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1. Evaluate the key indications for timing of joint replacement surgery.
2. Compare treatment options for patients with severe joint pain.
3. Analyze options for pre-operative education to make multiple learning modalities available to patients.
4. Examine the necessary rationale for pre-operative testing.
5. Summarize the Joint Commission SCIP Protocols as related to Total Hip Arthroplasty, Total Knee
6. Arthroplasty, Hip and Knee Revisions, and Hip Fracture repairs (ORIF).
7. Assess a multi-modal approach to post-operative pain.
8. Determine preventive measures for the most significant post-surgical complications that can occur.
9. Distinguish between the most effective planning strategies for patient success following hospital discharge.

Pre-operative Work-up

• The pre-operative work-up is a vitally important part of the operative process. Not all patients with arthritis require surgery. Knowing the treatment options allows patients to make informed decisions about their care. Radiology examples will be included for case study discussion.

Diagnosis

• Osteoarthritis
• Bone Cancers
• Recurrent Infections
• Acute Injury, Falls, i.e.

Treatment Options

• Exercise / Physical Therapy
• Injections
• Operative Treatments

Pre-operative Planning

• Understanding the processes that need to take place prior to the surgery will help the patient better prepare for the surgery, allow for less patient anxiety and establish realistic goals and expectations.
• Pre-operative Testing
• Pre-operative Clearances
• Medical
• Cardiac
• Pulmonary
• Other/Individualized
• Obtaining Consent
• Pre-operative Education
• One-to-one education
• Online education
• Pre-operative joint classes

Surgical Procedures

• Fixation
• Treatment for fractures that do not require joint replacement
• Total Joint Replacement
• Hip
• Knee
• Shoulder
• Other Joints
• The elbow, wrist, and ankle can also be replaced, but these surgeries are performed far less frequently. As well, there is currently a disk replacement surgery in study, but it is not yet FDA approved.
• Megaprosthetic Replacements
  • Replacement of both the joint and a portion of the surrounding bone
• Joint Revisions

Immediate Post-Operative Care

• Multi-modal Pain Management
• Oral vs. IV
• Nerve blocks
• Ambulation
• IV acetaminophen / NSAIDs
• Intra-operative steroid injection
• Age-related analgesia
• Opioid tolerance
• Physical and Occupational Therapy
• Positioning
• Movement restrictions
• Exercises
• Assistive devices
• Wound Care / Infection Prevention
• Dressings
• Antibiotics
• VTE Prophylaxis
• Mechanical
• Pharmaceutical
• Joint Commission S.C.I.P. (Surgical Care Improvement Project) Protocols
• Surgical/Medical Complications

Post-acute Care and Follow-up

• Discharge Planning
  • Acute Rehab / Skilled Nursing / Home
  • Follow-up appointments
  • Home medications
• Readmission/complications

Paul M. Levy is a Registered Nurse with certification in Orthopaedic Nursing. Throughout his career, he has specialized in Orthopedics, specifically Total Joint Replacement Surgery, Sports Medicine, and Musculoskeletal Oncology. Paul has worked on post-operative orthopedic units, serving as a staff nurse, charge nurse, preceptor, and mentor.

In Paul's current role as Clinical Education Specialist for Orthopedics and Emergency Medicine at a hospital in Pittsburgh, Pennsylvania, he is responsible for staff development and training, coordinates the Geriatric Fracture Program and the Crisis Management Training. In addition to his years of training experienced orthopedic staff, Paul has also developed an "Ortho for Non-ortho Nurses" program to help resource pool, staff, and new orthopedic nurses better understand orthopedic care. He also developed an Orthopedic Reference Guide for nurses to assist staff when orthopedic patients are admitted "off-service."

Paul is committed to his area of expertise. He has spoken at the National Association of Orthopaedic Nurses Annual Congress, and other national and local conferences focusing on a variety of orthopedic-related topics, and currently serves as the Chapter President of the Pittsburgh Chapter of the National Association of Orthopaedic Nurses.

Speaker Disclosures:

Financial: Paul Levy has an employment relationship with UPMD St. Margaret. He receives a speaking honorarium from PESI, Inc.

