3 Goals Inform the patient & family what to expect… Before, during & after surgeryReduce anxietyAnswer questionsHelp you become better-prepared
4 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
5 What To Bring List of medications and allergies Glasses, hearing aids, denturesToiletry itemsToothbrushToothpasteFlat, 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)
6 What To Bring Night clothes/pajamas, loose clothing Books, magazines, hobby items
7 Day of Surgery- Park in parking deck P-2 (To the left of the hospital)
8 Infection PreventionChlorhexidine Gluconate (CHG) wipes will be used to cleanse and disinfect the surgical site before surgery beginsConstant handwashing/use of anti-bacterial lotionIV antibiotics (before, during, after surgery)
9 IV or Intravenous Therapy May have one or two linesFluids-body water, blood, antibiotics, pain medicationWill leave it in until discharge
10 Your Surgery Surgery is about 1-2 hours long Recovery is about 1 ½ hoursStaff 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.
12 After Surgery - Oxygen Only used a short time Let us know if you have sleep apnea or use oxygen or CPAP at homeIf so, bring CPAP manual with settings as prescribed by MD
13 Dressings and Drains Large dressing initially Drains and dressings removed 1st or second day after surgeryDressing changed dailyafter thatCell Saver
14 Foley Catheter To Drain Urine Stays in about 1 dayHelps to keep track of fluid balanceGood initially when not moving wellPut in after you are asleep
15 Pain ManagementOur 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 neededAlternative pain options may be used such as cold therapy and relaxationOur staff will make every effort to best manage your pain.
16 PCA - Patient Controlled Analgesia “Pain Button”Administer to selfClose monitoringNO ONE IS TO PUSH THE BUTTON EXCEPT THE PATIENT!!!***Please ask your surgeon if this is an option he will use for you
17 Femoral Nerve Block/Catheter ***Some surgeons prefer not to use this*** Numbs the front part of the leg from the groin to the kneeStays in about two daysMay cause you to have a “noodle leg”Need to wear a kneeimmobilizer while standingor walking
18 Knee ImmobilizerMay also wear at night to remind you to keep the leg straightUsed for safety reasonsNote: You may or may not walk with the knee immobilizer on while exercising with a Therapist. However, you shouldALWAYS continue to wear it with Nursing untilyou are able to do a full straight leg raise (with nobend at the knee)"ALWAYS WEAR IT WITH NURSING UNTIL YOU ARE ABLE TO DO A FULL STRAIGHT LEG RAISE WITH NO BEND AT THE KNEE"?Tara JennetteAcute Rehab Team LeaderFrom: Patrick C KrejciSent: Monday, January 03, :16 PMTo: Elizabeth Jackson; Pamela Laumakis; Sherry Foster; Tara JennetteSubject: Knee ImmobilizerIs the following worded correctly? I will add this to the knee immobilizer slide in the Powerpoint for the Pre-Op Class....ThanksNote: You may or may not walk with the knee immobilizer on while exercising with a Therapist. However, you should ALWAYS continue to wear it throughout your hospital stay whenever getting out of the bed or chair with assistance.
19 Cryotherapy - “Polar Care” Device 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 managementHelps with pain and swellingYou take this home with you(if it is ordered by your surgeon)
21 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
22 Preventing Pneumonia Incentive Spirometer Breathe in times an hourwhile awakeHelps to expand air sacs in lungs
23 Preventing Blood Clots Medication (“Blood Thinners”)“Calf/Foot Pumps”Walking and Exercising
24 Coumadin, Xarelto, Lovenox Coumadin, Xarelto, Lovenox ***Please check with your surgeon as to which blood thinner will be prescribed***Will help to prevent bloodclots from formingWill need to learn how totake these medications safelyWill need to watch a video
25 Compression Devices Foot or calf pumps Help to push the blood back into circulationWear them when you are in bed
26 Walking and Exercising Helps to prevent bloodclots from formingExercise in and out of bedAnkle circles, foot pumps,tightening leg muscles
27 Bedside Shift Report Takes place @7:00AM and @7:00PM at shift change Promotes patient safetyOpportunity for patients and/or Caregiver(s) to ask questions and address patient needs
28 Diet Initial diet is typically clear liquid Diet will be advanced as you can tolerateFirst tray is “house tray”, then you will orderConstipation because of pain medsHigh fiberIncrease activityFluidsNausea
29 Call for Help Never get out of bed or chair unless you call for assistanceCall as soon as possibleTry to ask for help when a staff member is already in the room.
30 Condition H (Help) Dial 3111 and give room number Gives family and friends a way to call a Medical Emergency team to the bedsideCall if after speaking to the healthcare teamYou notice a change in your loved one’s conditionYou still have serious concerns about your loved one’s condition
31 Sleep / Relaxation Dial L.O.U.D. (5683) on phone if sleep disturbed Anonymous callTV ChannelsRelaxation/Meditation channelsFree WiFi
32 Case Management & Discharge Planning Goal: To get you home safely!!!
33 Discharge PlanEveryone is assigned a Case Manager who will usually meet with you the day after surgeryAverage Length of Stay: 2-3 nightsThat means you should be ready for discharge around the 2nd or 3rd day after surgery
34 DischargeSometimes 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.
35 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 WalkerBedside CommodeCPM (if ordered by Doctor)***Your Case Manager will set up a Home Health Agency (of your choice) for you
36 Discharge Plan Options: Short-Term Rehab Two types of Rehab Facilities…SNF: 1 to 3 hours of therapy/dayAverage Length of Stay: weeks-as needed2. Acute: 3 or more hours of therapy/dayAverage Length of Stay: days
37 Discharge Plan Transportation (depends on what is medically necessary) CarWheelchair VanNot covered by insuranceCost: $55-$120AmbulanceCovered by insurance if “medically necessary”***Your Case Manager will set up your Wheelchair Van or Ambulance for you (if needed)
38 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)Pick up from the Main Pharmacy on weekends or after 4:30PM (but make payment arrangements with Plaza Pharmacy during M-F business hours)
40 Treatment Sessions Seven days/week Will typically begin the day after surgeryOne or two times per day with the PTGoals will be simply to get you up walking, start you on an exercise program, and teach you any appropriate precautions
41 Treatment Sessions (cont) Sessions will typically be brief, lasting approximately 30 minutesSessions are tailored for each patient and therefore will vary from patient to patientA 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
42 CPM Machine ***Some surgeons prefer not to use this*** Continuous Passive Motion machineMay be used for total knee patients (if ordered)Passively bends knee while in bed
44 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 kneeDo not sleep or rest with a pillow or anything under your kneeOperated leg out in front while sitting or standing
45 General Precautions Hip Replacement Do not bend hip past 90 degrees Do not cross middle of your body with operated legDo not lie on stomach for at least 6-8 weeks after surgeryDo not stay in one position for more than an hour or two
47 Preparing for Therapy Now General strengthening for arms and legsDon’t do anything that would make your symptoms worse or irritate any other problem you may haveChair push-ups can be useful for strengthening arms and preparing to use a walker or crutchesWalking or riding a stationary bike can improve your endurance
49 TreatmentSessions will usually begin Post-Op Day #1 (the day after surgery)You may not have a session every dayInstruction will include: lower body dressing, bed transfers, bedside commode transfers, tub bench/shower transfers, personal hygiene, and use of ADL equipment if needed
50 Treatment (cont) Demonstration of equipment Reacher Sock aid ***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.ReacherSock aidBathing sponge
51 Helpful TipsHow to properly carry items in pockets and/or basket while driving a walkerSafety 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
52 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