total joint replacement
DESCRIPTION
Total Joint Replacement. A patient and family guide To Total hip Total knee And Total shoulder surgery. Created by Dottie Megnia, BSN, RN, CNOR, ONC. Objectives. Understand what is expected of them and what to expect from the health care team - PowerPoint PPT PresentationTRANSCRIPT
A PATIENT AND FAMILY GUIDETO
TOTAL HIPTOTAL KNEE
ANDTOTAL SHOULDER SURGERY
Total Joint Replacement
Created by Dottie Megnia, BSN, RN, CNOR, ONC
Objectives
Understand what is expected of them and what to expect from the health care team
Will be able to recall three reasons for early mobilization after a joint replacement surgery
Describe four preventable complications and the measures used to prevent them
Together with their care plan partner, will be able to choose a discharge plan
Target Audience
TJR patient
Ideally two-four weeks before surgery
Arthritis
Osteoarthritis OA
Rheumatoid Arthritis
RA
Gout Traumatic Arthritis
Avascular necrosis
What Causes Arthritis
Heredity-recessive gene discovered
Generalized wear and tearInjury or accident (torn rotator cuff or anterior cruciate ligament)
Chronic steroid useAutoimmune diseasePrevious surgery
Arthritis
Worn or degenerated cartilage
Bone spursBone rubbing on boneEffusions
Synovial changes
Goal of Surgery
Relieve painRestore function and mobilityImprove quality of life
In the 1960’s goal was to relieve pain only
Surgical Procedure
Remove diseased bone, including bone spurs (osteophytes) and fluid (effusions)
Damaged or diseased ligaments and cartilage
Bone edges are resurfaced and fitted with metal and plastic prosthetic components
Surgery takes between two and four hours
Saw Bones Demonstration
Sawbones are passed around and questions are encouraged-someone always asks about the weight of the prosthesis
Preparing for Surgery
Prepare a list of medications including herbal preparations for anesthesia consult
Pack light-wear in what you will wear home
Good walking shoes (mile)Bring dentures, glasses, and hearing
aidsLeave jewelry and money at homePack a separate bag if you think you
are going to a rehab center
Preparing for Surgery cont…
Television and phone may be purchased together and billed to your home
Do NOT need pajamas, bathrobes, slippersWill wear hospital johnnies and skid free
slippersKeep it simpleMay bring cell phone but AT&T does not get
service on the orthopedic floorThose wishing to bring laptops may do so
Airport Security
Your new prosthesis will set off airport security
Leave extra time so you won’t missyour flight
Dental Prophylaxis
Let your dentist know about your new prosthesis
Antibiotic prophylaxis may be used for minor dental procedures such as cleanings
Prevention of Complications-Infection
Screening
Normal flora versus dangerous MRSA flora
Surgical Site Infection (SSI)
Antibiotics will be given through your intravenous within one hour of your incision.
You will be given two more doses through your intravenous over a 24 hour period and this is the latest evidence based practice shown to prevent a SSI.
Infection cont.
Hibiclens is an antiseptic liquid skin cleanser that removes dangerous bacteria from skin that could enter the surgical incision
Shower with Hibiclens up to two days before surgery
Available from your orthopedic surgeon
Avoid contact with eyes and ears
Two tablespoons of Hibiclens- full body shower.
Prevention of Late Infections
Antibiotic prophylax
is
Anytime there is danger that bacteria may enter the bloodstream and travel to your prosthesis. The body treats the prosthesis as a foreign body.
Prevention of Blood clots
• Early assisted mobilization• Blood-thinning medication such as Coumadin, Aspirin, or Lovenox for four weeks• Sequential sleeves on calves• Compression stockings
Constipation
Anesthesia
Pain Meds
Iron therapy
Immobility
Change in diet
Increase dietary fiber and/or metamucil and water.
Early assisted mobilization
Stool softeners Mild laxative
Post-operative pneumonia
Post-operative Nausea
Nausea and vomiting protocol (N/V)Best to eat a light meal on evening of surgeryCall your nurse at the first sign of N/V
Pain Management
THR patients wish they have had their surgery sooner-post-operative pain is easily managed by oral medications and the use of ……..
Pre-emptive analgesiaPre-op oral cocktail of oxycontin and
celebrex IV tylenol q. six hours ARC for 36
hours
New Oral Pain Cocktail
Oxycodone 5-10 mg BIDCelebrex 200 mg BIDOxycontin 5-10 mg PRN
Pain is better controlled with new oral pain cocktail versus patient-controlled analgesia (PCA)
Less post-operative N/V
Post-operative Pain Control
Total Knee Patients Total Shoulder Patients
Nerve Blocks
Femoral nerve blockSciatic nerve block Intrascalene nerve block
Nerve Blocks cont……
Adjunct to anesthesia-helps to control post-operative pain
Less sedation w/ resultant decreased anesthesia risk
Less narcotic w/ decreased incidence of constipation, pneumonia, n/v & drowsiness
Femoral nerve block is left in for two daysSciatic and Intrascalene are one time
injections that usually wear off anywhere from 12-18 hours
Prepare Your Home
Arrange for a recovery station and a first floor set-up with access to a bathroom
Prepare simple meals and freeze themRemove scatter rugs or tape downClear commonly used pathwaysMeasure height of toilets and beds for the
occupational therapistsDepending on your height, hip patients will need a
good chair with armsArrange for someone to be with your for the first
24 hours after discharge
Physical and Occupational Therapy
Continuous passive motion machine-CPM
PT and OT continued
ContinuumDay One-The physical and occupational
therapists (PT & OT) will come together on day one to get you up to the commode or the bedside chair. You should get up with assistance three times a day for meals.
Day Two-You should be walking to the bathroom with assistance
Day Three- You should be walking in the hallway with assistance
Day Three-Day of discharge
Simple Exercises
Quad set
Ankle pumps
Gluteal set
Hip Precautions
•No bending more than 90 degrees at the waist•No crossing your legs•No turning your toes in
Total Shoulder Rehab
Plan on button down shirts (large)
Front closing undergarments
Rehab is less aggressive in the beginning
Pendulum swings
Case Management
A case manager will also visit with you on day one after surgery to begin planning for your discharge
Home is bestA short stay (anywhere from a few days to
two weeks) at a skilled nursing facility may be needed
The case managers meet with your healthcare team daily
Nothing is ever set in stoneBest to have two or three options for
discharge
Skilled Nursing Facility
If you think you are going to a SNF, pack a separate suitcase with personal items and comfortable clothing as you will be expected to dress each day
Two hours of therapy per dayDischarged home when safe to
perform activities of daily livingArrangements will be made for home
or out-patient therapy upon discharge
Discharge to home
Physical therapist will visit within 24 hours
Including weekendsBy carDurable medical equipment Detailed discharge instructionsFollow-up appointments Prescriptions for pain medicines
Returning to Activity
Consider pool therapy after your incision is healedTake it to the gymMake exercise a part of your lifeTake care of your new jointBiking, golfing, swimming, and walking are encouragedAvoid high impact exercises such as running marathonsand mogul skiing Avoid the pounding impact of a treadmill Instead use softer surfaces such as high school track
Don’t do anything crazy!
References
Antibiotic prophylaxis for dental patients with total joint replacements (2003). Retrieved August 15, 2011 from http://jada.ada.org/content/134/7/895.full
Conrad, S. (nd) Knee replacement. Krames patient education.
Hockenbury, M.J. (2005). Essentials of pediatric nursing, (Ed. 7). St. Louis, MI: Mosby, Inc.
Incentive spirometry. Retrieved August 16, 2011 from shutterstock.com