Non-financial: Paul Levy is a member of the National Association of Orthopaedic Nurses. He is Chapter President for the Pittsburgh Chapter of the National Association of Orthopaedic Nurses. Mr. Levy indicates that he has a bias as an opponent of single payer healthcare delivery.

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Listed below are the continuing education credit(s) currently available for this non-interactive self-study package. Please note, your state licensing board dictates whether self study is an acceptable form of continuing education. Please refer to your state rules and regulations.

Certificates of Successful Completion are available for email, download and/or printing from your online account immediately following the successful completion of the post-test/evaluation.

**Materials that are included in this course may include interventions and modalities that are beyond the authorized practice of mental health professionals. As a licensed professional, you are responsible for reviewing the scope of practice, including activities that are defined in law as beyond the boundaries of practice in accordance with and in compliance with your professions standards.

All members of the PESI, Inc. planning committee have provided disclosures of financial relationships with ineligible organizations and any relevant non-financial relationships prior to planning content for this activity. None of the committee members had relevant financial relationships with ineligible companies or other potentially biasing relationships to disclose to learners. For speaker disclosures, please see the faculty biography.

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Nurses/Nurse Practitioners/Clinical Nurse Specialists - Credit Expired: 10/5/2019
No CE available for this board.

California Nurses: PESI, Inc. is a provider approved by the California Board of Registered Nursing, Provider #:17118 for 6.0 self-study contact hours.

You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Nurses: PESI, Inc. is an approved provider by the Florida Board of Nursing. Provider #: FBN2858. These materials qualify for 6.0 self-study contact hours.

Iowa Nurses: PESI, Inc. is an approved provider by the Iowa Board of Nursing. Provider #: 346. Nurses successfully completing these self-study materials will earn 6.3 self-study contact hours.

Copies of the evaluation may be sent to the IBON. You will need to provide your license number to PESI. PESI must have this number on file in order for your hours to be valid.

Florida Occupational Therapists & Occupational Therapy Assistant: PESI, Inc. is an approved provider with the Florida Board of Occupational Therapy. Provider Number 50-399. This self-study course qualifies for 6.3 continuing education credits.

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Physical Therapists & Physical Therapist Assistants
This self-study course consists of 6.25 clock hours of instruction that is applicable for physical therapists. CE requirements for physical therapists vary by state/jurisdiction. Please retain the certificate of completion that you receive and use as proof of completion when required.

California Physical Therapists & Physical Therapist Assistants: PESI, Inc. is recognized by the Physical Therapy Board of California as an approval agency to approve providers. This self-study lecture qualifies for 6.25 continuing competency hours.

Illinois Physical Therapists & Physical Therapist Assistants: PESI, Inc. is a Registered Physical Therapy Continuing Education Sponsor through the State of Illinois Department of Financial and Professional Regulation, Division of Professional Regulation. License #: 216.000270. This self-study course qualifies for 6.0 CE credit hours.

New York Physical Therapists & Physical Therapist Assistants: PESI, Inc. is recognized by the New York State Education Department, State Board for Physical Therapy as an approved provider for physical therapy and physical therapy assistant continuing education. This self-study course qualifies for 7.6 contact hours.

Texas Physical Therapists & Physical Therapist Assistants: This self-study activity is provided by the Texas Board of Physical Therapy Examiners Accredited Provider #2106032TX and meets continuing competence requirements for physical therapist and physical therapist assistant licensure renewal in Texas. This activity will provide 6.25 CCUs. The assignment of Texas PT CCUs does not imply endorsement of specific course content, products, or clinical procedures by TPTA or TBPTE. Full attendance is required; no partial credits will be offered for partial attendance.

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Other Professions
This self-study activity qualifies for 6.25 clock hours of instructional content as required by many national, state and local licensing boards and professional organizations. Retain your certificate of completion and contact your board or organization for specific filing requirements.

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**It is your ethical responsibility to report accurate hours to your licensing board.
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Athletic Trainers, Nurses, Occupational Therapists & Occupational Therapy Assistants, Physical Therapists/Physical Therapist Assistants, Physician Assistants, and other Healthcare Professionals