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Pre-Op Total Joint Class

Welcome!

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Goals

Inform the patient & family what to expect… Before, during & after surgery Reduce anxiety Answer questions Help you become better-prepared

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We Care About You!!!

In an effort to personalize your care while in the hospital, please let us know of any needs ahead of timePlease complete the enclosed “Care Card” and turn it in at the end of class

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What To Bring

List of medications and allergies Glasses, hearing aids, dentures Toiletry items

Toothbrush Toothpaste

Flat, supportive, non-slip walking shoes (with a backing)

Incontinence products (if you use and prefer a specific product that may not available at the hospital)

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What To Bring

Night clothes/pajamas, loose clothing

Books, magazines, hobby items

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Day of Surgery

- Park in parking deck P-2 (To the left of the hospital)

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Infection Prevention

Chlorhexidine Gluconate (CHG) wipes will be used to cleanse and disinfect the surgical site before surgery begins

Constant handwashing/use of anti-bacterial lotion IV antibiotics (before, during, after surgery)

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IV or Intravenous Therapy

May have one or two lines Fluids-body water, blood, antibiotics, pain

medication Will leave it in until discharge

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Your Surgery

•Surgery is about 1-2 hours long•Recovery is about 1 ½ hours•Staff will page family/visitors once patient is out of recovery and give the room number. This is where you will meet your family/visitors after surgery.

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Welcome to your room!

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After Surgery - Oxygen

Only used a short time Let us know if you have sleep apnea or use

oxygen or CPAP at home If so, bring CPAP manual with settings as

prescribed by MD

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Dressings and Drains

Large dressing initially Drains and dressings removed 1st or second

day after surgery Dressing changed daily after that Cell Saver

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Foley Catheter To Drain Urine

Stays in about 1 day Helps to keep track of fluid balance Good initially when not moving well Put in after you are asleep

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Pain Management

Our goal is to keep you comfortable and functional. It is unlikely that your pain will be 0.

We ask that you partner with us and ask for additional pain medicine if needed

Alternative pain options may be used such as cold therapy and relaxation

Our staff will make every effort to best manage your pain.

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PCA - Patient Controlled Analgesia

“Pain Button” Administer to self Close monitoring

NO ONE IS TO PUSH THE BUTTON EXCEPT THE PATIENT!!!

***Please ask your surgeon if this is an option he will use for you

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Exparel

Numbing medication injected into incision Only knee patients may receive this Helps control pain up to 72 hours after

surgery. Will be given other pain medication along

with this method.

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Femoral Nerve Block/Catheter***Some surgeons prefer not to use this***

Numbs the front part of the leg from the groin to the knee

Stays in about two days May cause you to have a “noodle leg” Need to wear a knee immobilizer while standing or walking

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Knee Immobilizer

May also wear at night to remind you to keep the leg straight

Used for safety reasons

Note: You may or may not walk with the knee immobilizer on while exercising with a Therapist. However, you should ALWAYS continue to wear it with Nursing until you are able to do a full straight leg raise (with nobend at the knee)

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Cryotherapy - “Polar Care” Device**Some surgeons prefer to use ice instead of the Polar Care Device**

**Some surgeons may choose not to use the Polar Care Device or ice**

Sends a cold signal to the brain to help with pain management

Helps with pain and swelling You take this home with you

(if it is ordered by your surgeon)

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TENS Unit

Electrical stimulation that helps to block pain receptors.

May be given to patient prior to surgery.

Bring to the hospital if you have been given one by your doctor’s office.

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While You Are Here

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Medications

Different color and number Always ask nurse what meds are for “Combination medications” that you may

take at home may be given as separate pills while in the hospital

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Preventing Pneumonia

Incentive Spirometer

Breathe in 10-12 times an hour while awake

Helps to expand air sacs in lungs

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Preventing Blood Clots

1. Medication (“Blood Thinners”)

2. “Calf Pumps”

3. Walking and Exercising

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Coumadin, Xarelto, Lovenox***Please check with your surgeon as to which blood thinner will be prescribed***

Will help to prevent blood clots from forming

Will need to learn how to take these medications safely

Will need to watch a video

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Compression Devices

Foot or calf pumps Help to push the blood back into circulation Wear them when you are in bed

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Walking and Exercising

Helps to prevent blood clots from forming

Exercise in and out of bed Ankle circles, foot pumps,

tightening leg muscles

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Bedside Shift Report

Takes place @7:00AM and @7:00PM at shift change

Promotes patient safety Opportunity for patients and/or Caregiver(s)

to ask questions and address patient needs

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Diet

Initial diet is typically clear liquid Diet will be advanced as you can tolerate First tray is “house tray”, then you will order Constipation because of pain meds

High fiber Increase activity Fluids

Nausea

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Call for Help

Never get out of bed or chair unless you call for assistance

Call as soon as possible

Try to ask for help when a staff member is already in the room.

