elastic bands should be tight enough so the toes are in a straight line with the rest of the foot.
Toe slings are removed every 4 hours for approximately 20 minutes. Check the toes and in-between them to make sure there isn't any skin breakdown.
Clean between the toes every night and put some powder between them to keep them dry. The toe slings can be worn overnight without needing to check them every 4 hours. Remove the toe slings and monitor the toes first thing in the morning.
Correction/frame adjustment:-

The surgeon or nurse teaches the client and his/her attendant how to do the correction.  The client/patient and the attendant must be able to verbalize that they understand where adjustment is to be made, how often and how much.
A turn chart is made available to the patient..