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Condition H (Help)

Dial 3111 and give room number

Gives family and friends a way to call a Medical Emergency team to the bedside

Call if after speaking to the healthcare team You notice a change in your loved one’s condition You still have serious concerns about your loved one’s

condition

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Sleep / Relaxation

Dial L.O.U.D. (5683) on phone if sleep disturbed Anonymous call

TV Channels Relaxation/Meditation channels

Free WiFi

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Case Management &Discharge Planning

Goal: To get you home safely!!!

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Discharge Plan

Everyone is assigned a Case Manager who will usually meet with you the day after surgery

Average Length of Stay: 1-3 nights That means you should be ready for discharge

around the 1st, 2nd or 3rd day after surgery

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Discharge

Sometimes the discharge process can take up to 4 or 5 hours. We know you’ll be eager to leave the hospital, and we want to be sure everything’s in place to ensure a smooth and safe transition.

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Discharge Plan Options:Home Health & Equipment

You will choose agency (list provided) RN (if on Coumadin) Physical Therapy (2-3 times/wk) Occupational Therapy (if ordered by Doctor)

Equipment ordered… Rolling Walker Bedside Commode CPM (if ordered by Doctor)

***Your Case Manager will set up a Home Health Agency (of your choice) for you

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Support At Home

You will need support at home for the first 48 hours around the clock

From there, Home Health will help determine what your needs are

Can someone help to make meals for you? Pet care?

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Discharge Plan Options:Short-Term Rehab

Two types of Rehab Facilities…1. SNF: 1 to 3 hours of therapy/day

Average Length of Stay: 1-2 weeks-as needed

2. Acute: 3 or more hours of therapy/dayAverage Length of Stay: 5 - 7 days

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Discharge Plan

Transportation (depends on what is medically necessary) Car Wheelchair Van

Not covered by insurance Cost: $55-$120

Ambulance Covered by insurance if “medically necessary”

***Your Case Manager will set up your Wheelchair Van or Ambulance for you (if needed)

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If You Are Going Home…

You may fill your prescriptions at our Plaza Pharmacy (Located on the First Floor of the hospital)

Hours of Operation: Mon-Fri (9:00AM-4:30PM) (919) 954-3921

Pick up from the Main Pharmacy on weekends or after 4:30PM (but make payment arrangements with Plaza Pharmacy during M-F business hours)

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Physical Therapy

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Treatment Sessions

Seven days/week Will typically begin the day after surgery One or two times per day with the PT Goals will be simply to get you up walking, start

you on an exercise program, and teach you any appropriate precautions

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Treatment Sessions (cont)

Sessions will typically be brief, lasting approximately 30 minutes

Sessions are tailored for each patient and therefore will vary from patient to patient

A few of you may do well enough to walk with family, but only if approved by your therapist!

Last visit will usually be morning of discharge

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CPM Machine ***Some surgeons prefer not to use this***

Continuous Passive Motion machine May be used for total knee patients (if

ordered) Passively bends knee while in bed

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Precautions

Knee Replacement Do not stay in one position for longer than an hour

without standing up, walking a short distance, and straightening and bending your knee

Do not sleep or rest with a pillow or anything under your knee

Operated leg out in front while sitting or standing

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General Precautions

Hip Replacement Do not bend hip past 90 degrees

Do not cross middle of your body with operated leg Do not lie on stomach for at least 6-8 weeks after surgery Do not stay in one position for more than an hour or two

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Homeward Bound Gym

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Preparing for Therapy Now

General strengthening for arms and legs Don’t do anything that would make your

symptoms worse or irritate any other problem you may have

Chair push-ups can be useful for strengthening arms and preparing to use a walker or crutches

Walking or riding a stationary bike can improve your endurance

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Occupational Therapy

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Treatment

Sessions will usually begin Post-Op Day #1 (the day after surgery)

You may not have a session every day Instruction will include: lower body dressing, bed

transfers, bedside commode transfers, tub bench/shower transfers, personal hygiene, and use of ADL equipment if needed

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Treatment (cont)

Demonstration of equipment***Knee patients rarely need this equipment at discharge while most hip patients

do need this equipment at discharge. The Therapist will determine your specific needs.

Reacher

Sock aid

Bathing sponge

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Helpful Tips

How to properly carry items in pockets and/or basket while driving a walker

Safety in the shower (have someone close by) While at home prior to surgery, move low- and

high-lying items to waist level (i.e. in kitchen/bathroom cupboards, refrigerator) Make arrangements to have appropriate-sized car

available for your discharge

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Before Surgery…

Assess your home environment and let the Therapist know the following once you are in the hospital…

Tub/Shower (location, height, grab bars) Number of steps (outside of home and upstairs)

Height of bed

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Thank You!!!